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Dry eye disease (DED) has a higher prevalence than many important systemic disorders like cardiovascular disease and diabetes mellitus, representing a significant quality of life burden for the affected patients. It is a common reason for consultation in general eye clinics worldwide. Nowadays, the diagnostic and therapeutic approach at the high co...
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Purpose
To investigate age- and sex-related differences in tear film parameters of normal Indian population and study interparametric relationships.
Methods
Healthy subjects with no ocular disease (median ocular surface disease index = 0) were subjected to an automated evaluation of tear meniscus height (TMH), non-invasive tear breakup time (NIBUT...
Citations
... DED was defined as patients presenting with an OSDI score of ≥13 along with at least one homeostasis marker, as defined by the DEWS-II diagnostic approach [78]. Patients were categorized as having mild-to-moderate DED, corresponding to Grades I and II of the Tear Film and Ocular Surface Society (TFOS) DEWS I severity classification [79]. To be included in the study, patients had to test positive for the presence of MMP-9 with an InflammaDry© (Quidel Eye Health, San Diego, CA, USA) test result exceeding 40 ng/mL. ...
The aim of this work was to assess the tolerability, safety, and efficacy of an ophthalmic topical formulation containing helenalin from Arnica montana and hyaluronic acid 0.4% (HA) in patients with mild-to-moderate Dry Eye Disease (DED) exhibiting positive Matrix Metalloproteinase 9 (MMP-9) test results. Tolerability and safety were evaluated in 24 healthy subjects. Participants were instructed to apply one drop of the formulation three times a day in the study eye, for 2 weeks, followed by a clinical follow-up of 21 days. Efficacy was studied in 48 DED patients randomized into Study (Group 1/receiving the studied formulation) or Control (Group 2/Receiving HA 0.4% eye lubricant) groups for 1 month. Assessments included an MMP-9 positivity test, conjunctival impression cytology (CIC), Ocular Surface Disease Index (OSDI), non-invasive film tear breakup time (NIBUT), non-invasive average breakup time (NIAvg-BUT), ocular surface staining, Schirmer’s test, and meibomiography. A crossover design with an additional 1-month follow-up was applied to both groups. Healthy subjects receiving the studied formulation exhibited good tolerability and no adverse events. Regarding the efficacy study, Group 1 exhibited a statistically significant reduction in the MMP-9 positivity rate compared to Group 2 (p < 0.001). Both Group 1 and Group 2 exhibited substantial improvements in OSDI and NIBUT scores (p < 0.001). However, Group 1 demonstrated a significant improvement in NI-Avg-BUT and Schirmer’s test scores (p < 0.001), whereas Group 2 did not (p > 0.05). Finally, after the crossover, the proportion of MMP-9-positive subjects in Group 1 increased from 25% to 91.6%, while Group 2 showed a significant decrease from 87.5% to 20.8%. Overall, the topical formulation containing sesquiterpene helenalin from Arnica montana and hyaluronic acid was well tolerated and exhibited a favorable safety profile. Our formulation reduces DED symptomatology and modulates the ocular surface inflammatory process; this is evidenced by the enhancement of CIC, the improvement of DED-related tear film status, and the reduction of the MMP-9 positivity rate.
... The restoration of the parameters affected by DED was defined by the reduction of the OSDI score back to normal values (<13), the improvement of TBUT ≥10 seconds, and/or the presence of no epithelial staining (grade 0) after a one-month treatment period in at least one group. 1,2,16 The OSDI questionnaire is the most widely used test in DED clinical trials. It measures frequency of symptoms in several environmental settings and vision-related quality of life. ...
Purpose
A randomized clinical trial was run to evaluate the effectiveness of a preservative-free 0.4% sodium hyaluronate eye drop (LOF) in different dosage schemes to alleviate signs and symptoms of dry eye disease (DED).
