目的：比较左氧氟沙星眼凝胶与妥布霉素地塞米松眼膏治疗睑板腺功能障碍(MGD)所致的蒸发过强型干眼的疗效。

方法：将确诊为MGD所致干眼(蒸发过强型)180例360眼患者随机分组。A组应用左氧氟沙星眼凝胶+玻璃酸钠滴眼液治疗； B组采用妥布霉素地塞米松眼膏+玻璃酸钠滴眼液治疗。A、B两组患者均采用综合治疗：用棉棒挤压排出阻塞在睑板腺管内的分泌物，每周1次，连续4wk为一个疗程； 热毛巾湿热敷眼睑，水温45℃左右，每天3次，每次15min，使残留在睑板腺管内的油脂稀薄软化脂质排出。每次眼睑湿热敷完毕后，A组将左氧氟沙星眼凝胶滴入结膜囊内并涂抹在眼睑睫毛根部，B组将妥布霉素地塞米松眼膏涂抹在眼睑睫毛根部，两组患者均滴玻璃酸钠滴眼液每天4次。观察患者术后的疗效。

结果：两组患者治疗后，临床症状评分、分泌物性状评分、泪膜破裂时间评分和泪液分泌试验评分差异均无统计学意义(Z_症状=-0.64，P_症状=0.524； Z_分泌物=-1.37，P_分泌物=0.171； Z_破裂时间=-1.06，P_破裂时间=0.288； Z_分泌时间=-1.06，P_分泌时间=0.288)。角膜荧光染色评分：A组治愈83.3%，好转11.1%，无效5.6%； B组治愈55.6%，好转27.8%，无效16.7%； A组疗效优于B组(Z=-4.02，P<0.001)。

结论：治疗MGD所致的蒸发过强型干眼，以物理疗法为主，药物治疗为辅，除了患病时间长、病情严重的患者可短期使用妥布霉素地塞米松眼膏外，一般均使用左氧氟沙星眼凝胶完全能达到消炎抗菌、安全稳定、无毒副作用的治疗效果，二者药物之间在治疗效果没有明显的差异。

METHODS: The 180 cases(360 eyes)with dry eye(evaporative type)caused by confirmed meibomian gland dysfunction were randomly divided into two groups(i.e. A and B): In group A, 90 individuals with 180 eyes were treated with levofloxacin eye gel+ sodium hyaluronate eye solution; The other 90 cases in group B took Tobramycin and Dexamethasone Ophthalmic Ointment+ sodium hyaluronate eye drops for curing the MGD. In addition, the same comprehensive therapy were used to the MGD patients in groups A and B, after surface anesthesia on binoculus, secretion, obstructing meibomian gland secretions, were discharged by utilizing cotton stick to extrusion mass weekly and four times consecutive treatments were regard as a course of treatment. To remove residual the thin oil soften lipid in meibomian gland, heat can be applied to the eyelids with hot water(around 45℃)on towel for 15min and do that three times a day. After each hot compress, we use levofloxacin eye gel to the patients in group A by dropping into the conjunctival sac and apply to the root of the eyelid lashes. The group B of 90 patients were applied Tobramycin and Dexamethasone Ophthalmic Ointment to the root of the eyelid lashes. All patients were dripped odium eye drops eye into their eyes four times a day.

RESULTS: After treatment(Z= -0.64, P=0.524), there were no significant differences in clinical symptoms(Z= -1.37, P=0.171), secretion characteristics(Z= -1.06, P=0.288), tear film rupture time and tear secretion time between groups A and B(P>0.05). Corneal fluorescence staining score: group A(cured 83.3%, improved 11.1%, ineffective 5.6%)and group B(cured 55.6%, improved 27.8%, ineffective 16.7%). The therapeutic effect of group A was better than that of group B, with statistical significance(Z= -4.02, P<0.001).

CONCLUSION: Physical therapy for meibomian gland dysfunction caused by evaporative dry eye is given priority, and medication is treated as adjunctive therapy. Generally, the patients can achieve totally anti-inflammatory, antibacterial, safe and stable, without side effects by using levofloxacin eye gel. However, the patients with worst condition and lingering illness should cured by Tobramycin and Dexamethasone Ophthalmic Ointment. In addition, statistical significant difference is not found between the two drugs on curative effects.