Dry eye disease: identification and therapeutic strategies for primary care clinicians and clinical specialists

Rodent models for dry eye syndrome (DES)

Dry eye syndrome (DES) is a range of ophthalmic conditions characterized by compromised tear film homeostasis, resulting from various pathological factors and primarily manifesting as ocular discomfort and impaired ocular surface integrity. With the rise in screen time due to modern lifestyles, the prevalence of DES is increasing annually, posing a significant global public health challenge. Pathophysiologically, DES involves damage to the lacrimal functional unit (LFU), including the lacrimal glands, meibomian glands, and corneoconjunctival epithelium, highlighting its multifactorial etiology. Current treatments mainly focus on artificial tears for moisture replacement and anti-inflammatory therapies, but both are limited. Consequently, animal models are crucial for understanding the complex pathological mechanisms of DES and identifying potential therapeutic agents. Rodent eyes, with their structural and physiological similarities to human eyes and cost-effectiveness, have become widely used in DES research. This manuscript reviews the current understanding of DES pathogenesis and rodent models, discussing their strengths, weaknesses, and relevant genetic models. The aim is to furnish critical insights and provide a scholarly resource to propel future investigative endeavors into the pathogenesis of and therapy for DES.

Is Botulinum toxin A effective in treating dry eye disease? A systematic review and meta-analysis

Dry eye disease (DED) is a complex condition characterized by tear film instability, inflammation, and neurosensory abnormalities. The efficacy of Botulinum toxin A (BTX-A) in treating DED is unknown. A systematic search was conducted across PubMed, the Cochrane Library, Scopus, Web of Science, and Embase databases for studies published until December 2024. Inclusion criteria encompassed randomized controlled trials (RCTs) and non-RCTs examining BTX-A's effects on DED, with TBUT, Schirmer test scores, tear meniscus height (TMH), and OSDI as primary outcomes. Data were synthesized using fixed and random-effects models, accounting for heterogeneity. Fourteen studies (total n = 634 patients) were included. This meta-analysis evaluates the effectiveness of BTX-A in improving outcomes for DED. In 10 studies with 513 participants, BTX-A significantly improved TBUT by 1.79 s (95% CI: 1.48 to 2.10, p < 0.00001), Schirmer test scores by 3.72 mm (95% CI: 3.50 to 3.95, p < 0.00001), and OSDI scores by -7.51 (95% CI: -10.76 to -4.26, p < 0.00001). TMH increased by 0.10 mm (95% CI: 0.08 to 0.11, p < 0.00001). This meta-analysis demonstrates that BTX-A effectively improves clinical outcomes in DED. Post-treatment, TBUT increased by 1.79 s, Schirmer test scores improved by 3.72 mm, OSDI scores decreased by -7.51 points, and TMH increased by 0.10 mm, reflecting enhanced tear stability, production, and symptom relief. These findings support the use of BTX-A in clinical practice as a promising treatment for DED.

Proteomics analysis of the mechanism of the treatment of corneal injury in dry-eye mice

Dry eye disease (DED) is a common ocular surface disorder affecting millions globally. Clinical and experimental studies have shown that the traditional Chinese medicine formula Qingxuan Runmu Yin decoction (QXRMY) is effective in treating DED. This study aimed to explore the molecular mechanisms of corneal damage in DED and evaluate QXRMY's therapeutic effects. A total of 120 C57BL/6 mice were divided into control, DED model, and QXRMY treatment groups. DIA sequencing of corneal tissue identified 2411 differentially expressed proteins. Enrichment analysis revealed these proteins were involved in RNA polymerase II regulation, apoptosis, and protein phosphorylation. KEGG pathway analysis highlighted key roles of the PI3K/AKT, HIF-1 signaling pathways, and cytoskeleton regulation in QXRMY's effects. FL, BUT, Schirmer I tests, HE, and PAS staining confirmed corneal damage in DED and the repair effects of QXRMY. ELISA showed QXRMY significantly reduced IL-1β, IL-6, and TNF-α levels, suggesting anti-inflammatory properties. PCR and Western blot further confirmed QXRMY repairs corneal damage via the PI3K/AKT/HIF1α pathway. This study provides new insights into the pathogenesis of DED and supports QXRMY's therapeutic potential in treating DED by alleviating inflammation and promoting corneal repair.

MicroRNAs in Corneal Diseases: Emerging Roles as Biomarkers, Regulators, and Therapeutics

MicroRNAs (miRNAs) are conserved, short, non-coding RNAs that play a crucial role in regulating gene expression. Emerging evidence suggests that miRNAs are closely involved in the pathophysiology of various corneal diseases, particularly in regulating corneal wound healing, inflammation and neovascularization. In this review, we summarized the recent progress of miRNAs in corneal diseases, especially focused on their application as diagnostic biomarkers, regulators of cell biology, and therapeutic targets. Recent advances in miRNA detection technology have made it possible to analyze minimal miRNAs in samples such as tears or exosomes, further enhancing the ability to identify disease-specific miRNA profiles and providing potential objective indicators for the early diagnosis of disease. Meanwhile, we summarized the mechanisms and pathways of multiple miRNAs in regulating various biological processes of corneal cells, as well as the advantages of studying miRNA compared to proteins or genes. Furthermore, we explore the potential of miRNAs-based therapies, especially introduce various miRNA delivery systems and challenges associated with clinical translation. This review highlights the need for further research to harness the full potential of miRNAs in treating various corneal diseases.

How effective and safe are punctal plugs in treating dry eye disease? A systematic review and meta-analysis

BACKGROUND

Dry eye disease (DED) is a common multifactorial condition characterized by tear film instability and ocular discomfort, often treated with punctal plugs to enhance tear retention. Despite their widespread use, the efficacy, safety, and retention profiles of punctal plugs require comprehensive evaluation.

OBJECTIVES

To assess the effectiveness and safety of punctal plugs in managing DED, focusing on tear film stability, tear production, symptom relief, ocular surface integrity, and plug retention rates.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines and was registered on PROSPERO (CRD42024559417). The search strategy included PubMed, Cochrane Library, Scopus, Web of Science, and Embase for studies published up to January 2025, including randomized controlled trials (RCTs) and cohort studies. Eligible studies involved adults with DED treated with punctal plugs, reporting outcomes such as tear break-up time (TBUT), Schirmer's test, Ocular Surface Disease Index (OSDI) scores, fluorescein and Rose Bengal staining, and retention rates. Data were pooled using fixed- or random-effects models based on heterogeneity (I2 statistic). Risk of bias was assessed with Cochrane RoB2 (RCTs) and ROBINS-I (non-RCTs) tools, and publication bias was evaluated using Begg's and Egger's tests.

RESULTS

Seventeen studies (1,658patients) were included. Punctal plugs significantly improved TBUT (mean difference (MD): 1.8 s; 95 % CI: 1.8-1.9; p < 0.001), Schirmer's test scores (MD: 3.1 mm; 95 % CI: 3.1-3.2; p < 0.001), OSDI scores (MD: -20.6; 95 % CI: -21.3 to -19.9; p < 0.001), fluorescein staining (MD: -1.79; 95 % CI: -1.82 to -1.76; p < 0.001), and Rose Bengal staining (MD: -0.7; 95 % CI: -0.79 to -0.67; p < 0.001). Retention rates were high of 86 % (logit: 1.78; 95 % CI: 1.62-1.94) with smart plug showing high retention of 97.3 %. Heterogeneity was low (I2 = 0-24.1 %) across most outcomes. Evidence was moderate to high, supported by RCTs, though some cohort studies exhibited moderate bias in confounding, selection, and outcome measurement. Publication bias was minimal.