Methods
A total of 116 subjects with mild-to-moderate DED were included, and 111 completed the study (from which 67.6% were female and 65.3% were users of oral contraceptives). Patients were randomly assigned to instill a drop of LOF either 2 (BID), 4 (QID) or 6 (6TD) times a day (at least 3 hours apart) for 30 days. The clinical parameters and symptom endpoints were Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), ocular surface staining, and conjunctival hyperemia. Other parameters evaluated were chemosis, best corrected visual acuity, and the incidence of adverse events (AE).
Results
There was a significant reduction in OSDI scores by day 30 in all groups. The recovery of the OSDI score back to normal values was observed in 51.4% of patients treated (50%, 48.6%, and 55.6% in BID, QID, and 6TD, respectively, p = 0.822). Similar improvement was observed for TBUT, 50.5% of patients increased this variable to >10 seconds (39.5%, 51.4%, and 61.1%, p = 0.175), and for ocular surface staining, ≥72% showed Grade 0. There were no significant differences among posology groups regarding ocular surface staining, conjunctival hyperemia, or any safety parameters. No overall improvement in OSDI and TBUT to normal values was noted for 31 patients (21 were female and 71.4% users of contraceptive drugs).
Conclusion
The ophthalmic use of preservative free LOF, 2, 4 or 6 times a day, may alleviate clinical parameters and symptoms in 50% of patients with mild-to-moderate DED after a one-month treatment. This improvement seemed to be less ubiquitous in patients within reproductive age and using oral contraceptives.
Trial Registration
This trial is registered at clinicaltrials.gov (NCT0704531).
... Dry eye is a common disorder that affects the ocular surface (Craig et al., 2017). There are various reasons for dry eye, but the most common is the loss of the tear film's homeostasis (Rodriguez-Garcia et al., 2022). The dryness of the eye leads to symptoms of discomfort, visual disturbance, irradiation, inflammation, burning, and redness. ...
The purpose of the research was to examine how the addition of dilute solutions of sodium chloride (NaCl), potassium chloride (KCl), or a combination of the two would impact the tear ferning (TF) patterns in artificial tears. Artificial tears (1 μL) were mixed with solutions (1–7 μL) of NaCl, KCl, or both (10–30 mg), prepared in double-distilled water (100 mL), to produce homogenous mixtures. A sample (1 μL) of each mixture was dried on a microscopic glass slide at 20°C and with less than 20% humidity. The TF patterns were inspected using a light microscope, graded, and compared with the corresponding TF grades of pure artificial tears. Significant improvements (Wilcoxon test, P = 0.001) in the TF grades of the artificial tears were observed after the addition of solutions of NaCl and KCl or a mixture of both. The TF grades of the artificial tears decreased after adding different volumes and concentrations of electrolyte solutions. Generally, NaCl was more efficient than KCl in improving such grades. The TF grades of Blink Contact Soothing Eye Drops and Refresh Plus Tears were noticeably improved compared to the other grades. For example, Blink Contact Soothing Eye Drops' TF grade improved from 1.7 to 0.6 when 6 μL of NaCl solution (30 mg/100 mL water) was added to 1 μL of the eye drops. When a mixture of NaCl and KCl (1:2; 5-7 μL; 30 mg each in 100 mL water) was added, the TF grade improved to 0.5. In conclusion, the TF test evaluated the effect of adding dilute electrolyte solutions to artificial tears in vitro. Adding dilute solutions of NaCl and KCl, or a mixture of both, significantly improved the TF grades of artificial tears.
... Patients with prior DED, those exposed to preserved pressure-lowering medications (PLMs), and those requiring ≥1 agent (Saade et al., 2015), are at an increased risk of experiencing worse OSD symptoms. Furthermore, dry eye symptoms can result in increased patient depression, anxiety, and poor quality of life (QoL), which, in turn, is associated with poor compliance to glaucoma therapy and an increased risk of glaucoma progression (Stringham et al., 2018;Tirpack et al., 2019;Rodriguez-Garcia et al., 2022). Thus, addressing OSD in patients with glaucoma is necessary. ...
