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Ballesteros-Sánchez A, Sánchez-González JM, Borrone MA, Borroni D, Rocha-de-Lossada C. The Influence of Lid-Parallel Conjunctival Folds and Conjunctivochalasis on Dry Eye Symptoms with and Without Contact Lens Wear: A Review of the Literature. Ophthalmol Ther 2024; 13:651-670. [PMID: 38217793 PMCID: PMC10853109 DOI: 10.1007/s40123-023-00877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/18/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Lid-parallel conjunctival folds (LIPCOF) and conjunctivochalasis (CCH) are similar conditions that seem to be related to dry eye severity. In addition, there is a lack of studies on the topic of LIPCOF and CCH on dry eye symptoms in non-contact lens and contact lens (CL) wearers. Therefore, the aim of this study is to review the relationship of LIPCOF and CCH with dry eye symptoms in non-CL and CL wearers, as well as to report the treatment of dry eye disease (DED) in non-CL and CL wearers who present LIPCOF or CCH. METHODS A literature review of full-length original studies in two databases, PubMed and Scopus, was performed. The search period included observational studies in humans published between April 21, 2009 and March 20, 2023. RESULTS A total of 26 studies were included. The studies suggest that LIPCOF and CCH are significantly related to dry eye symptoms in non-CL and CL wearers. However, the impact of CL wear on LIPCOF and CCH may be complex and may vary depending on individual factors such as lens type, lens care regimen, and pre-existing ocular conditions. Regarding LIPCOF management, tear substitutes seem to significantly reduce LIPCOF and dry eye symptoms in non-CL wearers, while vectored thermal pulsation (VTP) and microblepharoexfoliation (MBE) are suggested as promising treatment for LIPCOF and dry eye symptoms in CL wearers. Regarding CCH management, surgical interventions may be effective in reducing CCH when medical treatments have no response. In addition, an ocular examination by slit lamp is necessary to distinguish both conditions. CONCLUSIONS Tear substitutes, VTP, MBE, and fitting CLs with low coefficient of friction (CoF) seem to reduce and prevent LIPCOF. However, surgical treatment options seem to be more effective in the complete elimination of CCH. An adequate evaluation and differentiation between LIPCOF and CCH are important, and they should be considered by practitioners in managing dry eye symptoms in non-CL and CL wearers.
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Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain.
- Department of Ophthalmology, Clínica Novovisión, Murcia, Spain.
| | - José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain
| | - María Agustina Borrone
- Department of Ophthalmology, Hospital General de Agudos Dr Ignacio Pirovano, Buenos Aires, Argentina
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, Riga, 1007, Latvia
- Advalia Vision, Cornea Research Unit, 20145, Milan, Italy
| | - Carlos Rocha-de-Lossada
- Qvision, Ophthalmology Department, VITHAS Almeria Hospital, 04120, Almeria, Spain
- Ophthalmology Department, VITHAS Malaga, 29016, Malaga, Spain
- Regional University Hospital of Malaga, Hospital Civil Square, 29009, Malaga, Spain
- Surgery Department, Ophthalmology Area, University of Seville, Doctor Fedriani, 41009, Seville, Spain
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Xiang M, Liu J, Ma K, Sha Y, Zhan Y, Zhang W, Kong X. The mechanism of Qijing Mingmu decoction on cellular senescence of conjunctivochalasis. BMC Complement Med Ther 2023; 23:302. [PMID: 37644481 PMCID: PMC10466834 DOI: 10.1186/s12906-023-04138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Qijing Mingmu decoction (QJMM), a compound Chinese medicine preparation, which consists of Lycium barbarum, Polygonatum, Ophiopogon japonicus, Poria cocos, Glycyrrhiza, Eclipta prostrata and Ligusticum striatum, has been confirmed to be effective for the treatment of conjunctivochalasis (CCH) in clinic and reduce cellular senescence. However, the underlying mechanism is still unknown. Our previous study revealed that p38-mediated cellular senescence contributed to the pathogenesis of CCH. METHODS To explore whether p38 might be the potential therapeutic target of QJMM for CCH, CCH fibroblasts were treated with QJMM granule and then the effect of QJMM granule on the expression and promoter activity of p38α was determined by western blot and dual luciferase reporter gene assay, respectively. Meanwhile, the influence of QJMM granule on cell proliferation, oxidative stress, cellular senescence and the expression of the cellular senescence-associated genes were measured by corresponding methods. RESULTS QJMM granule significantly decreased the protein expression of p38α and p-p38α in CCH fibroblasts in a dose-dependent manner and inhibited p38α promoter activity. QJMM granule as well as the p38 inhibitor SB203580 reduced the level of reactive oxygen species and increased the activity of superoxide dismutase in CCH fibroblasts. QJMM granule and SB203580 promoted cell proliferation and reduced the percentage of SA-β-Gal-positive cells. The mRNA and protein expression of p53 and p21 was remarkably down-regulated by QJMM granule as well as SB203580 and that of SMP30 was up-regulated in CCH fibroblasts. CONCLUSIONS Our findings demonstrated that QJMM granule was effective for alleviating cellular senescence of CCH fibroblasts by p38 MAPK signaling and the followed p53/p21 signaling.
