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Ciprandi G, Bonini S, Schiavetti I, Damiani V. A combined treatment for patients with dry eye and associated laryngopharyngeal reflux: a real-life approach. Int J Ophthalmol 2023; 16:1616-1622. [PMID: 37854363 PMCID: PMC10559018 DOI: 10.18240/ijo.2023.10.09] [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: 06/07/2023] [Accepted: 07/25/2023] [Indexed: 10/20/2023] Open
Abstract
AIM To evaluate the efficacy and tolerability of administering a combined therapy in patients with dry eye syndrome (DES) and associated laryngopharyngeal reflux (LPR). METHODS The study was retrospective, open, observational, and conducted in a real-life setting. Patients had pathological symptom assessment in dry eye (SANDE) and reflux symptom index (RSI) at baseline. Patients were re-assessed after 1mo and at the end of treatment. The treatment consisted of a three-month course based on the combined therapy: Gastroftal eye drops, one drop three times a day, and Gastroftal tablets, two tablets after lunch and two tablets after dinner. Tear break-up-time (TBUT) test, Schirmer test, RSI, and SANDE questionnaire were evaluated. RESULTS The study included 253 patients. The mean age was 58±11.19y. TBUT test score and Schirmer's test significantly increased (both P<0.001) after 1mo and at the end of treatment. The RSI score and SANDE scores significantly decreased (both P<0.001) after 1mo and at the end of treatment. CONCLUSION The current, retrospective, and open study shows that combined therapy using Gastroftal eye drops and tablets could represent a valuable option in managing patients with DES associated with LPR.
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Affiliation(s)
- Giorgio Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Genoa 16145, Italy
| | - Stefano Bonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome 00100, Italy
| | - Irene Schiavetti
- Health Science Department, University of Genoa, Genoa 16142, Italy
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Bonini S, Di Zazzo A, Surico PL, Balzamino BO, Luccarelli V, Niutta M, Coassin M, Micera A. Inflammation and Dry Eye-like Symptoms as Concomitant Manifestations of Laryngo-Pharyngeal Reflux. Curr Eye Res 2023:1-7. [PMID: 37092761 DOI: 10.1080/02713683.2023.2207210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE Laryngo-pharyngeal reflux (LPR) is a common worldwide disease. LPR symptoms may involve distant organs and tissues including the ocular surface with manifestations of a Dry Eye-like disease. We evaluated the concomitant involvement of the ocular surface in patients with LPR. We also defined the clinical signs and the roles of chemical and neuro-inflammatory mediators in the tears of LPR patients. METHODS Seventy-seven patients with LPR (mean age 65.8 ± 16.8 SD) and 25 healthy controls (mean age 56.5 ± 16.3 SD) were recruited from the otorhinolaryngology unit. Each subject was evaluated for the presence of concomitant ocular surface disease through clinical examination, including the measurement of tear break-up time (TBUT) and the Ocular Surface Disease Index (OSDI) questionnaire. Tears and conjunctival imprints were collected. The presence of pepsin in tears was detected by ELISA. HLA-DR in conjunctival imprints were imaged by immunofluorescence microscopy. RT-PCR quantified conjunctival mRNA transcripts of HLA-DR, IL-8, MUC5AC, NADPH, VIP, and NPY. RESULTS Patients with LPR had significantly increased OSDI and reduced TBUT scores compared to control subjects (p < 0.05 each). Pepsin was detected in 51% of patient tears while it was not measurable in the controls (p < 0.01). Immunoreactivity for HLA-DR in the conjunctival impressions was greater than for the controls with an increased mRNA expression (p < 0.05). mRNA transcripts for IL-8, NADPH, and VIP were significantly increased in LPR patients (p < 0.05 each), but neither MUC5AC nor NPY were different from controls. CONCLUSIONS LPR can adversely affect the ocular surface, leading to moderate signs and symptoms of dry eye. This study provides evidence that the presence of pepsin, HLA-DR immunoreactivity, and increased mRNA expression of neuro-inflammatory markers in the tears and conjunctival imprints of LPR patients suggests a potential link between LPR inflammation and ocular surface disease.
