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Dry eye: Diagnosis and current treatment strategies

Abstract

One in four patients attending ophthalmic clinics report symptoms of dry eye, making it one of the most common complaints seen by ophthalmologists. Aqueous-layer deficiency is the most common form of dry eye and is frequently caused by decreased secretion of tears by the lacrimal glands. Evaporative dry eye is often secondary to meibomian gland disease and results in a defective lipid layer. Tear replacement or preservation using artificial tears and/or punctal occlusion are the mainstay of treatment. Newer forms of therapy were designed to modify the underlying disease process. These include the use of topical cyclosporin A, autologous serum, and sodium hyaluronate drops, which suppress underlying inflammation, provide growth factors, and prevent the onset of squamous metaplasia in ocular surface epithelium. Hormonal therapy might have a role in the future of dry eye therapy.

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References and Recommended Reading

  1. 1.

    Pflugfelder SC, Tseng SCG, Sanabria O, et al.: Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea 1998, 17:38–56.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Schein OD, Munoz B, Tielsch JM, et al.: An epidemiological study of medication use and symptoms of dry eye. Invest Ophthalmol Vis Sci 1997, 38:S213.

    Google Scholar 

  3. 3.

    Doughty MJ, Fonn D, Richter D, et al.: A patient questionnaire approach to estimating the prevalence of dry eye symptoms in patients presenting to optometric practices across Canada. Optom Vis Sci 1997, 74:624–631.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Mackie IA, Seal DV: Diagnostic implications of tear film protein profiles. Br J Ophthalmol 1984, 68:321–324.

    PubMed  CAS  Google Scholar 

  5. 5.

    Pflugfelder SC, Liu Z, Monroy D, et al.: Detection of sialomucin complex (MUC4) in human ocular surface epithelium and tear fluid. Invest Ophthalmol Vis Sci 2000, 41:1316–1326.

    PubMed  CAS  Google Scholar 

  6. 6.

    Lemp MA: Report of the National Eye Institute/Industry Workshop on Clinical Trials in Dry Eyes. CLAO J 1995, 21:221–232.

    PubMed  CAS  Google Scholar 

  7. 7.

    Dougherty JM, McCulley JP, Silvany RE, Meyers DR: The role of tetracycline in chronic blepharitis: inhibition of lipase production in staphylococci. Invest Ophthalmol Vis Sci 1991, 32:2970–2975.

    PubMed  CAS  Google Scholar 

  8. 8.

    Tsubota K, Xu K, Fujihara T, et al.: Decreased reflex tearing is associated with lymphocytic infiltration in lacrimal glands. J Rheumatol 1996, 23:313–320.

    PubMed  CAS  Google Scholar 

  9. 9.

    Bawazeer AH, Hodge WG: One-minute Schirmer test with anesthesia. Cornea 2003, 22:285–287.

    PubMed  Article  Google Scholar 

  10. 10.

    Lemp MA: Management of the dry eye patient. Int Ophthalmol Clinics 1994, 34:101–113.

    Article  CAS  Google Scholar 

  11. 11.

    White WL, Bartley GB, Hawes MJ, et al.: Iatrogenic complications related to the use of Herrick lacrimal plugs. Ophthalmology 2001, 108:1835–1838.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Marsh P, Pflugfelder SC: Topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjogren’s syndrome. Ophthalmology 1999, 106:811–816.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Pflugfelder SC, Wilhelmus KR, Osato MS, et al.: The autoimmune nature of aqueous tear deficiency. Ophthalmology 1986, 93:1513–1517.

    PubMed  CAS  Google Scholar 

  14. 14.

    Damato BE, Allan D, Murray SB, Lee WR: Senile atrophy of the human lacrimal gland: the contribution of chronic inflammatory disease. Br J Ophthalmol 1984, 68:674–680.

    PubMed  CAS  Google Scholar 

  15. 15.

    Power WJ, Mullaney P, Farrell M, Collum LM: Effect of topical cyclosporin A on conjunctival T cells in patients with secondary Sjogren’s syndrome. Cornea 1993, 12:507–511.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Kunert KS, Tisdale AS, Gibson IK: Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. Arch Ophthalmol 2002, 120:330–337.

    PubMed  CAS  Google Scholar 

  17. 17.

    Kunert KS, Tisdale AS, Stern ME, et al.: Analysis of topical cyclosporine treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. Arch Ophthalmol 2000, 118:1489–1496.

    PubMed  CAS  Google Scholar 

  18. 18.