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Affiliation(s)
- Minhong Xiang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China.
- Shanghai Putuo Central School of Clinical Medicine, Anhui Medical University, Hefei, 230032, China.
| | - Jiang Liu
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
| | - Kai Ma
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
| | - Yongyi Sha
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
| | - Yueping Zhan
- Department of Central Lab, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China
| | - Wei Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
| | - Xueqing Kong
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
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Liu Y, Feng J, Ren Y, Shi W, Kang H, Peng Y, Tan Y, Wu R, Zhang G, He Y. Ocular surface involvement and histopathologic changes in the acute stage of Stevens-Johnson syndrome and toxic epidermal necrolysis: a cross-sectional study. BMC Ophthalmol 2023; 23:297. [PMID: 37400766 DOI: 10.1186/s12886-023-03052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/19/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and extremely serious drug-induced dermatological disorders. The ocular surface condition at the early stage has been little studied and should contribute to novel perspectives in early and effective topical therapy of these diseases. The objectives of the study were to evaluate the acute phase of ocular surface involvement and histopathologic changes in patients with acute SJS/TEN. METHODS Ten patients with acute phase of SJS/TEN onset and eleven age- and sex-matched healthy volunteers were recruited. Ocular surface symptoms and signs, conjunctival impression cytology, and tear multi-cytokine were assessed. RESULTS Ocular surface objective signs were normal at the acute stage of SJS/TEN, while most patients have abnormal ocular surface subjective symptoms and meibomian gland secretion. Conjunctival impression cytology showed a significant decrease in goblet cell density and severe ocular surface squamous metaplasia in acute SJS/TEN patients. Tear multi-cytokine analysis showed all 21 pro- and anti-inflammatory cytokines all sharply elevated. Goblet cell density was significantly negatively correlated with tear C-X3-C motif chemokine ligand 1 (CX3CL1) and interleukin 13. CONCLUSIONS Severe pathologic squamous metaplasia and inflammation onset in the ocular surface at the acute stage of the SJS/TEN, even if the ocular surface condition seemed basically normal with adequate systemic immunosuppressant and general supportive treatment. Early topical anti-inflammatory therapy should be carried out actively.
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Affiliation(s)
- Yingyi Liu
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Jianing Feng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Northwest University Affiliated People's Hospital, Xi'an, Shaanxi Province, China
| | - Yuerong Ren
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Wen Shi
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Huanmin Kang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Yingqian Peng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Yixin Tan
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ruifang Wu
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guiying Zhang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan He
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China.
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Yvon C, Patel B, Malhotra R. Conjunctivochalasis. Int Ophthalmol Clin 2023; 63:209-223. [PMID: 37439619 DOI: 10.1097/iio.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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Ma K, Liu J, Sha Y, Zhang W, Ni Z, Kong X, Xiang M. Qi Jing Mingmu decoction inhibits the p38 signaling pathway in conjunctivochalasis fibroblasts by down-regulation of Th17 cell differentiation. JOURNAL OF ETHNOPHARMACOLOGY 2023; 301:115812. [PMID: 36223843 DOI: 10.1016/j.jep.2022.115812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/25/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Qi Jing Mingmu (QJMM) decoction is a traditional Chinese medicine that has been widely used for the clinical treatment of conjunctivochalasis (CCH). It is an effective treatment to relieve ocular symptoms including improving tear film and promoting tear secretion. However, its effects and molecular mechanisms need to be elucidated. AIM OF THE STUDY To determine whether QJMM decoction affected T helper 17 (Th17) cell differentiation of CCH patients. MATERIALS AND METHODS Blood samples and conjunctival tissues were collected from CCH patients and normal controls. The fibroblasts were separately induced, and CD4+ T cells were incubated with increasing concentrations of QJMM decoction and co-cultured with CCH fibroblasts. Th17 cell numbers were then analyzed using flow cytometry. Serum levels of interleukin 17 (IL-17) and IL-22 were detected using enzyme-linked immunosorbent assays. The expressions of signal proteins and genes were detected using western blotting and quantitative real-time PCR. RESULTS Compared with normal controls, Th17 cell numbers and serum levels of IL-17 and IL-22 were elevated in patients with CCH. QJMM decoction down-regulated the expressions of IL-17, IL-22, and STAT3 of CD4+T cells from CCH patients, suggesting that QJMM decoction impeded Th17 cell differentiation. QJMM decoction-treated CD4+ T cells inhibited the expression of p38 in CCH fibroblasts. CONCLUSION QJMM decoction inhibited Th17 cell differentiation of CD4+T cells from CCH patients, and QJMM decoction-treated CD4+T cells down-regulated the p38 signal pathway in CCH fibroblasts. Our study showed that Th17 cells may be good candidates for clinical treatment of CCH.
