Dry eye: Diagnosis and current treatment strategies

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.

[1]  J. Belmont,et al.  Beneficial effect of artificial tears made with autologous serum in patients with keratoconjunctivitis sicca. , 1984, Arthritis and rheumatism.

[2]  J. Jumblatt,et al.  Regulation of ocular mucin secretion by P2Y2 nucleotide receptors in rabbit and human conjunctiva. , 1998, Experimental eye research.

[3]  W. Feuer,et al.  Interleukin-6 Levels in the Conjunctival Epithelium of Patients with Dry Eye Disease Treated with Cyclosporine Ophthalmic Emulsion , 2000, Cornea.

[4]  K. Carraway,et al.  Detection of sialomucin complex (MUC4) in human ocular surface epithelium and tear fluid. , 2000, Investigative ophthalmology & visual science.

[5]  K. Tsubota,et al.  Decreased reflex tearing is associated with lymphocytic infiltration in lacrimal glands. , 1996, The Journal of rheumatology.

[6]  B. Munoz,et al.  An epidemiologic study of medication use and symptoms of dry eye , 1997 .

[7]  P. Mullaney,et al.  Effect of Topical Cyclosporin A on Conjunctival T Cells in Patients with Secondary Sjögren’s Syndrome , 1993, Cornea.

[8]  P. Aragona,et al.  Sodium hyaluronate eye drops of different osmolarity for the treatment of dry eye in Sjögren's syndrome patients , 2002, The British journal of ophthalmology.

[9]  S. Pflugfelder,et al.  Aqueous Tear Production in Patients with Neurotrophic Keratitis , 1996, Cornea.

[10]  P. Voulgari,et al.  Oral pilocarpine for the treatment of ocular symptoms in patients with Sjögren’s syndrome: a randomised 12 week controlled study , 2003, Annals of the rheumatic diseases.

[11]  J. Daniels,et al.  Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies , 2001, The British journal of ophthalmology.

[12]  T. Fujihara,et al.  INS365 suppresses loss of corneal epithelial integrity by secretion of mucin-like glycoprotein in a rabbit short-term dry eye model. , 2002, Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics.

[13]  B. Damato,et al.  Senile atrophy of the human lacrimal gland: the contribution of chronic inflammatory disease. , 1984, The British journal of ophthalmology.

[14]  I. Gipson,et al.  Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. , 2002, Archives of ophthalmology.

[15]  G. Milazzo,et al.  Long term treatment with sodium hyaluronate-containing artificial tears reduces ocular surface damage in patients with dry eye , 2002, The British journal of ophthalmology.

[16]  I. Toda,et al.  Identification of androgen receptor protein and 5α-reductase mRNA in human ocular tissues , 2000, The British journal of ophthalmology.

[17]  M. Lemp Management of the Dry-Eye Patient , 1994, International ophthalmology clinics.

[18]  M. Dana,et al.  Is Complete Androgen Insensitivity Syndrome Associated with Alterations in the Meibomian Gland and Ocular Surface? , 2003, Cornea.

[19]  M. Lemp Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. , 1995, The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc.

[20]  D. Seal,et al.  Diagnostic implications of tear protein profiles. , 1984, The British journal of ophthalmology.

[21]  W. White,et al.  Iatrogenic complications related to the use of Herrick Lacrimal Plugs. , 2001, Ophthalmology.

[22]  S. Pflugfelder,et al.  Topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjögren syndrome. , 1999, Ophthalmology.

[23]  I. Gipson,et al.  Analysis of topical cyclosporine treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. , 2000, Archives of ophthalmology.

[24]  R. L. Font,et al.  The autoimmune nature of aqueous tear deficiency. , 1986, Ophthalmology.

[25]  K. Tsubota,et al.  Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation. , 1999, The New England journal of medicine.

[26]  T. Fujihara,et al.  P2Y2 receptor stimulation increases tear fluid secretion in rabbits , 2000, Current eye research.

[27]  D. Kellerman,et al.  Ocular safety of INS365 ophthalmic solution, a P2Y2 agonist, in patients with mild to moderate dry eye disease. , 2002, Advances in experimental medicine and biology.

[28]  K. Tsubota,et al.  Treatment of dry eye by autologous serum application in Sjögren’s syndrome , 1999 .

[29]  J. McCulley,et al.  The role of tetracycline in chronic blepharitis. Inhibition of lipase production in staphylococci. , 1991, Investigative ophthalmology & visual science.

[30]  D Fonn,et al.  A Patient Questionnaire Approach to Estimating the Prevalence of Dry Eye Symptoms in Patients Presenting to Optometric Practices across Canada , 1997, Optometry and vision science : official publication of the American Academy of Optometry.

[31]  K. Tsubota,et al.  Albumin as a tear supplement in the treatment of severe dry eye , 2003, The British journal of ophthalmology.

[32]  W. Feuer,et al.  Evaluation of Subjective Assessments and Objective Diagnostic Tests for Diagnosing Tear‐Film Disorders Known to Cause Ocular Irritation , 1998, Cornea.

[33]  M. Dana,et al.  Are women with Sjögren's syndrome androgen-deficient? , 2003, The Journal of rheumatology.

[34]  B. Reis,et al.  Efficacy and safety of cyclosporin a ophthalmic emulsion in the treatment of moderate-to-severe dry eye disease: A dose-ranging, randomized trial☆ , 2000 .

[35]  W. Hodge,et al.  One-Minute Schirmer Test With Anesthesia , 2003, Cornea.