CONCLUSIONS

Punctal plugs are an effective and safe treatment for moderate-to-severe DED, significantly improving tear film stability, tear production, symptoms, and ocular surface health, with high retention rates. Low heterogeneity and minimal publication bias strengthen these findings, though moderate bias in some non-RCTs suggests caution. Future research should refine plug designs and address methodological limitations to optimize outcomes.

Delayed effects of the relative humidity on the outpatient visits of dry eye disease in Shanghai, China: effect modification by green and blue space

Background

Few studies have examined the influence of relative humidity (RH) on dry eye disease (DED), particularly in the context of the urban environment. The objective of this study was to investigate the influence of RH on the frequency of outpatient visits for DED among patients residing in diverse urban settings.

Methods

Data pertaining to outpatient visits, together with data on the DED, meteorological factors and air pollutants in Shanghai for the period 2019-2023, were retrieved. To analyse the nonlinear connection and lag impact between RH and outpatient visits for DED patients, a distributed lag nonlinear model (DLNM) was fitted.

Results

A total of 159 832 cases were utilised for the investigation. The results of the single-day lag pattern demonstrated a significant correlation between elevated RH exposure and DED. Lower RH was a substantial risk factor for DED on the basis of the cumulative-day effect pattern. Male were more susceptible to DED, and patients aged 0-18 years presented more stable performance in response to RH influences. In the cumulative-day lag pattern, the green space groups, the RR of the >60 years subgroup was greater than that of the other subgroups, and in the blue space groups, the RR of the 19-60 subgroup of blue space low was higher than that of the blue space high.

Conclusions

Reduced RH increases the relative risk of DED outpatient visits and suggests that a specific disease burden is associated with low RH exposure. Additionally, green and blue spaces in urban areas influence RH, which in turn affects the outpatient visits of DED at different ages.

Advances in the application of gelatin-based materials in anterior segment diseases

Anterior segment diseases are among the most common ocular conditions, severely impacting individuals' visual health. Additionally, due to the barrier functions of the anterior segment tissues, traditional treatment methods often suffer from low efficiency and significant side effects, presenting urgent challenges that need to be addressed. Gelatin inherently possesses excellent biocompatibility and biodegradability, and when combined with its unique cell adhesion sequences and the ability to flexibly modulate mechanical and optical properties through physical and chemical modifications, it demonstrates tremendous potential in anterior segment tissue engineering and drug delivery applications. Compared to conventional surgical and eye drop therapies, gelatin-based materials can reduce the risk of complications, enhance drug bioavailability, extend drug retention time, and achieve personalized and precise treatment for various anterior segment diseases through technologies such as 3D bioprinting. However, gelatin-based materials have limitations, including low mechanical strength and thermal stability. Therefore, this paper focuses on recent research regarding the application of gelatin-based materials in anterior segment diseases, systematically summarizing their advantages in treatment, the challenges they face, and their developmental potential.

Safety and Efficacy of 0.1% Cyclosporine Solutions in Dry Eye Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Purpose: Cyclosporine A (CsA) is a primary treatment for dry eye disease (DED). Ophthalmic solutions containing CsA are available in concentrations of 0.05%, 0.09%, and 0.1%. While 0.1% CsA solutions have been used to treat DED, their safety and effectiveness remains somewhat uncertain. Therefore, we conducted a meta-analysis to evaluate their safety and efficacy. Methods: We searched PubMed, Cochrane Database, Embase, and Web of Science for randomized controlled trials (RCTs) that compared 0.1% CsA solutions with their vehicle. Statistical analysis was performed using Review Manager 5.4.1. Results: We included six RCTs (2,170 patients) with follow-up periods ranging from 4 weeks to 6 months. A total of 1,119 patients (51.56%) with DED were treated with 0.1% CsA. The mean age of patients was 57.9 ± 4.8 years, with 79.7% being female. The total corneal fluorescein staining (tCFS) at last follow-up [mean differences (MD) -0.49; 95% confidence interval (CI) (-0.73, -0.24); P < 0.0001], at 4 weeks [MD -0.64; 95% CI (-1.07, -0.22); P = 0.003], and central corneal fluorescein staining (cCFS) [MD -0.19; 95% CI (-0.35, -0.03); P = 0.02] scores were lower in patients treated with 0.1% CsA compared with vehicle. The Lissamine Green conjunctival staining (LGCS) [MD -0.51; 95% CI (-0.78, -0.24); P = 0.0002] and ocular surface disease index (OSDI) scores [MD -3.04; 95% CI (-5.84, -0.23); P = 0.03] were lower in the 0.1% CsA group compared with vehicle. Adverse events associated with 0.1% CsA solution in the treatment of DED varied across studies, but were generally mild to moderate. Notably, similar events were also significantly present in the vehicle group, supporting the safety profile of this treatment. Conclusion: Ophthalmic 0.1% CsA seems safe for treating DED, and significantly reduced tCFS, cCFS, LGCS, and OSDI scores compared with vehicle solutions.

Experiences and Perceptions of Chinese Elderly Dry Eye Patients Seeking Health Behavior Management: A Qualitative Study Based on a Health Belief Model

Aim

This study aims to explore the life experiences and health behavior management experiences of elderly patients with dry eye disease, and to provide a reference for improving the health status of patients with dry eye disease.

Methods

A qualitative phenomenological design was employed to collect data from 16 dry eye patients who visited the eye clinic of a tertiary hospital in Shanghai, China, from October to December 2024, by conducting face-to-face semi-structured interviews, and analyzing the data using the Colaizzi 7-step analysis method. Interviews were transcribed verbatim, and themes were coded and extracted using NVivo 14.0.

Results

The participants, aged between 60 and 78 years, mostly had mild to moderate levels of dry eye. Based on the theoretical model of the Health Belief Model, five main themes and eleven sub-themes were summarized from the analysis: (a) Perceived threat of disease (Perceived severity, Perceived susceptibility); (b) Perceived benefits (Perceived sense of gain, Improved quality of life); (c) Perceived barriers (Lack of willingness to manage behavior, Insufficient intrinsic motivation, Cognitive misconceptions); (d) Low self-efficacy (Lack of confidence in responding, Negative coping style); (e) Perception of behavioral cues (Lack of external support, Perception of self-management).

Conclusion

This study found an interaction between reduced threat perception and inadequate health behavior management in elderly dry eye patients, and future research is needed to develop more specific and feasible intervention programs to encourage patients to move from passive treatment to active management.

Short-Term Changes in Tear Film Stability and Tear Volume Following the Application of Various DED Management Options in a Healthy Young Population

Background: To determine short-term changes in tear film volume and stability after various treatments for dry eye disease in healthy participants. Methods: 36 healthy participants aged from 18 to 35 years were recruited for a single-session examination and randomly assigned to one of three treatment groups (1:1:1 treatment, 1:1 eye): Group 1 (artificial tears 'Comfort Drops'), Group 2 (eyelid wipes 'Systane Lid Wipes'), and Group 3 (ocular bath 'Acuaiss'). Tear Meniscus Height (TMH) was assessed at baseline, 2, 5, 10, 15, and 20 min, and Non-Invasive Break-Up Time (NIBUT) at baseline, 2, 10, and 20 min, all using the OCULUS Keratograph 5M by one examiner. Results: Of the initially recruited participants, 35 were analyzed; one was excluded for reflex tearing. Group 1 (n = 12) showed a significant TMH increase at 2 min compared to 10 and 20 min (Friedman, p = 0.004; Bonferroni, p ≤ 0.028). Group 3 (n = 12) showed a significant increase at 2 and 5 min compared to baseline and decrease at 10 min against 2 and 5 min (Friedman, p < 0.001; Bonferroni, p ≤ 0.034). Group 2 (n = 11) showed no significant changes over time (Friedman, p = 0.108). NIBUT showed no significant differences at any time-point in any group (Friedman, p ≥ 0.231). Basal TMH differed between groups (ANOVA, p = 0.048), but post hoc analysis found no significance (Bonferroni, all p ≥ 0.088). No significant differences in TMH at other time-points (Kruskal-Wallis/ANOVA, p ≥ 0.265) or in NIBUT between groups (Kruskal-Wallis/ANOVA, p = 0.108) were found. Conclusions: In healthy participants, artificial tears and ocular baths temporarily increase TMH, while eyelid wipes do not. Neither has an immediate impact on NIBUT.