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Affiliation(s)
- Kai Ma
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Jiang Liu
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Yongyi Sha
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Wei Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Zhenhua Ni
- Department of Central Lab, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Xueqing Kong
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Minhong Xiang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China; Shanghai Putuo Central School of Clinical Medicine, Anhui Medical University, Hefei, 230032, China.
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Hynnekleiv L, Magno M, Vernhardsdottir RR, Moschowits E, Tønseth KA, Dartt DA, Vehof J, Utheim TP. Hyaluronic acid in the treatment of dry eye disease. Acta Ophthalmol 2022; 100:844-860. [PMID: 35514082 DOI: 10.1111/aos.15159aos15159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 05/25/2023]
Abstract
Dry eye disease (DED) is a highly prevalent and debilitating condition affecting several hundred million people worldwide. Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan commonly used in the treatment of DED. This review aims to critically evaluate the literature on the safety and efficacy of artificial tears containing HA used in DED treatment. Literature searches were conducted in PubMed, including MEDLINE, and in Embase via Ovid with the search term: "(hyaluronic acid OR hyaluronan OR hyaluronate) AND (dry eye OR sicca)". A total of 53 clinical trials are included in this review, including eight placebo-controlled trials. Hyaluronic acid concentrations ranged from 0.1% to 0.4%. Studies lasted up to 3 months. A broad spectrum of DED types and severities was represented in the reviewed literature. No major complications or adverse events were reported. Artificial tears containing 0.1% to 0.4% HA were effective at improving both signs and symptoms of DED. Two major gaps in the literature have been identified: 1. no study investigated the ideal drop frequency for HA-containing eyedrops, and 2. insufficient evidence was presented to recommend any specific HA formulation over another. Future investigations assessing the optimal drop frequency for different concentrations and molecular weights of HA, different drop formulations, including tonicity, and accounting for DED severity and aetiology are essential for an evidence-based, individualized approach to DED treatment.
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Affiliation(s)
- Leif Hynnekleiv
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, London, UK
| | - Morten Magno
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology and Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Emily Moschowits
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Darlene A Dartt
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jelle Vehof
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, London, UK
- Department of Ophthalmology and Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Tor P Utheim
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Ophthalmology, Stavanger University Hospital, Oslo, Norway
- Department of Ophthalmology, Vestre Viken Hospital, Drammen, Norway
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Hynnekleiv L, Magno M, Vernhardsdottir RR, Moschowits E, Tønseth KA, Dartt DA, Vehof J, Utheim TP. Hyaluronic acid in the treatment of dry eye disease. Acta Ophthalmol 2022; 100:844-860. [PMID: 35514082 PMCID: PMC9790727 DOI: 10.1111/aos.15159] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 12/31/2022]
Abstract
Dry eye disease (DED) is a highly prevalent and debilitating condition affecting several hundred million people worldwide. Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan commonly used in the treatment of DED. This review aims to critically evaluate the literature on the safety and efficacy of artificial tears containing HA used in DED treatment. Literature searches were conducted in PubMed, including MEDLINE, and in Embase via Ovid with the search term: "(hyaluronic acid OR hyaluronan OR hyaluronate) AND (dry eye OR sicca)". A total of 53 clinical trials are included in this review, including eight placebo-controlled trials. Hyaluronic acid concentrations ranged from 0.1% to 0.4%. Studies lasted up to 3 months. A broad spectrum of DED types and severities was represented in the reviewed literature. No major complications or adverse events were reported. Artificial tears containing 0.1% to 0.4% HA were effective at improving both signs and symptoms of DED. Two major gaps in the literature have been identified: 1. no study investigated the ideal drop frequency for HA-containing eyedrops, and 2. insufficient evidence was presented to recommend any specific HA formulation over another. Future investigations assessing the optimal drop frequency for different concentrations and molecular weights of HA, different drop formulations, including tonicity, and accounting for DED severity and aetiology are essential for an evidence-based, individualized approach to DED treatment.
