Purpose

Dry eye disease (DED) is a common age-related ocular surface disease. However, it is unknown how aging influences the ocular surface microenvironment. This systematic review aims to investigate how the aging process changes the ocular surface microenvironment and impacts the development of DED.

Methods

An article search was performed in PubMed, EMBASE, and Web of Science. 44 studies reporting on age-related ocular changes and 14 large epidemiological studies involving the prevalence of DED were identified. 8 out of 14 epidemiological studies were further analyzed with meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed. Study-specific estimates (impact of aging on the prevalence of DED) were combined using one-group meta-analysis in a random-effects model.

Results

Meta-analysis revealed the prevalence of DED in the elderly aged 60 years old or older was 5519 of 60107 (9.2%) and the odds ratio of aging compared to younger age was 1.313 (95% confidence interval [CI]; 1.107, 1.557). With increasing age, the integrity of the ocular surface and tear film stability decreased. Various inflammatory cells, including senescent-associated T-cells, infiltrated the ocular surface epithelium, lacrimal gland, and meibomian gland, accompanied by senescence-related changes, including accumulation of 8-OHdG and lipofuscin-like inclusions, increased expression of p53 and apoptosis-related genes, and decreased Ki67 positive cells.

Conclusions

The aging process greatly impacts the ocular surface microenvironment, consequently leading to DED.

中文翻译：

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衰老对干眼病病理生理学的影响：系统评价和荟萃分析

目的

干眼症（DED）是一种常见的与年龄相关的眼表疾病。然而，尚不清楚衰老如何影响眼表微环境。本系统综述旨在研究衰老过程如何改变眼表微环境并影响 DED 的发展。

方法

在 PubMed、EMBASE 和 Web of Science 中进行了文章搜索。确定了 44 项报告与年龄相关的眼部变化的研究和 14 项涉及 DED 患病率的大型流行病学研究。对 14 项流行病学研究中的 8 项进行了荟萃分析。遵循系统评价和元分析 (PRISMA) 报告指南的首选报告项目。研究特定的估计（老化对 DED 患病率的影响）在随机效应模型中使用一组荟萃分析进行组合。

结果

荟萃分析显示，60 岁或以上老年人中 DED 的患病率为 60107 人中的 5519 人（9.2%），年龄与年轻年龄相比的优势比为 1.313（95% 置信区间 [CI]; 1.107, 1.557） . 随着年龄的增长，眼表的完整性和泪膜的稳定性下降。各种炎症细胞，包括衰老相关的 T 细胞，浸润眼表上皮、泪腺和睑板腺，并伴有衰老相关的变化，包括 8-OHdG 和类脂褐质包涵体的积累，p53 表达增加和细胞凋亡相关基因，并减少 Ki67 阳性细胞。

结论

老化过程极大地影响眼表微环境，从而导致 DED。