A first-in-human, prospective pilot trial of umbilical cord-derived mesenchymal stem cell eye drops therapy for patients with refractory non-Sjögren's and Sjögren's syndrome dry eye disease

BACKGROUND

Patients with refractory dry eye disease (DED) often face the threat of diminished visual quality and have limited responses to existing treatments. Ocular injection of Mesenchymal stem cells (MSCs) has recently emerged as a promising new therapeutic strategy for DED. Topical eye drops are the clinical favorable choice for drug administration in DED. To date, the clinical use of MSC eye drops has not been reported in settings. This clinical trial represents a groundbreaking exploration into the preliminary therapeutic potential and safety of umbilical cord MSC eye drops for patients with refractory DED, including both non-Sjögren's dry eye (NSDE) and Sjögren's syndrome dry eye (SSDE). The study also aimed to investigate the possible underlying mechanisms.

METHODS

In this open-label, prospective, single-arm, self-controlled trial, 11 NSDE and 5 SSDE patients received twice-daily MSC eye drops for two weeks, subsequent follow-up visits were scheduled at 4 weeks and 12 months after treatment. The primary efficacy was evaluated using the ocular surface disease index (OSDI) score, tear meniscus height (TMH), non-invasive break-up time (NIBUT), Schirmer I test (SIT), and corneal fluorescein staining (CFS) score. Secondary assessments focused on the evaluation of lipid layer, meibomian gland function, and bulbar conjunctival redness. Safety was monitored by recording adverse events (AEs) throughout the study. Changes in tear levels of interleukin-6 (IL-6), IL-17A, Mucin 5AC (MUC5AC), C-C chemokine ligand 20 (CCL20) and IL-23, along with proteomic alterations, were compared between baseline and T-week2.

RESULTS

Significant clinical improvements were observed in most symptoms and signs following MSC eye drops treatment in both NSDE and SSDE patients, particularly in tear production as measured by SIT and TMH, and the alleviation of meibomian gland blockage. The therapeutic effect on OSDI, NIBUT, and the lipid layer was more pronounced in NSDE patients compared to SSDE. No serious AEs were reported during the treatment and follow-up period. Post-treatment reductions in tear levels of IL-6 and IL-17A, along with an increase in MUC5AC, further confirmed the efficacy. Tear proteomic analysis indicated that the efficacy of MSC eye drops is associated with the inhibition of inflammation caused by T helper 17 (Th17) cells in both NSDE and SSDE groups.

CONCLUSIONS

In this prospective exploratory clinical study, we have demonstrated that MSC eye drops might offer clinical efficacy and manageable safety in treating refractory DED for the first time, potentially bringing a new perspective on the treatment of such patients. Our research represents a preliminary exploratory endeavor, paving the way for future large-scale randomized positive-controlled trials.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05784519. Registered 28 February 2023, https://clinicaltrials.gov/study/NCT05784519 .

Patients' knowledge, attitudes, and practices regarding lifestyle related dry eye

Rising incidences of dry eye, often attributed to modern lifestyle and environmental factors, highlight the need for knowledge, attitudes, and practices (KAP) studies to inform tailored interventions. This study evaluated patients' KAP concerning lifestyle-related dry eye at the Ophthalmology Hospital of the China Academy of Chinese Medical Sciences from July 1 to July 26, 2024. A self-designed questionnaire was used to gather demographic data and assess KAP scores, yielding 556 valid responses (98.93%). Among participants, 342 (61.51%) were female, with a mean age of 39.26 ± 13.56 years. Mean KAP scores were 7.44 ± 4.65 (knowledge), 35.20 ± 4.10 (attitude), and 35.77 ± 6.15 (practice). Mediation analysis indicated direct influences of age and familial dry eye history on knowledge, with knowledge impacting attitude, and various factors influencing practice. While patients exhibited limited knowledge, they generally held positive attitudes and engaged in proactive practices. Enhancing patient education on lifestyle factors related to dry eye is essential to boost knowledge and foster effective prevention and management strategies.

A novel Schirmer strip-based tear matrix metalloproteinase measurement in dry eye evaluation

PURPOSE

The diagnosis and evaluation of dry eye require easy-to-use, precise, and consistent tools in clinical setting. Matrix metalloproteinase 9 (MMP-9) has been proven to be a reliable indicator of dry eye inflammation. The aim of this study is to establish an Eu-time resolved fluorescence immunochromatography (Eu-TRFICO) method for quantitative detection of MMP-9 in human tear based upon widely used Schirmer strips.

METHODS

The Eu-TRFICO method for Schirmer strip-based tear MMP-9 measurements were optimized and assembled. The sensitivity, repeatability and homogeneity were evaluated using MMP-9 standard dilutions. The diagnostic and treatment monitoring performance were evaluated in both dry eye patients and normal subjects.

RESULTS

The standard curve equation was y = 0.0037 + 8.0692/[1+ (x/188.322)-0.8972] (R2 = 0.99998), and the sensitivity was 0.25 ng/mL. The Schirmer strip-based MMP-9 measurements showed acceptable repeatability and homogeneity with different saturation length in both low and high standard solutions. A total of 162 participants (162 eyes) were enrolled in this study, including 41 normal and 121 dry eye subjects. This method exhibited a sensitivity of 74.17 % and specificity of 77.5 % for dry eye diagnosis, with an AUC value of 0.8275, and cutoff value of 150.67 ng/mL, using normal subjects as negative control. The tear MMP-9 concentrations monitored with this method correlated well with the therapeutic response in dry eye patients.

CONCLUSIONS

This study developed Eu-TRFICO Schirmer strips with high sensitivity, specificity, precision, and satisfactory clinical testing performance, which provides a convenient and quantitative option for clinical testing of tear MMP-9 in dry eye patients.

Performance and Safety of a Sodium Hyaluronate, Xanthan Gum, and Osmoprotectants Ophthalmic Solution in the Treatment of Dry Eye Disease: An Observational Clinical Investigation

INTRODUCTION

Dry eye disease (DED) is characterized by an imbalance in the tear film, resulting in symptoms such as dryness, redness, and discomfort. The management of DED involves tear supplements, medications, or surgery in severe cases. To evaluate the clinical performance and safety of a hypotonic ophthalmic solution containing sodium hyaluronate 0.2%, xanthan gum 0.2%, and osmoprotectants (glycine and betaine) for treating DED.