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Affiliation(s)
- Leif Hynnekleiv
- Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Department of OphthalmologyHaukeland University HospitalBergenNorway,Department of Twin Research & Genetic EpidemiologyKing's College LondonSt Thomas' HospitalLondonUK
| | - Morten Magno
- Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of Ophthalmology and EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Faculty of MedicineInstitute of Clinical MedicineUniversity of OsloOsloNorway
| | | | - Emily Moschowits
- Department of Medical BiochemistryOslo University HospitalOsloNorway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Faculty of MedicineInstitute of Clinical MedicineUniversity of OsloOsloNorway
| | - Darlene A. Dartt
- Schepens Eye Research Institute/Massachusetts Eye and EarDepartment of OphthalmologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Jelle Vehof
- Department of Twin Research & Genetic EpidemiologyKing's College LondonSt Thomas' HospitalLondonUK,Department of Ophthalmology and EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Department of OphthalmologyVestfold Hospital TrustTønsbergNorway
| | - Tor P. Utheim
- Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of OphthalmologySørlandet Hospital ArendalArendalNorway,Department of OphthalmologyStavanger University HospitalOsloNorway,Department of OphthalmologyVestre Viken HospitalDrammenNorway
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Sánchez-González JM, De-Hita-Cantalejo C, Sánchez-González MC. Hyaluronic Acid and Galacto-Xyloglucan Eyedrop Efficacy in Young-Adult Oral Contraceptive Users of Childbearing Age. J Clin Med 2022; 11:jcm11154458. [PMID: 35956073 PMCID: PMC9369423 DOI: 10.3390/jcm11154458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 01/25/2023] Open
Abstract
To assess the efficacy of 0.4% hyaluronic acid and 0.2% galacto-xyloglucan for the subjective symptoms of dry eye disease and tear film invasive and noninvasive signs in 34 young-adult oral contraceptive users of childbearing age, a prospective, longitudinal, single-blind, clinical study was performed in a population of childbearing-age oral-contraceptive consumers. Subjective dry eye disease questionnaires, and invasive and noninvasive tear film assessments were reported before and after six weeks of hyaluronic acid with galacto-xyloglucan (HA-GX) treatment versus hyaluronic acid alone (HA). HA-GX treatment resulted in a greater decrease in the ocular surface disease index (17.01 ± 11.36 score points, p < 0.01) than the HA variation (11.61 ± 11.18 score points, p < 0.01). The standard patient evaluation of eye dryness also decreased more in the HA-GX group (4.06 ± 5.50 score points, p < 0.01) than in the HA alone group (0.70 ± 3.16, p = 0.21). Regarding noninvasive break-up time (NIBUT), the HA-GX group’s first NIBUT achieved an increase of 1.75 ± 1.16 s, p < 0.01, while the HA-alone group increased by only 0.54 ± 1.01 s, p < 0.01. The HA-GX group’s mean NIBUT reported an increase of 3.72 ± 5.69 s, p < 0.01; however, the HA-alone group achieved 2.19 ± 5.26 s, p = 0.05. Hyaluronic acid in combination with galacto-xyloglucan significantly decreased subjective dry eye disease symptoms and increased first and mean NIBUT compared to hyaluronic acid alone. Galacto-xyloglucan added efficacy in young-adult childbearing-age oral contraceptive users.
