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Effects of Dry Eye Therapies on Environmentally Induced Ocular Surface Disease.

ABSTRACT: To evaluate the effectiveness of artificial tears and corticosteroids on mitigating the acute ocular surface response to low-humidity environments.Single-group, crossover clinical trial.Twenty subjects with aqueous deficient dry eye were enrolled. Subjects meeting inclusion criteria at visit 1 were exposed to a baseline 90-minute low-humidity environment at visit 2. They then used artificial tears for 2 weeks prior to low-humidity exposure at visit 3, followed by 0.1% dexamethasone for 2 weeks prior to the final low-humidity exposure at visit 4. Outcome measures included corneal and conjunctival staining, blink rate, and irritation symptoms before and after each low-humidity exposure. Digital polymerase chain reaction (PCR) was performed to measure HLA-DR RNA transcripts in conjunctival cells taken by impression cytology at each visit.There was significantly less corneal and conjunctival epitheliopathy after the low-humidity exposure at visit 4 compared to after the low-humidity exposure at visit 3 (P = .003). Subjects reported significantly less eye irritation during the low-humidity exposure after using the dexamethasone (visit 4) compared to artificial tears (visit 3) (P = .01). HLA-DR transcripts significantly decreased after the stress at visit 4 (post dexamethasone) compared to visit 2.Our study demonstrates that corticosteroid eye drops mitigate the acute adverse effects of an experimental low-humidity challenge, likely owing to suppression of stress-activated inflammatory pathways. While extended use of corticosteroids is not indicated, other anti-inflammatory therapies with activity against stress-activated pathways may prove as effective.

SUBMITTER: Moore QL

PROVIDER: S-EPMC4464943 | biostudies-literature | 2015 Jul

REPOSITORIES: biostudies-literature

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Effects of Dry Eye Therapies on Environmentally Induced Ocular Surface Disease.

Moore Quianta L QL De Paiva Cintia S CS Pflugfelder Stephen C SC

American journal of ophthalmology 20150411 1

<h4>Purpose</h4>To evaluate the effectiveness of artificial tears and corticosteroids on mitigating the acute ocular surface response to low-humidity environments.<h4>Design</h4>Single-group, crossover clinical trial.<h4>Methods</h4>Twenty subjects with aqueous deficient dry eye were enrolled. Subjects meeting inclusion criteria at visit 1 were exposed to a baseline 90-minute low-humidity environment at visit 2. They then used artificial tears for 2 weeks prior to low-humidity exposure at visit ...[more]

PMID: 25868759

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Project description:Dry eye disease can be a consequence of lacrimal gland insufficiency in Sjögren's Syndrome or increased tear film evaporation despite normal lacrimal gland function. To determine if there is a correlation between severity effects in these models and underlying pathophysiological responses, we compared the time dependent changes in each of these parameters that occur during a 6 week period. Dry eye was induced in 6-week-old female C57BL/6 mice by exposing them to an Intelligently Controlled Environmental System (ICES). Sixty mice were housed in ICES for 1, 2, 4 and 6 weeks respectively. Twelve were raised in normal environment and received subcutaneous injections of scopolamine hydrobromide (SCOP) 3 times daily for 5 days. Another sixty mice were housed in a normal environment and received no treatment. Corneal fluorescein staining along with corneal MMP-9 and caspase-3 level measurements were performed in parallel with the TUNEL assay. Interleukin-17(IL-17), IL-23, IL-6, IL-1, TNF-α, IFN-γ and TGF-β2 levels were estimated by real-time PCR measurements of conjunctival and lacrimal gland samples (LGs). Immunohistochemistry of excised LGs along with flow cytometry in cervical lymph nodes evaluated immune cell infiltration. Light and transmission electron microscopy studies evaluated LGs cytoarchitectural changes. ICES induced corneal epithelial destruction and apoptosis peaked at 2 weeks and kept stable in the following 4 weeks. In the ICES group, lacrimal gland proinflammatory cytokine level increases were much lower than those in the SCOP group. In accord with the lower proinflammatory cytokine levels, in the ICES group, lacrimal gland cytosolic vesicular density and size exceeded that in the SCOP group. ICES and SCOP induced murine dry eye effects became progressively more severe over a two week period. Subsequently, the disease process stabilized for the next four weeks. ICES induced local effects in the ocular surface, but failed to elicit lacrimal gland inflammation and cytoarchitectural changes, which accounts for less dry eye severity in the ICES model than that in the SCOP model.

Project description:ObjectiveTo find preoperative screening criteria for dry eye syndrome (DES) that present after successful endoscopic dacryocystorhinostomy (EDCR).MethodsWe retrospectively analyzed medical records of 110 patients who underwent EDCR for nasolacrimal duct obstruction. DES diagnostic criteria were defined as tear break-up time (TBUT) less than 10 seconds, and ocular surface disease index (OSDI) score greater than 13 points. After EDCR, patients were divided into DES group and control group according to the DES diagnostic criteria. Preoperative OSDI score alone or in combination of preoperative TBUT and OSDI score were used to find screening criteria, which could discriminate the two groups preoperatively with a high positive predictive value (PPV). Criteria A was set same as the diagnostic criteria of DES, and Criteria B and C were set to improve PPV by increasing specificity while maintaining similar sensitivity to Criteria A.ResultsThirty patients (27.3%) were diagnosed with DES after EDCR, while 80 patients (72.7%) were normal. In patients with DES, preoperative TBUT was not different (p = 0.851), but OSDI score was significantly higher (p<0.001). Criteria A showed a sensitivity of 73.3%, specificity of 55.0%, and PPV of 38.0%. Criteria B and C excluded preoperative TBUT, which had no difference between the two groups, and set screening criteria with preoperative OSDI score alone. Criteria B (preoperative OSDI score of 19.6 points or more) showed a sensitivity of 75.0%, specificity of 60.6%, PPV of 41.7% and AUC of 0.739 (p < 0.001). Criteria C was consisted of 5 out of 12 OSDI items that showed significant differences between the two groups; blurred vision, reading, working with a computer, low humidity, and air conditioning. Criteria C (preoperative 5-item OSDI score of 24.4 points or more) was a better predictability, with a sensitivity of 75.0%, specificity of 71.3%, PPV of 49.5%, and AUC of 0.804 (p < 0.001). The AUC of Criteria C was significantly higher than that of Criteria B (p = 0.0037).ConclusionDES occurred after successful EDCR in 27.3% of patients, and an OSDI questionnaire helped to screen DES. The predictability could improve using the modified OSDI score which showed noticeable difference in five OSDI items before and after EDCR.

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Effects of Dry Eye Therapies on Environmentally Induced Ocular Surface Disease.

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Effects of Dry Eye Therapies on Environmentally Induced Ocular Surface Disease.

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