METHODS

This multicenter, prospective, observational clinical investigation included 35 subjects treated with one drop of the ophthalmic solution four times daily. Evaluations were conducted at baseline, on day 14, and at 1 and 3 months. The investigation assessed corneal and conjunctival fluorescein staining (NEI score), hyperemia index (Keratograph®), fluorescein tear film break-up time (TFBUT), best-corrected visual acuity, dry eye symptoms (SANDE), and quality of life (DEQS). Safety was monitored through adverse events, intraocular pressure measurements, and the Investigator Global Assessment of Safety.

RESULTS

Subjects were predominantly female (93.9%), with an average age of 59.9 ± 13.8 years. The ophthalmic solution significantly reduced keratitis lesions with global NEI score decreasing from baseline at 1 month (- 6.67 ± 4.6, p = 0.001) and 3 months (- 7.61 ± 4.0 points; p = 0.001). Conjunctival hyperemia improved significantly after 1 month (- 0.34 ± 0.7 points; p = 0.027), while fluorescein tear film stability increased significantly at 1 (1.85 ± 3.1 s; p = 0.002) and 3 months (1.98 ± 3.4 s; p = 0.001). Symptoms also improved significantly (p = 0.001) at 1 and 3 months (- 29.37 ± 22.2 points and - 26.41 ± 24.0 points, respectively), as did quality of life (- 20.81 ± 15.6 points at 1 month and - 18.43 ± 19.3 points at 3 months; p = 0.001 for both). The safety profile was very good, with no adverse events (only mild ocular discomfort reported in 14.3% of subjects).

CONCLUSIONS

The ophthalmic solution effectively improved DED symptoms and signs, enhancing patients' quality of life while maintaining a good safety profile.

TRIAL REGISTRATION NUMBER

NCT05778942.

Bringing ophthalmology into the scientific world: Novel nanoparticle-based strategies for ocular drug delivery

The distinctive benefits and drawbacks of various drug delivery strategies to supply corneal tissue improvement for sense organs have been the attention of studies worldwide in recent decades. Static and dynamic barriers of ocular tissue prevent foreign chemicals from entering and inhibit the active absorption of therapeutic medicines. The distribution of different medications to ocular tissue is one of the most appealing and demanding tasks for investigators in pharmacology, biomaterials, and ophthalmology, and it is critical for cornea wound healing due to the controlled release rate and increased drug bioavailability. It should be mentioned that the transport of various types of medications into the different sections of the eye, particularly the cornea, is exceedingly challenging because of its distinctive structure and various barriers throughout the eye. Nanoparticles are being studied to improve medicine delivery strategies for ocular disease. Repetitive corneal drug delivery using biodegradable nanocarriers allows a medicine to remain in different parts of the cornea for extended periods of time and thus improve administration route effectiveness. In this review, we discussed eye anatomy, ocular delivery barriers, as well as the emphasis on the biodegradable nanomaterials ranging from organic nanostructures, such as nanomicelles, polymers, liposomes, niosomes, nanowafers, nanoemulsions, nanosuspensions, nanocrystals, cubosomes, olaminosomes, hybridized NPs, dendrimers, bilosomes, solid lipid NPs, nanostructured lipid carriers, and nanofiber to organic nanomaterials like silver, gold, and mesoporous silica nanoparticles. In addition, we describe the nanotechnology-based ophthalmic medications that are presently on the market or in clinical studies. Finally, drawing on current trends and therapeutic approaches, we discuss the challenges that innovative optical drug delivery systems confront and propose future research routes. We hope that this review will serve as a source of motivation and inspiration for developing innovative ophthalmic formulations.

Responsive Microneedles for Diagnostic and Therapeutic Applications of Ocular Diseases

Traditional ophthalmic formulations are characterized by low bioavailability, short intraocular retention time, strong irritation, and failure to achieve the expected therapeutic effect due to the special physiological structure of the eye and the existence of many barriers. Microneedle drug delivery is a novel transdermal drug delivery modality. Responsive microneedles are defined as controllably releasing the drug payloads in response to physiological stimuli, including pH levels, temperature, enzymes, and reactive oxygen species (ROS), as well as external stimuli such as magnetic fields and light. In addition to inheriting the advantages of traditional microneedles, which include enhanced targeting and permeability, non-invasiveness, and painless application, the integration with stimulus-responsive materials enables responsive microneedles to achieve a personalized precision drug delivery process, which further increases the accuracy and efficiency of ocular treatments, making on-demand drug delivery possible. This article systematically reviews the classification, mechanisms, and characteristics of responsive microneedles and provides a detailed introduction to their diagnostic and therapeutic applications as well as real-time monitoring potential in ocular diseases, aiming to offer insights for the precision treatment of ocular diseases in the future.

Implications of nanotechnology for the treatment of Dry Eye Disease: Recent advances

Managing Dry Eye Disease (DED), a prevalent condition affecting the ocular surface, remains challenging despite advancements in diagnostics and therapies. Current treatments primarily involve lubricating eye drops and anti-inflammatory medications, which often require prolonged use and generally provide only symptomatic relief. The current study focuses on improving DED treatments through nano-drug delivery technologies and advanced formulations. These systems aim to address the limitations of conventional therapies by providing extended, targeted, and sustained drug release. The development of innovative nanomaterials offers improved precision, control, and customization for DED management. By enabling controlled and sustained drug release, these nano-drug delivery systems could offer longer-lasting relief, addressing the chronic nature of DED more effectively than current symptomatic therapies. Future research should focus on integrating multiple therapeutic agents within these systems to simultaneously target inflammation and tear film instability. This review examines the potential of nano-based materials for DED treatment, with a particular emphasis on lipid-based, polymer-based and polysaccharide-based systems.

Efficacy and safety of water-free topical cyclosporine for moderate to severe dry eye disease: a systematic review and meta-analysis

Background

Dry eye disease (DED) is a widely prevalent ocular symptom, with an estimated global prevalence of around 12%. The increasing prevalence of this disease among adults poses a significant morbidity burden. The aim of this study is to analyze the efficacy and safety of water-free cyclosporine, a new intervention suggested to be more effective in treating DED.

Methods

A comprehensive literature search was conducted using databases as PubMed, Cochrane, Scopus and Web of Science. Keywords used include “dry eye”, “water-free cyclosporine”, and “DED” among others. Randomized controlled trials (RCTs) evaluating the use of water-free cyclosporine in patients with dry eye disease were included.

Results

A total of 4 RCTs were included in our analysis, consisting of 1,471 participants. Primarily, efficacy outcomes were evaluated such as total and central corneal fluorescence staining score (tCFS and cCFS) and dryness score. Our secondary outcomes evaluated the safety of these drugs by considering the treatment-emergent adverse events (TEAEs) reported. Water-Free cyclosporine showed no significant improvement in tCFS (MD: -1.08; 95% CI, -3.48 to 1.32) and cCFS (MD: -0.21, 95% CI, -0.50 to 0.08). However, water free cyclosporine showed statistically and clinically significant results in improving the dryness score (MD, -7.48; 95% CI, -14.5 to -.082). Pooled analysis of total participants reporting TEAEs, ocular and serious TEAEs was not significant.

Conclusion

Our meta-analysis analyzed the safety and efficacy of water-free topical 0.1% cyclosporine eye drops for the treatment of moderate to severe DED. A significant reduction in dryness scores provides hope for further development of this drug, potentiated with the little to no significant increase in risk of adverse events. There is a need for diverse trials with a greater population to validate these results and generate rigorous evidence.

Efficacy and safety of water-free topical cyclosporine for moderate to severe dry eye disease: a systematic review and meta-analysis

BACKGROUND

Dry eye disease (DED) is a widely prevalent ocular symptom, with an estimated global prevalence of around 12%. The increasing prevalence of this disease among adults poses a significant morbidity burden. The aim of this study is to analyze the efficacy and safety of water-free cyclosporine, a new intervention suggested to be more effective in treating DED.