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Kim M, Lee Y, Mehra D, Sabater AL, Galor A. Dry eye: why artificial tears are not always the answer. BMJ Open Ophthalmol 2021; 6:e000697. [PMID: 33907713 PMCID: PMC8039249 DOI: 10.1136/bmjophth-2020-000697] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/18/2021] [Accepted: 03/31/2021] [Indexed: 12/25/2022] Open
Abstract
Dry eye disease (DED) is a multifactorial disease that manifests in patients with a variety of symptoms and signs such as ocular pain, visual issues, rapid tear evaporation and/or decreased tear production. It is a global health problem and is the leading cause of optometry and ophthalmology clinic visits. The mainstay therapy for DED is artificial tears (ATs), which mimics tears and improves tear stability and properties. ATs have been found to improve symptoms and signs of disease in all DED subtypes, including aqueous deficient DED and evaporative DED. However, given the heterogeneity of DED, it is not surprising that ATs are not effective in all patients. When AT fails to relieve symptoms and/or signs of DED, it is critical to identify the underlying contributors to disease and escalate therapy appropriately. This includes underlying systemic diseases, meibomian gland dysfunction, anatomical abnormalities and neuropathic dysfunction. Thus, this review will discuss the benefits and limitations of ATs and review conditions when escalation of therapy should be considered in DED.
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Affiliation(s)
- Minji Kim
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Yonghoon Lee
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Divy Mehra
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida, USA
| | - Alfonso L Sabater
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida, USA
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Formulation Considerations for the Management of Dry Eye Disease. Pharmaceutics 2021; 13:pharmaceutics13020207. [PMID: 33546193 PMCID: PMC7913303 DOI: 10.3390/pharmaceutics13020207] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/25/2022] Open
Abstract
Dry eye disease (DED) is one of the most common ocular surface disorders characterised by a deficiency in quality and/or quantity of the tear fluid. Due to its multifactorial nature involving several inter-related underlying pathologies, it can rapidly accelerate to become a chronic refractory condition. Therefore, several therapeutic interventions are often simultaneously recommended to manage DED efficiently. Typically, artificial tear supplements are the first line of treatment, followed by topical application of medicated eyedrops. However, the bioavailability of topical eyedrops is generally low as the well-developed protective mechanisms of the eye ensure their rapid clearance from the precorneal space, thus limiting ocular penetration of the incorporated drug. Moreover, excipients commonly used in eyedrops can potentially exhibit ocular toxicity and further exacerbate the signs and symptoms of DED. Therefore, formulation development of topical eyedrops is rather challenging. This review highlights the challenges typically faced in eyedrop development, in particular, those intended for the management of DED. Firstly, various artificial tear supplements currently on the market, their mechanisms of action, as well as their application, are discussed. Furthermore, formulation strategies generally used to enhance ocular drug delivery, their advantages and limitations, as well as their application in commercially available DED eyedrops are described.
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Posarelli C, Passani A, Del Re M, Fogli S, Toro MD, Ferreras A, Figus M. Cross-Linked Hyaluronic Acid as Tear Film Substitute. J Ocul Pharmacol Ther 2019; 35:381-387. [PMID: 31373862 DOI: 10.1089/jop.2018.0151] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: The aim of this review is to clarify the role of cross-linked Hyaluronic acid (HA) molecule as a tear supplement and to define its possible applications in dry eye disease. Methods: Current Literature about HA and its cross-linked derivatives has been examined. Results: HA is superior in increasing the viscosity and stability of the tear film compared with other tear supplements such as polyvinyl alcohol, hydroxypropyl methylcellulose, carboximethyl cellulose and polyethylene glycol. Moreover, HA can be modified in different ways to improve its properties such as molecular weight, viscosity, and hydrophobicity to adapt the new artificial molecule to different aims. Conclusions: The current pharmacological trend is to improve the properties of HA by cross-linking parts of the molecule to achieve better bioavailability and resistence to degradation. In dry eye disease, cross-linked HA as tear supplement seems to provide better ocular comfort than linear HA and is therefore subjected to growing interest and diffusion.