... In this regard, PLMs for the management of OHT and glaucoma have been shown to cause damage to the LFU through a myriad of mechanisms, including a decrease in conjunctival goblet cell (GC) density, squamous metaplasia (Baudouin et al., 2008), conjunctival human leukocyte antigen (HLA)-DR overexpression (Baudouin et al., 2008), and disruption of the degrading-remodeling effect between MMPs and tissue inhibitors of metalloproteinases (TIMPs) in the ECM compounds, including collagen fibers (Karli et al., 2018). Moreover, the need for fixed combinations, commonly required by patients exhibiting disease progression and lifelong treatment, as well as the vehicles and preservatives contained in drug formulations [i.e., benzalkonium chloride (BAK)], will result in a significant number of patients experiencing ocular surface damage (Tiedemann et al., 2019;Rodriguez-Garcia et al., 2022). Additionally, an impression cytology study reported significant overexpression of C-C chemokine receptors (CCR)-type 4 and 5 in the conjunctival epithelium of glaucoma subjects chronically treated with PLMs compared with controls (Baudouin et al., 2008). ...
Ocular surface disease (OSD), a disorder affecting the lacrimal and meibomian glands and the corneal and conjunctival epithelium, is a well-known complication of topical glaucoma therapy. OSD can present as a new or pre-existing condition that virtually any anti-glaucoma formulation can exacerbate. As such, both glaucoma and OSD frequently coexist. Typical OSD symptoms include ocular discomfort, redness, burning, and dryness, whereas signs include periorbital and eyelid skin pigmentation, conjunctival scarring, and superficial punctate keratitis. Pressure-lowering eyedrops can cause toxic, allergic, and inflammatory reactions on the ocular surface. The latter can result from either preservatives or direct toxicity from the active molecule. Although usually mild, OSD can cause significant symptoms that lead to poor quality of life, decreased compliance to therapy, glaucoma progression, and worse visual outcomes. Given the chronic nature of glaucoma, lack of curative therapy, and subsequent lifelong treatment, addressing OSD is necessary. This manuscript aims to provide an up-to-date overview of OSD’s signs, symptoms, and pathogenic mechanisms from glaucoma therapy toxicity.
... The corneal staining using sodium fluorescein is a potential technique to assess the corneal damage associated with the DED [15]. The DED condition was evaluated based on the corneal staining evaluation proposed by Mexican Dry Eye Disease Expert panel [31,32]. Briefly, cornea was divided into 4 zones. ...
Dry eye disease is a highly prevalent ocular condition that significantly affects the quality of life and presents a major challenge in ophthalmology. Animal models play a crucial role in investigating the pathophysiology and developing effective treatments. The goal of this study was to compare and standardize two dry eye disease rodent models and explore their recovery aspects. We have standardized benzalkonium chloride and scopolamine-induced dry eye disease models which represents two different classes of the dry eye i.e., evaporative dry eye and aqueous deficient dry eye, respectively. After the development of dry eye conditions, a self-recovery period of seven days was granted to assess the reversal of the induced changes. The dry eye condition was assessed by measuring tear volume, corneal slit lamp imaging, and histological examination of the cornea, the lacrimal and the harderian gland. The study indicated the development of chronic inflammation of the cornea and lacrimal gland in the case of benzalkonium after five days of the treatment, while the scopolamine treated group showed chronic inflammation of the lacrimal gland after five days and corneal inflammation after seven days of administration. The recovery study suggested that after discontinuation of inducing agent, the dry eye symptoms were still persistent suggesting the utility of the model in evaluating dry eye treatments. The study highlights the comparative changes in both models along with recovery which can serve as a base for drug discovery and development against dry eye disease.
