Dry eye disease

Introduction of Dry Eye Diseasse

Dry eye disease (DED) is widely prevalent and multifactorial innature. Dry eye disease is a continuing medical challenge in nowadays. Epidemiological studies explore the prevalence of dry eye disease depending on the definition and diagnosis of the disease, and the population surveyed.

In 2017, the Tear Film and Ocular Surface Society’s Dry Eye Workshop II (TFOS DEWSII) provided a new definition of dry eye disease based on the new findings, declaring that dry eye disease is a multifactorial disease of the ocular surface characterized by a loss of homoeostasis of the tear film, accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, as well as neurosensory abnormalities play aetiological roles. TFOS DEWS II classified dry eye disease into three types: aqueous-deficient, evaporative, and mixed.

In Netherlands, a cross-sectional study including 79,866 participants between 2014 and 2017 reveals a 9.1% prevalence of dry eye disease. Female and older individuals are more likely to be affected by DED. In a population based cross-sectional study in Korean found that the weighted prevalence of dry eye disease was 7.9 ± 0.4%.

The available largely empirical symptomatic, supportive, and restorative treatments have significant limitations as they do not alter local and systemic disease progression. Topical therapies have expanded to include biologics, surgical approaches, scleral lens fitting, the management of lid margin disease, systemic treatments, nutritional support, and the transplantation of stem cells. They are not curative, as they can not permanently restore the ocular surface's homeostasis. These approaches are efficacious in the short term in most studies, with more significant variability in outcome measures among studies in the long term.

Pathogenesis of Dry Eye Disease

Dry eye is a chronic and multifactorial ocular surface disease caused by tear film instability or imbalance in the microenvironment of theocular surface. It can lead to various discomforts such as inflammation of the ocular surface and visual issues. However, the mechanism of dry eye is not clear, which results in dry eye being only relieved but not cured in clinical practice.

The underlying reasons for dry eye disease can range from insufficient aqueous tear production to increased tear evaporation. Several studies have revealed that viral infection can induce inflammation of the ocular surfaceand reduce tear secretion of the lacrimal gland, consequently triggering ocular morphological and functional changes and resulting in dry eye disease.

Patients with autoimmune diseases experience impaired and weak immune systems, leading to abnormal immune responses and disrupted immuneregulation. This impairment puts the lacrimal gland, conjunctival membrane,cornea, and meibomian glands at high risk, causing tissue damage and dysfunction. In individuals with autoimmune diseases, a notable proportion of immune cells, predominantly T lymphocytes, infiltrate the lacrimal duct andaccessory lacrimal gland. This infiltration leads to autophagy and apoptosis ofacinar, ductal, and myoepithelial cells. This disrupts the function of the lacrimal gland and reduces tear secretion. The corneal subepithelial nerve repair mechanism wasdestroyed, may cause neurogenic dry eye.

Treatment of Dry Eye Disease

Dry eye disease is a complex disorder driven by several factors like reduced tear production, increased evaporation, or poor tear quality. There are several treatment of dry eye disease under research that attracting people’s attention.

Diquafosol sodium (DQS) is an agonist of the P2Y2 receptor to restore the integrity/stability of the tear film. Animal experiments demonstrated that DQS-loaded cerium oxidenanozyme (defined as Ce@PBD) significantly restored the defect of the corneal epithelium and increased the number of goblet cells, with the promotion of tear secretion, which was the best among commercial DQS ophthalmic solutions.

Hyaluronic acid eye drop is a useful therapy for dry eye disease, a high concentration of hyaluronic acid eye dropis recommended for dry eyes with positive corneal staining, whereas in other cases, a high concentration of hyaluronic acid eye drop does not offer a more pronounced advantage over a low concentration of hyaluronic acid eye drop in the treatment of dry eyes.

A clinical study showed that 3% diquafosol and2% rebamipide solution significantly improved the ocular surface disease index (p = 0.033 and 0.034, respectively), tear breakup time (p < 0.001 and 0.026, respectively), and corneal (p <0.001 and 0.001, respectively) and conjunctival (p = 0.017 and 0.042,respectively) staining after 4 weeks of treatment, which indicating that two mucin secretagogues showed comparable effects in ameliorating symptoms and improving signs (tear breakup time, corneal and conjunctival staining) in patients with dry eye disease.

In a clinical study, the efficacy of topic alautologous serum and platelet-rich plasma in patients with severe dry eye and persistent epithelial defects are compared. Significant visual improvement was achieved with platelet-rich plasma from 0.81 ± 0.73 LogMAR to 0.72 ± 0.63 (p = 0.025), whereas insignificant with serum from 0.60 ± 0.65 to 0.57 ± 0.67 (p = 0.147). Mean epithelial healing time was 6.7 ± 4.7 (2-14) days in serum and 3.6 ± 1.9 (2-7) in platelet-rich plasma (p = 0.195). The result shows that both treatments are equally effective in severe dry eye and persistent epithelial defects. Although, visual gain is higher in PRP, autologous serum may be preferable due to low cost.

Biological adhesive polymers, including chitosan, hyaluronic acid, cellulose, cyclodextrin, and poloxamer, known for their adhesive characteristics enhancing drug retention on ocular surfaces and increasing bioavailability.

For more information please refer to:

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11. Min Wu, Cuilian Sun, Qin Shi. Dry eyedisease caused by viral infection: Past, present and future. Virulence. 2024; 15(1):2289779. doi: 10.1080/21505594.2023.2289779.

12. Nan Zhou, Taige Chen, Qiao You. Enterovirus A71 infection-induced dry eye-like symptoms by damaging the lacrimal glands. Front Cell Infect Microbiol. 2024: 14:1340075. doi:10.3389/fcimb.2024.1340075.

13. Shu-Hua Lin, Yu-Hui Fang, Fa-Li Jia. Neurogenic dry eye associated with intravitreal injection of anti-VEGF agents. Eur J Ophthalmol. 2024; 34(1): NP35-NP40. doi: 10.1177/11206721231177475.

14. Haoyu Zou, Yueze Hong, Baoqi Xu. Multifunctional Cerium Oxide Nanozyme for Synergistic Dry Eye Disease Therapy. ACS Appl Mater Interfaces. 2024; 16(27):34757-34771. doi: 10.1021/acsami.4c07390.

15. Tsung-Jen Wang, Lekshmi Rethi, Min-Yi Ku. A review on revolutionizing ophthalmic therapy: Unveiling the potential of chitosan, hyaluronic acid, cellulose, cyclodextrin, and poloxamer in eye disease treatments. Int J BiolMacromol. 2024 Jul;273(Pt 2):132700. doi: 10.1016/j.ijbiomac.2024.132700.

16. Xiao-Wei Ouyang, Sheng Fang, Yun-Min Yi. Different concentrations of hyaluronic acid eye drops for dry eye syndrome: a systematic review and Meta-analysis. Int J Ophthalmol. 2024 Jun 18; 17(6):1110-1119. doi:10.18240/ijo.2024.06.17.

17. Yeonwoo Jin, Kyoung Yul Seo, Sun Woong Kim. Comparing two mucin secret agogues for the treatment of dry eye disease: a prospective randomized crossover trial. Sci Rep. 2024 Jun 10;14(1):13306. doi:10.1038/s41598-024-63784-4.

18. İbrahim Özlük, Bora Yüksel, Tuncay Küsbeci. Comparison of autologous serum and platelet-rich plasma in the treatment of severe dry eye and persistent epithelial defects. Cont Lens Anterior Eye. 2024: 102247. doi:10.1016/j.clae.2024.102247.