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Affiliation(s)
- Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Andrea Passani
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Marzia Del Re
- Department of Medical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Fogli
- Department of Medical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Antonio Ferreras
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
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Medical and surgical management of conjunctivochalasis. Ocul Surf 2019; 17:393-399. [DOI: 10.1016/j.jtos.2019.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/10/2019] [Accepted: 04/17/2019] [Indexed: 11/23/2022]
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13
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Efficacy of eyedrops containing cross-linked hyaluronic acid and coenzyme Q10 in treating patients with mild to moderate dry eye. Eur J Ophthalmol 2018; 28:25-31. [PMID: 28777385 DOI: 10.5301/ejo.5001011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Dry eye disease (DED) is a common condition causing substantial burden. A randomized, controlled, single-masked study was performed in 40 patients with mild to moderate DED to evaluate the efficacy and safety of a collyrium based on crosslinked hyaluronic acid (XLHA) with coenzyme Q10 (CoQ10). METHODS Enrolled subjects were divided into 2 groups: group A, treated with XLHA + CoQ10; and group B, treated with hyaluronic acid (HA). Eyedrops were administered 4 times daily for 3 months. The Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal and conjunctival staining, and meibomian gland assessment (MGD) were evaluated; furthermore, corneal aesthesiometry, in vivo corneal confocal microscopy, visual acuity, intraocular pressure (IOP), and fundus examination were performed. RESULTS At the end of treatment, OSDI score significantly decreased in groups A and B (p<0.01 and p<0.05, respectively); the decrease was significantly higher in group A. Corneal staining decreased in both groups, with lower scores in group A. The MGD was significantly ameliorated in group A patients. No differences were found for corneal aesthesiometry or TBUT. Epithelial cell reflectivity was significantly reduced only in group A. For keratocytes and stromal matrix parameters, there was a significant improvement in group A. No changes were found for visual acuity, IOP, or fundus examination. CONCLUSIONS The XLHA + CoQ10 treatment showed greater effectiveness in DED compared to HA alone, probably due to the longer permanency on ocular surface and the antioxidant activity of CoQ10. Therefore, XLHA + CoQ10 eyedrops could represent a new possibility in dry eye treatment.
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Conjunctivochalasis: a systematic review. Surv Ophthalmol 2017; 63:554-564. [PMID: 29128574 DOI: 10.1016/j.survophthal.2017.10.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 10/20/2017] [Accepted: 10/30/2017] [Indexed: 01/28/2023]
Abstract
Conjunctivochalasis (CCH) is a conjunctival condition characterized by loose, redundant conjunctival folds, most typically in the inferior bulbar conjunctiva of both eyes. Although CCH is a common cause of ocular irritation and discomfort, especially in the elderly, it is often overlooked in clinical practice. CCH may be associated with various ocular and nonocular conditions; however, the most important risk factor is aging. Although often asymptomatic, CCH may cause symptoms related to tear film instability and/or delayed tear clearance. Pathogenesis of CCH remains largely unknown but may involve different elements such as aged conjunctiva, unstable tear film, mechanical friction, ocular surface inflammation, and delayed tear clearance. Contradictory results have been reported on histopathologic changes in CCH, with some studies showing a normal microscopic structure. For symptomatic CCH, medical treatment may include lubrication and anti-inflammatory medications. For symptomatic patients who fail to respond to medical treatment, a surgical procedure may be considered. Although various surgical procedures have been used for CCH, more often, it consists of conjunctival cauterization or excision of the redundant conjunctiva, with or without amniotic membrane transplantation.
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Gan JY, Li QS, Zhang ZY, Zhang W, Zhang XR. The role of elastic fibers in pathogenesis of conjunctivochalasis. Int J Ophthalmol 2017; 10:1465-1473. [PMID: 28944209 DOI: 10.18240/ijo.2017.09.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/23/2017] [Indexed: 11/23/2022] Open
Abstract
The PubMed, MEDLINE databases and China National Knowledge Infrastructure (CNKI) were searched for information regarding the etiology and pathogenesis of conjunctivochalasis (CCh) and the synthesis and degradation of elastic fibers. After analysis of the literature, we found elastic fibers was a complex protein molecule from the structure and composition; the degradation of elastic fibers was one of the histopathological features of the disease; the vast majority of the factors related to the pathogenesis of CCh ultimately pointed to abnormal elastic fibers. By reasonably speculating, we considered that abnormal elastic fibers cause the conjunctival relaxation. In conclusion, we hypothesize that elastic fibers play an important role in the pathogenesis of CCh. Studies on the mechanism of synthesis, degradation of elastic fibers are helpful to clarify the pathogenesis of the disease and to find effective treatment methods.
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Affiliation(s)
- Jing-Yun Gan
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Qing-Song Li
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Zhen-Yong Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Wei Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Xing-Ru Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
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Nassiri N, Rodriguez Torres Y, Meyer Z, Beyer MA, Vellaichamy G, Dhaliwal AS, Chungfat N, Hwang FS. Current and emerging therapy of dry eye disease. Part A: pharmacological modalities. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1327350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nariman Nassiri
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Yasaira Rodriguez Torres
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Zachary Meyer
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Michael A. Beyer
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Gautham Vellaichamy
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Amar S. Dhaliwal
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Neil Chungfat
- Department of Ophthalmology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Frank S. Hwang
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
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