METHODS

A comprehensive literature search was conducted using databases as PubMed, Cochrane, Scopus and Web of Science. Keywords used include "dry eye", "water-free cyclosporine", and "DED" among others. Randomized controlled trials (RCTs) evaluating the use of water-free cyclosporine in patients with dry eye disease were included.

RESULTS

A total of 4 RCTs were included in our analysis, consisting of 1,471 participants. Primarily, efficacy outcomes were evaluated such as total and central corneal fluorescence staining score (tCFS and cCFS) and dryness score. Our secondary outcomes evaluated the safety of these drugs by considering the treatment-emergent adverse events (TEAEs) reported. Water-Free cyclosporine showed no significant improvement in tCFS (MD: -1.08; 95% CI, -3.48 to 1.32) and cCFS (MD: -0.21, 95% CI, -0.50 to 0.08). However, water free cyclosporine showed statistically and clinically significant results in improving the dryness score (MD, -7.48; 95% CI, -14.5 to -.082). Pooled analysis of total participants reporting TEAEs, ocular and serious TEAEs was not significant.

CONCLUSION

Our meta-analysis analyzed the safety and efficacy of water-free topical 0.1% cyclosporine eye drops for the treatment of moderate to severe DED. A significant reduction in dryness scores provides hope for further development of this drug, potentiated with the little to no significant increase in risk of adverse events. There is a need for diverse trials with a greater population to validate these results and generate rigorous evidence.

Overview of Dry Eye Disease for Primary Care Physicians

Dry eye disease (DED), also known as keratoconjunctivitis sicca, is a multifactorial ocular disease characterized by tear film insufficiency due to diverse etiologies including aging, incomplete and infrequent blinking, hormonal changes, medications, and systemic diseases. Classified into aqueous-deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed subtypes, DED presents with symptoms such as irritation, stinging, redness, foreign body sensation, sensitivity to light, and blurred or fluctuating vision. While rare, severe cases may lead to vision loss. With its rising global prevalence across age groups, DED poses a significant public health challenge. Primary care physicians (PCPs), often the first point of contact for DED patients, require timely screening and management strategies. This review explores the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of DED, emphasizing practical approaches for PCPs. This narrative review was conducted by searching MEDLINE, PubMed, and Google Scholar databases for relevant articles. Diagnostic approaches, including detailed history taking, patient-reported questionnaires, differential diagnosis, and assessments are discussed alongside management strategies, including symptomatic ophthalmic treatment, risk factor mitigation (e.g., reduced digital device screen time), prevention, and nutrition. By providing a synopsis of early symptoms that PCPs are often the first to encounter, practical approaches to screening and managing DED in the primary care setting, and guidelines on when to refer to specialty care, this comprehensive review aims to equip PCPs with the knowledge to improve DED screening and optimize patient outcomes.

Evodiamine Promotes Autophagy and Alleviates Oxidative Stress in Dry Eye Disease Through the p53/mTOR Pathway

Purpose

This study aims to explore the therapeutic efficacy of evodiamine (EVO) in the treatment of dry eye disease (DED).

Methods

Mouse models of DED was developed using benzalkonium chloride eye drops and subcutaneous atropine injections. Corneal epithelial defects were assessed by fluorescein sodium staining, and tear secretion was measured with the phenol red thread test. For the in vitro model, human corneal epithelial cells were cultured in a sodium chloride-enriched medium. Phenotypic and mechanistic analyses were conducted using real-time quantitative PCR, Western blotting, flow cytometry, and immunofluorescence staining.

Results

The administration of EVO eye drops significantly enhanced tear secretion in mice, ameliorated ocular surface damage, decreased the expression of corneal inflammatory factors, and increased the density of conjunctival goblet cells. Furthermore, EVO reduced oxidative stress by promoting autophagy. Mechanistically, EVO-induced autophagy was mediated via the p53/mammalian target of rapamycin pathway.

Conclusions

These findings suggest that EVO is a potential therapeutic agent for the treatment of DED, with its beneficial effects attributed to the activation of autophagy through the p53/mammalian target of rapamycin pathway.

Impact of cyclosporine A on the progression of ocular surface diseases: treatment efficacy and potential complications

Introduction. Eye diseases are widespread all over the world and, if left untreated, can lead to blindness.Hypothesis. The use of 0.05% cyclosporine A (CsA) solution for the treatment of dry eye causes a decrease in discomfort and pain and improves objective measures such as tear film breakdown time, Schirmer test results and Oxford scale scores due to its anti-inflammatory and immunomodulatory properties that contribute to improved tear film stability and tear production.Aim. This study aimed to investigate the impact of CsA on the progression of ocular surface diseases.Methodology. An experiment was conducted on the basis of the FOCUS ophthalmology centre, Kazakhstan. A group of 100 individuals diagnosed with mild to severe dry eye illness were administered 0.05% CsA eye drops as part of the treatment protocol.Results. The positive effect is explained by the anti-inflammatory and immunomodulatory effects of CsA. The study showed that the use of 0.05% CsA solution for the treatment of ocular surface disease led to a decrease in discomfort and pain, as well as an improvement in objective measures, including tear film breakdown time, Schirmer test results and Oxford scale scores. The visual analogue scale showed a significant reduction in symptoms, from 6.8 points at baseline to 3.7 points at day 60. In total, 20% of patients reported moderate side effects, such as pain during instillation and redness of the eye surface.Conclusion. It is concluded that the use of these drops reduced pain, improved patient condition and enhanced indicators such as the visual analogue scale, tear film breakup time, Schirmer test and Oxford scale of corneal and conjunctival staining. This study differs from the previous ones in that it focuses on the efficacy of 0.05% CsA solution in the treatment of dry eye and also examines the spectrum and frequency of side effects, which is not sufficiently covered in previous studies.

Exploring the immunological underpinnings of allergic conjunctivitis: the role of CD4 + T Cells and SLAM expression in ocular surface disease

BACKGROUND

Allergic conjunctivitis is a common ocular disease characterized by inflammation of the conjunctiva, often associated with environmental allergens. CD4 + T cells and signal lymphocyte activation molecule (SLAM) expression has been implicated in the pathogenesis of allergic conjunctivitis, but their roles and interactions remain unclear.

METHODS

This prospective cross-sectional observational study enrolled 100 participants, 50 with allergic conjunctivitis and 50 healthy controls, to investigate the relationship between peripheral blood CD4 + T cells, SLAM expression, and allergic conjunctivitis. Participants were evaluated using the Aston university allergy questionnaire (AUAQ), ocular surface disease index (OSDI), and dry eye questionnaire (DEQ-5). Peripheral blood mononuclear cells were isolated and analyzed for SLAM expression on CD4 + T cells using flow cytometry. Total serum IgE levels were measured using ELISA.

RESULTS

The allergic group demonstrated significantly higher AUAQ, OSDI, and DEQ-5 scores compared to the control group, indicating a more severe allergic and ocular surface disease burden. Flow cytometry analysis revealed a significant increase in SLAM expression on CD4 + T cells in the allergic group (22.6% ± 5.3%) compared to the control group (15.2% ± 4.7%) (p < 0.001). Total serum IgE levels were also significantly higher in the allergic group (255.3 ± 131.2 IU/mL) compared to the control group (36.7 ± 19.8 IU/mL) (p < 0.001). Spearman's rank correlation analysis indicated significant correlations between AUAQ and OSDI scores (R = 0.38, p < 0.001), and between TBUT and OSDI scores (R = 0.21, p = 0.008), suggesting that reduced tear film stability is associated with more severe ocular surface symptoms.