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Affiliation(s)
- Stefano Bonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Pier Luigi Surico
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Bijorn Omar Balzamino
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences; Research Laboratories in Ophthalmology, IRCCS - Fondazione Bietti, Rome, Italy
| | - Vitaliana Luccarelli
- Otorhinolaryngology (ENT) Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Matteo Niutta
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences; Research Laboratories in Ophthalmology, IRCCS - Fondazione Bietti, Rome, Italy
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"All that glitters is not gold": sialomegaly, xerostomia, and dry eye is not always Sjögren's syndrome. Reumatologia 2021; 59:346-352. [PMID: 34819710 PMCID: PMC8609384 DOI: 10.5114/reum.2021.110321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/02/2021] [Indexed: 11/17/2022] Open
Abstract
Although dry mouth, dry eye, and swollen salivary glands are the hallmark manifestations of Sjögren's syndrome (pSS), a wide spectrum of other conditions should be considered for differential diagnosis. The diagnostic challenge is mainly encountered in patients presenting with dry eyes and/or dry mouth, who do not meet the full established classification criteria for pSS. Presented case-based review highlights the relationship between dry eye, parotid swelling, and psychiatric disorders. The obsessive-compulsive disorder may be separately be a cause of dryness symptoms even were not using any psychiatric drugs. The presented review widely discussed this problem and the aim is to shed new light on the interpretation of the dryness symptom and the necessity of individual patient assessment, excluding causes other than pSS before making a final diagnosis and making a decision on the treatment method.
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Dolar-Szczasny J, Toro MD, Dworzańska A, Wójtowicz T, Korona-Glowniak I, Sawicki R, Boguszewska A, Polz-Dacewicz M, Tomasiewicz K, Załuska W, Rejdak R, Bagnoli P, Rusciano D. Ocular Involvement of SARS-CoV-2 in a Polish Cohort of COVID-19-Positive Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2916. [PMID: 33809199 PMCID: PMC8001647 DOI: 10.3390/ijerph18062916] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/25/2022]
Abstract
The coronavirus SARS-CoV-2 responsible for the current human COVID-19 pandemic has shown tropism toward different organs with variable efficiency, eyes included. The purpose of this study has been to investigate the presence of detectable SARS-CoV-2 infection in ocular swabs in patients affected by COVID-19. A consecutive series of 74 COVID-19-positive patients (age 21-89) were enrolled at two Polish COVID-19 hospitals for 4 months and were characterized by PCR for the presence of the SARS-CoV-2 genetic material in nasopharyngeal (NP) and ocular swabs, while their respiratory and ocular symptoms were noted. Almost 50% of them presented with severe/critical respiratory involvement, and some degree of eye disease. No tight correlation was observed between the presence of ocular and respiratory symptoms. Three male patients presenting with severe/critical lung disease tested positive in ocular swab, however with mild/moderate ocular symptoms. In conclusion, our study lends further support to the view that overt ocular infection by the SARS-CoV-2 virus is not such a frequent occurrence.
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Affiliation(s)
- Joanna Dolar-Szczasny
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (J.D.-S.); (M.D.T.); (R.R.)
| | - Mario D. Toro
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (J.D.-S.); (M.D.T.); (R.R.)
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland
| | - Anna Dworzańska
- Department of Infectious Diseases, Medical University of Lublin, 20-059 Lublin, Poland; (A.D.); (K.T.)
| | - Tomasz Wójtowicz
- Department of Ophthalmology, Specialist Hospital of Radom, 26-610 Radom, Poland;
| | - Izabela Korona-Glowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Rafał Sawicki
- Department of Biochemistry and Biotechnology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Anastazja Boguszewska
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-059 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Małgorzata Polz-Dacewicz
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-059 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Krzysztof Tomasiewicz
- Department of Infectious Diseases, Medical University of Lublin, 20-059 Lublin, Poland; (A.D.); (K.T.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (J.D.-S.); (M.D.T.); (R.R.)