... De antemano, el panel reconoce que el tratamiento del ojo seco es complejo debido a su naturaleza multifactorial. El objetivo principal del tratamiento es restablecer la homeostasis de la superficie ocular, rompiendo el círculo vicioso de la enfermedad 1,8 . Mientras que los tratamientos pueden estar indicados explícitamente para un aspecto de la condición, varias modalidades de tratamiento podrían recomendarse para múltiples aspectos de una presentación clínica del ojo seco. ...
... eficaz basada en la evidencia, el panel propone el algoritmo de tratamiento ilustrado en la figura 3. En función de la gravedad del ojo seco, el tratamiento escalonado recomendado para los pacientes refractarios a la terapia es aditivo y secuencial. Independientemente de la gravedad de la enfermedad, las recomendaciones específicas son adecuadas para todos los pacientes, incluidos los lubricantes oculares según sea necesario, con una frecuencia que depende de la gravedad de los síntomas 1,23 . ...
... Para ello resulta crucial determinar la frecuencia de los episodios, los síntomas y signos de presentación, la ingesta de medicamentos sistémicos y las condiciones sistémicas asociadas. También resulta esencial evaluar el apego terapéutico en cada visita e identificar los posibles factores agravantes del ojo seco 1,8,23 . ...
El Panel Mexicano de Expertos en Ojo Seco está conformado por un grupo académico representativo de especialistas en córnea y superficie ocular, líderes de opi- nión en el tema, preocupados por el incremento expo- nencial del ojo seco y los cambios patológicos que pro- duce en la superficie ocular, incluyendo la visión y afectando a cada vez más grupos etarios de la población en general. El panel tiene como objetivos principales: mejorar el reconocimiento temprano y la clasificación del ojo seco de acuerdo con su gravedad, para planificar un tratamiento eficaz de los pacientes que lo padecen1.
En la actualidad existen múltiples reportes sobre la clasificación y el tratamiento del ojo seco, y aunque la cantidad es exhaustiva y la calidad de conocimiento es excelente, pocos informes se centran en un enfoque práctico para los oftalmólogos que se enfrentan a estos pacientes por primera vez en la consulta diaria.
El presente informe propone una metodología siste- mática, práctica y simple para la detección temprana, la clasificación basada en la gravedad y el tratamiento eficaz de los pacientes que padecen cualquier enfermedad re- lacionada con el ojo seco. Se han recopilado los concep- tos esenciales del NEI/Workshop, los informes del TFOS DEWS-I y II, los grupos de consenso europeo ODISSEY, la Sociedad Japonesa del Ojo Seco (JDES), la Sociedad Asiá- tica del Ojo Seco (ADES) y la Società Italiana di Dacriologia e Superficie Oculare (SIDSO), entre otros informes relevan- tes para formular nuestra propuesta2-8.
El panel cree que este esfuerzo se convertirá en una herramienta diagnóstica y terapéutica de gran utilidad para los oftalmólogos latinoamericanos que día con día atienden a pacientes con este trastorno tan importante y común.
Purpose
Dry eye disease (DED) is a prevalent ocular surface disease that is conventionally characterized by tear film hyperosmolarity and instability. This review presents a summarized classification of DED, followed by a comprehensive discussion of the most recent topical and systemic medications and clinical recommendations for selecting the most appropriate option for each patient.
Methods
An extensive literature search was conducted on electronic databases, such as PubMed, Scopus, and Web of Science, using keywords including “dry eye syndrome,” “ocular surface disease,” “medical management,” “artificial tears,” “topical immunomodulators,” and “meibomian gland dysfunction.”
Results
The underlying reasons for DED can range from insufficient aqueous tear production to increased tear evaporation. Recent literature has provided a more in-depth understanding of the pathophysiology of DED by examining the tear film's lipid, aqueous, and mucin layers. However, despite these advancements, medical management of patients with symptomatic DED has not fully reflected this modernized knowledge of its pathophysiology.
Conclusion
To develop a rationalized strategy for treating DED, it is crucial to have updated knowledge of therapeutic options, their mechanisms of actions, and indications based on the DED type and underlying causes.