CONCLUSION

The study findings suggest a significant association between allergic symptoms, ocular surface disease, and immunological markers in individuals with allergic conjunctivitis. The increased SLAM expression on CD4 + T cells and elevated total serum IgE levels in the allergic group may play a pivotal role in the pathophysiology of allergic conjunctivitis. These insights could inform the development of targeted therapies that address both the allergic and ocular surface components of the disease, potentially improving management and outcomes for patients with allergic conjunctivitis.

Exosomes in Corneal Homeostasis and Wound Healing

PURPOSE

The cornea is a transparent avascular tissue that serves as the first line of defense against opportunistic pathogens and provides a smooth refractive surface for vision. Due to its external location, the cornea is vulnerable to stress from the outer environment. This can lead to corneal epithelial breakdown and subsequent corneal disease. Extracellular vesicles (EVs) are nano-sized vesicles enclosed within a lipid bilayer that are secreted by all cells in the body and play a key role in cell-to-cell communication. Within the cornea field, EVs and exosomes, the latter of which represents a subpopulation of small EVs, have emerged as potential therapies for treating corneal diseases and have increased our understanding of the mechanisms by which EVs, and more specifically, exosomes released by stressed or unhealthy cells, leads to corneal dysfunction and disease.

METHODS

We conducted a literature search using PubMed and Google Scholar using keywords relevant to exosomes, extracellular vesicles, and cornea. We reviewed the literature focusing on EV studies on corneal wound healing and therapy.

RESULTS

This review provides a comprehensive overview of the current state of exosome biology as it relates to corneal disease and wound healing. Studies to date provide compelling data indicating that EVs and exosomes may play an integral role in the maintenance of corneal homeostasis. EVs and exosomes also have exciting potential as therapeutics in corneal wound healing and disease; and their presence in tear fluid may serve as potential diagnostic biomarkers for ocular and systemic diseases.

CONCLUSION

While corneal exosome biology is still in its infancy state, continued progress in this area will improve our understanding of the functional capacity of these small vesicles in the human cornea and may lead to the development of novel regenerative therapies.

The Duration of Cataract Surgery and the Change in Postoperative Dry Eye Disease Parameters: A Retrospective Cohort Study

Objective: The aim of this study was to evaluate the correlation between the duration of cataract surgery and the postoperative dry eye disease (DED) parameters. Methods: A retrospective cohort study was conducted on individuals who received cataract surgery at our institution. In total, 72 and 36 eyes were split into the short and long surgery groups, respectively. The main outcomes were the postoperative tear break-up time (TBUT), the Schirmer II test result, the ocular surface staining score, the DED symptoms, and the presence of meibomian gland dysfunction (MGD). A generalized linear model was employed to compare the changes in the DED parameters between the two groups. Results: The uncorrected visual acuity (UDVA) was significantly better in the short surgery group compared to the long surgery group (p = 0.031). The latter group also demonstrated a significantly shorter TBUT and a higher ocular surface stain score compared to those of the short surgery group (both p < 0.05). The change in the TBUT and ocular surface stain score were significantly higher in the long surgery group than the short surgery group (both p < 0.05). No DED parameters were significantly associated with the postoperative UDVA in the short surgery group (all p > 0.05). However, the TBUT and the ocular surface stain score correlated with worse postoperative UDVA in the long surgery group (both p < 0.05). Conclusions: Operating on a cataract for more than 20 min correlates with a long TBUT and a poor ocular surface staining score, which could influence the postoperative UDVA.

Association between traffic-related air pollution and risk of outpatient visits for dry eye disease in a megacity along the subtropical coast in South China

BACKGROUND

Traffic-related air pollution especially in highly socioeconomically developed megacity is usually considered as a severe problem leading to inevitable adverse health outcomes. This study aimed to investigate the associations between traffic-related air pollutants with risk of dry eye disease (DED) outpatient visits in a megacity (Guangzhou) along the subtropical coast in South China.

METHODS

Daily data on DED outpatient visits and environmental variables from 1 January 2014 to 31 December 2020 in Guangzhou were obtained. A time-series study using a quasi-Poisson generalized linear model (GLM) combined with distributed lag non-linear model (DLNM) was adopted. Subgroup analyses stratified by age, gender, and season were conducted.

RESULTS

Totally, 27, 828 DED cases were identified during the study period including 2557 days. Daily number of outpatient visits for DED ranged from 0 to 41. An increase of 10 μg/m3 in PM2.5, NO2 and SO2 concentration was associated with 3.1%, 5.9% and 17.4% increase in the risk of DED outpatient visits, respectively (RRPM2.5 = 1.031, 95%CI: 1.004-1.059, lag 0-11 day; RRNO2 = 1.059, 95% CI: 1.027-1.092, lag0-14 day; RRSO2 = 1.174, 95% CI: 1.036-1.330, lag0-13 day). Subgroup analyses indicated that the effects of PM2.5 exposure on the risk of DED outpatient visits remained significant in aged < 60 years (RR max = 1.008, 95% CI: 1.003-1.013, lag0 day) and the effects of SO2 exposure on the DED outpatient visits risk remained significant in the females (RR max = 1.025, 95% CI: 1.006-1.044, lag0 day). The associations of PM2.5 (RR = 1.010, 95% CI: 1.003-1.016, lag0 day) and SO2 (RR = 1.030, 95% CI: 1.003-1.058, lag14 day) exposure with DED outpatient visits risk remained significant in warm seasons, whereas NO2 (RR = 1.006, 95% CI: 1.002-1.009, lag14 day) exposure was significantly associated with DED outpatient visits in cold seasons. The associations of PM2.5 (first visit, RR = 1.006, 95% CI: 1.001-1.011, lag0 day; re-visit, RR = 1.002, 95% CI: 1.000-1.005, lag6 day), NO2 (first visit, RR = 1.006, 95% CI: 1.001-1.012, lag0 day; re-visit, RR = 1.007, 95% CI: 1.002-1.012, lag0 day), and SO2 (first visit, RR = 1.023, 95% CI: 1.002-1.044, lag0 day; re-visit, RR = 1.023, 95% CI: 1.000-1.045, lag0 day) exposure with risk of DED outpatient visits were significant for both first- and re-visits.

CONCLUSIONS

Our study revealed that short-term exposure to PM2.5, NO2 and SO2 were positively associated with risk of DED outpatient visits, especially for the youngers, females and during warm seasons, providing evidence for making public health policy to improve life quality in developed megacity.

Applications and latest research progress of liposomes in the treatment of ocular diseases

The special structure of eyes and the existence of various physiological barriers make ocular drug delivery one of the most difficult problems in the pharmaceutical field. Considering the problems of patient compliance, local administration remains the preferred method of drug administration in the anterior part of eyes. However, local administration suffers from poor bioavailability, need for frequent administration, and systemic toxicity. Administration in the posterior part of the eye is more difficult, and intravitreal injection is often used. But intravitreal injection faces the problems of poor patient compliance and likely side effects after multiple injections. The development of nanocarrier technology provides an effective way to solve these problems. Among them, liposomes, as the most widely used carrier in clinical application, have the characteristics of amphiphilic nanostructure, easy surface modification, extended release time, good biocompatibility, etc. The liposomes are expected to overcome obstacles and effectively deliver drugs to the target site to improve ocular drug bioavailability. This review summarized the various controllable properties of liposomes for ocular delivery as well as the application and research progress of liposomes in various ocular diseases. In addition, we summarized the physiological barriers and routes of administration contained in eyes, as well as the prospects of liposomes in the treatment of ocular diseases.