| | - Paola Bagnoli
- Department of Biology, University of Pisa, 56126 Pisa, Italy;
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Plateroti R, Sacchetti M, Magliulo G, Plateroti AM, Pace A, Moramarco A, Lambiase A, Bruscolini A. Evidence of Pepsin-Related Ocular Surface Damage and Dry Eye (PROD Syndrome) in Patients with Laryngopharyngeal Reflux. Life (Basel) 2020; 10:life10090202. [PMID: 32942541 PMCID: PMC7554736 DOI: 10.3390/life10090202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background: patients with laryngopharyngeal reflux (LPR) showed detectable levels of tear pepsin that explain the nasolacrimal obstruction. The purpose of this study was to determine whether patients with LPR show ocular surface changes and to investigate the relationship between lacrimal pepsin concentration and ocular alterations. Methods: Fifty patients with positive endoscopic signs for LPR and an equal or higher score of 13 and 7 for Reflux Symptom Index and Reflux Finding Score were enrolled. Twenty healthy patients with no reflux disease and dry eye were included as the control group. After evaluation of ocular discomfort symptoms, the tear break-up time test, corneal staining, and tear sampling were performed. Tear pepsin levels were measured using Pep-testTM kit. Results: Patients with LPR showed ocular surface changes including epithelial damage (48%) and impairment of lacrimal function (72%). Tear pepsin levels were detectable in 32 out of 50 (64%) patients with LPR (mean ± SD: 55.4 ± 67.5 ng/mL) and in none of the control subjects. Most of the LPR patients complained of ocular discomfort symptoms, including itching (38%), redness (56%), or foreign body sensation (40%). Tear pepsin levels were significantly correlated with the severity of LPR disease and with ocular surface changes. Conclusions: A multidisciplinary approach, including ophthalmological evaluation, should be considered in order to improve the management of patients with LPR.
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Affiliation(s)
- Rocco Plateroti
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (R.P.); (M.S.); (G.M.); (A.P.); (A.M.); (A.B.)
| | - Marta Sacchetti
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (R.P.); (M.S.); (G.M.); (A.P.); (A.M.); (A.B.)
| | - Giuseppe Magliulo
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (R.P.); (M.S.); (G.M.); (A.P.); (A.M.); (A.B.)
| | - Andrea Maria Plateroti
- NESMOS Department, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy;
| | - Annalisa Pace
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (R.P.); (M.S.); (G.M.); (A.P.); (A.M.); (A.B.)
| | - Antonietta Moramarco
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (R.P.); (M.S.); (G.M.); (A.P.); (A.M.); (A.B.)
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (R.P.); (M.S.); (G.M.); (A.P.); (A.M.); (A.B.)
- Correspondence: ; Tel.: +39-06-4997-5300
| | - Alice Bruscolini
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (R.P.); (M.S.); (G.M.); (A.P.); (A.M.); (A.B.)
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Balestrazzi A, Passali GC, Passali D, Damiani V, Ciprandi G, Balestrazzi E. A new therapeutic approach for the Dry Eye Syndrome in patients with laryngopharyngeal reflux: first data. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:36-42. [PMID: 32073559 PMCID: PMC7947740 DOI: 10.23750/abm.v91i1-s.9250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 11/04/2022]
Abstract
Laryngopharyngeal reflux (LPR) is a common disorder. Pepsin has been detected also at eye level, this was a starting point for newest theories about LPR impact on Dry Eye Syndrome. The current preliminary study compared two treatments in patients with Dry Eye Syndrome and LPR. Patients were treated with Gastroftal eye drops and Gastroftal tablets or hyaluronic acid eye drops for 3 months. The following parameters were evaluated: Ocular Surface Disease Index (OSDI), OSDI categories, Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Fluorescein Tear Breakup Time (B-TUT), and Schirmer test before and after treatment. On the whole, 21 patients were enrolled: 10 were treated with hyaluronic acid Atlantis (Group A) and 11 with Gastroftal eye drops and tablets (Group B). After treatment, in Group A only OSDI significantly diminished (p=0.029); in Group B there were significant reductions concerning OSDI (p=0.0277), OSDI categories (p=0.0211), RSI (p=0.0172), Schirmer test (p=0.0172), T-BUT (p=0.0265), and RFS (p=0.0205). The current preliminary demonstrated that the combined ocular and systemic therapy with hyaluronic acid, Magnesium alginate, Simethicone, and Camelia sinensis may be considered a promising treatment in patients with Dry Eye Syndrome due to LPR.
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