    Turner K, Pflugfelder SC, Ji Z, et al.: Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclosporine ophthalmic emulsion. Cornea 2000, 19:492–496.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Stevenson D, Tauber J, Reis BL, The Cyclosporin A Phase 2 Study Group: Efficacy and safety of cyclosporin A ophthalmic emulsion in the treatment of moderate-to-severe-dry eye disease. Ophthalmology 2000, 107:967–974. The use of cyclosporin emulsion eye drops was very safe and significantly improved the signs and symptoms of dry eye disease. The most appropriate concentrations were 0.05% and 0.1%.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Fox R, Chan R, Michelson J, et al.: Beneficial effect of artificial tears made with autologous serum in patients with keratoconjunctivitis sicca. Arthritis Rheum 1984, 27:459–461.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Tsubota K, Goto E, Fujita H, et al.: Treatment of dry eye by autologous serum application in Sjogren’s syndrome. Br J Ophthalmol 1999, 83:390–395. This paper describes the method for producing autologous serum drops and shows that they provide essential components to the ocular surface. Storage of drops is also assessed.

    PubMed  CAS  Article  Google Scholar 

  22. 22.

    Poon AC, Geerling G, Dart JKG, et al.: Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies. Br J Ophthalmol 2001, 85:1188–1197.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Tsubota K, Satake Y, Kaido M, et al.: Stem cell transplantation of corneal epithelium for the treatment of severe ocular surface disorders. N Engl J Med 1999, 340:1697–1703.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Heigle TJ, Pflugfelder SC: Aqueous tear production in patients with neurotrophic keratitis. Cornea 1996, 15:135–138.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Shimmura S, Ueno R, Goto E, et al.: Albumin as a tear supplement in the treatment of severe dry eye. Br J Ophthalmol 2003, 87:1279–1283.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Aragona P, Papa V, Micali A, et al.: Long-term treatment with sodium hyaluronate-containing artificial tears reduces ocular surface damage in patients with dry eye. Br J Ophthalmol 2002, 86:181–184. Sodium hyaluronate was shown to improve both fluorescein and rose bengal staining in patients with dry eye, suggesting that the treatment with this agent promotes corneal and conjunctival epithelial healing.

    PubMed  Article  Google Scholar 

  27. 27.

    Aragona P, Di Stefano G, Ferreri F, et al.: Sodium hyaluronate eye drops of different osmolarity for the treatment of dry eye in Sjogren’s syndrome patients. Br J Ophthalmol 2002, 86:879–884.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Sullivan DA, Belanger A, Cermak JM, et al.: Are women with Sjogren’s syndrome androgen-deficient? J Rheumatol 2003, 30:2413–2419.

    PubMed  Google Scholar 

  29. 29.

    Cermak JM, Krenzer KL, Sullivan RM, et al.: Is complete androgen insensitivity syndrome associated with alterations in the meibomian gland and ocular surface? Cornea 2003, 22:516–521.

    PubMed  Article  Google Scholar 

  30. 30.

    Rocha EM, Wickham LA, da Silveira LA, et al.: Identification of androgen receptor protein and 5alpha-reductase mRNA in human ocular tissues. Br J Ophthalmol 2000, 84:76–84.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Murakami T, Fujihara T, Nakamura M, Nakata K: P2Y2 receptor stimulation increases tear fluid secretion in rabbits. Curr Eye Res 2000, 21:782–787.

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Jumblatt JE, Jumblatt MM: Regulation of ocular mucin secretion by P2Y2 nucleotide receptors in rabbit and human conjunctiva. Exp Eye Res 1998, 67:341–346.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Fujihara T, Murakami T, Nagano T, et al.: INS365 suppresses loss of corneal epithelial integrity by secretion of mucinlike glycoprotein in a rabbit short-term dry eye model. J Ocul Pharmacol Ther 2002, 18:363–370.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Yerxa BR, Mundasad M, Sylvester RN, et al.: Ocular safety of INS365 ophthalmic solution, a P2Y2 agonist, in patients with mild to moderate dry eye disease. Adv Exp Med Biol 2002, 506:1251–1257.

    PubMed  CAS  Google Scholar 

  35. 35.

    Tsifetaki N, Kitsos G, Paschides CA, et al.: Oral pilocarpine for the treatment of ocular symptoms in patients with Sjogren’s syndrome: a randomised 12 week controlled study. Ann Rheum Dis 2003, 62:1204–1207.

    PubMed  Article  CAS  Google Scholar 

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O’Brien, P.D., Collum, L.M.T. Dry eye: Diagnosis and current treatment strategies. Curr Allergy Asthma Rep 4, 314–319 (2004). https://doi.org/10.1007/s11882-004-0077-2

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Keywords

  • Ocular Surface
  • Lacrimal Gland
  • Sodium Hyaluronate
  • Meibomian Gland
  • Meibomian Gland Dysfunction