Evaluation of the Performance of an Ocular Surface Modulator Containing ST-Lysyal Versus Hyaluronic Acid Eyedrops in Patients with Dry Eye Disease: A Pilot Study

INTRODUCTION

Dry eye disease (DED) is a multifactorial condition of the ocular surface, primarily treated with tear substitutes, which do not fully restore natural tear functions. In this pilot study, we tested the hypothesis that T-Lysyal (T-Lys) improves symptoms and signs in patients with DED. Additionally, we provide a literature overview on the effects of T-Lys in ophthalmology and non-ophthalmology conditions to elucidate its mechanisms of action.

METHODS

A double-masked, randomized pilot study was conducted in patients with DED treated with T-Lys or hyaluronic acid (HA) 0.2% combined with tamarind seeds polysaccharide (control group) for 2 months. Inclusion criteria were a diagnosis of DED with symptoms lasting ≥ 6 months, Symptom Assessment in Dry Eye (SANDE) score ≥ 30, and at least one of the following: fluorescein staining of the cornea (score ≥ 3, NEI scale), conjunctival staining (Lissamine Green, score ≥ 3), or tear breakup time (T-BUT) ≤ 10 s. Data from the right eye were used for statistical analysis. A PubMed literature search of T-Lys studies was also performed without publication year restrictions.

RESULTS

Twelve patients in the T-Lys group and 15 in the control group completed the study (mean age 67 ± 11 years). T-Lys treatment resulted in significant improvements from baseline (V0) to 2 months (V2) in symptoms assessed by visual analogue scale (T-Lys: 4.58 ± 2.57 mm at V0, 2.92 ± 1.38 mm at V2, p < 0.05; control: 5.13 ± 2.29 mm at V0, 5.3 ± 2.4 mm at V2), T-BUT (T-Lys: 2.58 ± 1.31 s at V0, 3.58 ± 1.37 s at V2, p < 0.05; control: 3.07 ± 1.43 s at V0, 3 ± 1.13 s at V2), and corneal staining (T-Lys: 2.16 ± 4.17 at V0, 1.41 ± 3.70 at V2, p < 0.05; control: 1.4 ± 2.19 at V0, 1.4 ± 2.16 at V2). No adverse events were reported. Literature findings supported T-Lys's efficacy in managing both ophthalmology and non-ophthalmology conditions.

CONCLUSION

This study provides the first clinical evidence of T-Lys efficacy in patients with DED, supporting preclinical data and highlighting its potential as a promising ocular surface modulator.

TRIAL REGISTRATION

The study was registered in the ISRCTN registry for Clinical Studies with no. 13587929.

Qualitative Study on the Real Experiences of Patients with Meige Syndrome Based on the Individual and Family Self-Management Theory

Objective

This study aimed to analyze the real experiences of patients with Meige Syndrome, which is an idiopathic dystonia, during the perioperative period and to explore the practical application and effectiveness of Individual and Family Self-Management Theory (IFSMT) in improving patient experiences.

Methods

A qualitative descriptive research methodology was employed to elucidate the intricate psychological and social experiences encountered by patients with Meige Syndrome throughout the perioperative phase. This study conduct face-to-face, one-on-one, semi-structured interviews with 16 Meige Syndrome patients to gain an in-depth understanding of the patients' true feelings and needs. Interview data were organized and analyzed using Colaizzi's method, and themes were refined in conjunction with IFSMT to reveal patients' self-management practices and influencing factors.

Results

Through in-depth analysis using Colaizzi's method and the application of IFSMT to the perioperative experiences of patients with Meige Syndrome, and reported according to COREQ standards, three core themes were identified: (1) Context Dimension (specific disease factors, physical and social environmental factors, personal and family factors), (2) Process Dimension (knowledge and beliefs, self-regulation and self-efficacy, social facilitation), and (3) Outcome Dimension (proximal and distal outcomes of self-management behaviors).

Conclusion

This study demonstrates that IFSMT has significant application value in the perioperative experiences of patients with Meige Syndrome. Enhancing patients' knowledge, beliefs, self-regulation abilities, and social support can promote effective self-management behaviors, thereby improving their quality of life and health status. Additionally, the study reveals the complexity of self-management in perioperative patients, emphasizing the importance of interdisciplinary collaboration and comprehensive interventions in enhancing patient experiences. Future research can further explore how to apply these theories in clinical practice to optimize perioperative management and rehabilitation processes for patients with Meige Syndrome.

Influence of Lifestyle Factors on Ocular Surface Parameters in Relation to Age

PURPOSE

To evaluate how Video Display Terminal (VDT) use, Contact Lens (CL) wear, and eyedrop use affect ocular surface parameters in participants with ocular discomfort and how these factors may vary across different age groups.

METHODS

The current cross-sectional study initially involved a total of 252 participants who completed a self-administered survey to collect information about ocular discomfort and lifestyle factors. This online survey was composed of an Ocular Surface Disease Index (OSDI) questionnaire and three extra questions regarding lifestyle factors (VDT use, CL wear, and eyedrop use). Only 185 symptomatic participants, those with OSDI values > 12, were scheduled to undergo a comprehensive ocular examination that included tear film osmolarity, Fluorescein Break-Up Time (FBUT), Maximum Blink Interval (MBI), and corneal staining.

RESULTS

Differences in ocular parameters and lifestyle factors across age groups (<40 years, 40-60 years, >60 years) were analyzed, along with their correlations and regression. Significant age group differences were found in OSDI, osmolarity, FBUT, and MBI (One-way ANOVA, all p ≤ 0.029). Correlations were observed between CL wear and osmolarity and MBI (Pearson's correlation, both p ≤ 0.049). Multiple regression confirmed age associations with OSDI, osmolarity, FBUT, and MBI (Multiple linear regression, all p ≤ 0.040) and found links between VDT use and osmolarity and MBI (Multiple linear regression, both p ≤ 0.038) and between eyedrop use and OSDI (Multiple linear regression, p = 0.040).

CONCLUSION

Aging is a primary factor affecting ocular homeostasis, with older adults showing lower FBUT and MBI values and higher osmolarity. Prolonged use of VDTs exacerbates this effect, further contributing to ocular discomfort and destabilized tear film. No associations between CL wear and any of the ocular parameters were found. Eyedrop use shows varied effects on ocular comfort across age groups, emphasizing the need for age-specific ocular care. Overall, these findings confirm that aging and extended VDT use play a significant role in ocular surface discomfort.

Predisposing factors for poor outcomes after intense pulsed light treatment for dry eye disease: A retrospective case-control study

Purpose: To evaluate the potential risk factors for poor dry eye disease (DED) outcomes after intense pulse light (IPL) treatment. Methods: A retrospective case-control study was conducted, and patients who received IPL were enrolled. A total of 63 eyes were included in the present study after exclusion and were divided into a fair outcome group and a poor outcome group according to posttreatment improvements in DED-related signs and symptoms. The primary outcomes are the pretreatment parameters between the two groups. The Mann‒Whitney U test and generalized linear model were adopted to analyze the differences in pretreatment indices between the two groups. Results: Both the fluorescein stain results and the Schirmer II test results after IPL treatment were significantly better than those before IPL treatment (both P < 0.05). Nevertheless, the overall DED-related symptoms did not significantly improve after IPL treatment (P = 0.834). In terms of indicators of poor outcomes after IPL treatment, the rates of advanced age, female sex, previous refractive surgery, lower pretreatment noninvasive tear break-up time (NITBUT) and greater meibomian gland loss were significantly greater in the poor outcome group (all P < 0.05). Female sex and previous refractive surgery were associated with less improvement in DED-related symptoms (all P < 0.05), whereas advanced age, a lower pretreatment NITBUT and a higher meibomian gland loss rate were related to poor DED sign improvement (all P < 0.05). Conclusion: The major limitations are the retrospective design, small study population, and absence of detailed posttreatment exams. In conclusion, old age, female sex, previous refractive surgery, a lower NITBUT, and a higher meibomian gland loss rate are associated with worse outcomes after IPL treatment.

Multidimensional immunotherapy for dry eye disease: current status and future directions

Dry Eye Disease (DED) is a multifactorial condition driven by tear film hyperosmolarity, immune dysregulation, and neuro-immune interactions. The immune system plays a central role in its pathogenesis, influencing both inflammation and ocular surface damage. While traditional immunotherapies like anti-inflammatory agents and immunosuppressants offer symptom relief, their long-term use is limited by side effects. This review focuses on emerging immunotherapies, including biologics, stem cell therapy, gene therapy, nanotechnology, and exosome-based treatments, all of which hold promise in modulating immune responses and promoting tissue repair. The relationship between the ocular microbiome and DED is also explored, with an emphasis on personalized immunotherapy. Key challenges for future research include identifying novel therapeutic targets, optimizing clinical translation, and evaluating the long-term efficacy of these innovative treatments.

Innovations in Nanoemulsion Technology: Enhancing Drug Delivery for Oral, Parenteral, and Ophthalmic Applications

Nanoemulsions (NEs) are submicron-sized heterogeneous biphasic liquid systems stabilized by surfactants. They are physically transparent or translucent, optically isotropic, and kinetically stable, with droplet sizes ranging from 20 to 500 nm. Their unique properties, such as high surface area, small droplet size, enhanced bioavailability, excellent physical stability, and rapid digestibility, make them ideal for encapsulating various active substances. This review focuses on recent advancements, future prospects, and challenges in the field of NEs, particularly in oral, parenteral, and ophthalmic delivery. It also discusses recent clinical trials and patents. Different types of in vitro and in vivo NE characterization techniques are summarized. High-energy and low-energy preparation methods are briefly described with diagrams. Formulation considerations and commonly used excipients for oral, ocular, and ophthalmic drug delivery are presented. The review emphasizes the need for new functional excipients to improve the permeation of large molecular weight unstable proteins, oligonucleotides, and hydrophilic drugs to advance drug delivery rapidly.

Advancements in Ocular Therapy: A Review of Emerging Drug Delivery Approaches and Pharmaceutical Technologies

Eye disorders affect a substantial portion of the global population, yet the availability of efficacious ophthalmic drug products remains limited. This can be partly ascribed to a number of factors: (1) inadequate understanding of physiological barriers, treatment strategies, drug and polymer properties, and delivery systems; (2) challenges in effectively delivering drugs to the anterior and posterior segments of the eye due to anatomical and physiological constraints; and (3) manufacturing and regulatory hurdles in ocular drug product development. The present review discusses innovative ocular delivery and treatments, encompassing implants, liposomes, nanoparticles, nanomicelles, microparticles, iontophoresis, in situ gels, contact lenses, microneedles, hydrogels, bispecific antibodies, and gene delivery strategies. Furthermore, this review also introduces advanced manufacturing technologies such as 3D printing and hot-melt extrusion (HME), aimed at improving bioavailability, reducing therapeutic dosages and side effects, facilitating the design of personalized ophthalmic dosage forms, as well as enhancing patient compliance. This comprehensive review lastly offers insights into digital healthcare, market trends, and industry and regulatory perspectives pertaining to ocular product development.

Understanding the Dry Eye Disease-Related Symptoms in South America: Prevalence and Associated Factors-A Systematic Review

Background/Objectives: Dry eye disease is a leading cause of ophthalmologic consultations worldwide and can significantly impact quality of life. While global prevalence rates vary widely, data specific to South America are limited. This systematic review aims to describe and analyze the prevalence and associated factors of dry eye disease-related symptoms in South American populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using databases such as PubMed, Web of Science, Scopus, and LILACS. Primary studies in English and Spanish that examined the prevalence of dry eye disease-related symptoms in South American populations and its associated factors were included without date restrictions. Studies were screened and selected based on predefined inclusion and exclusion criteria, resulting in the final inclusion of 16 studies from six South American countries. Results: This review identified significant variability in the prevalence of dry eye disease-related symptoms in South American populations in the region, ranging from 4% to 77.5%, with a mean prevalence of 39.3%. Higher prevalence rates were observed among specific groups, such as university students (58.6%) and administrative workers (57.9%). Factors associated with dry eye disease-related symptoms in South American populations included female sex, older age, prolonged screen time, insufficient sleep, and medical conditions such as hypertension, connective tissue disorders, and the use of medications like antihypertensives and antidepressants. Conclusions: The prevalence of dry eye disease-related symptoms in South American populations is notably higher than global averages, highlighting regional challenges. This study emphasizes the need for standardized diagnostic tools and comprehensive epidemiological research across South America, particularly in underrepresented countries, to inform public health strategies tailored to the specific needs of these populations.

Cell death pathways in dry eye disease: Insights into ocular surface inflammation

Dry eye disease (DED) is increasingly prevalent, with inflammation playing a crucial role in its pathogenesis. Severe cases of DED result in significant ocular discomfort and visual impairment due to damage and loss of ocular surface epithelial cells. The precise mechanisms underlying the loss of these epithelial cells remain a subject of ongoing research and debate. Programmed cell death (PCD) mechanisms, including pyroptosis, apoptosis, and necroptosis, are known to be critical in maintaining ocular surface homeostasis and responding to stressors in DED. The concept of PANoptosis, which integrates elements of various PCD pathways, has been implicated in the development of numerous systemic diseases, including infections, cancer, neurodegenerative, and inflammatory conditions. It also provides novel insights into the inflammatory processes underlying DED. This review highlights the crosstalk of PCD pathways in DED, particularly the significance of PANoptosis in ocular inflammation and its potential as a therapeutic target for more effective interventions.

M2 macrophage-derived extracellular vesicles ameliorate Benzalkonium Chloride-induced dry eye

Dry eye disease (DED) is a common ocular condition affecting a significant portion of the global population, yet effective treatment options remain elusive. This study investigates the therapeutic potential of M2 macrophage-derived extracellular vesicles (M2-EVs) in a mouse model of DED. The DED model was established using 0.2% benzalkonium chloride (BAC) eye drops, applied twice daily for a week. Post induction, the mice were categorized into 5 groups: PBS, Sodium Hyaluronate (HA, 0.1%), Fluoromethalone (FM, 0.1%), M0-EVs, and M2-EVs. The efficacy of M2-EVs was assessed through tear production, corneal fluorescein staining and HE staining. RNA sequencing (RNA-seq) was employed to investigate the mechanisms underlying the therapeutic effects of M2-EVs in DED. Notably, the M2-EVs treated group exhibited the highest tear secretion, indicating improved tear film stability and reduced corneal surface damage. Histological analysis revealed better corneal structure organization in the M2-EVs group, suggesting enhanced ocular surface repair and corneal preservation. Furthermore, M2-EVs treatment significantly decreased pro-inflammatory cytokine levels and showed unique enrichment of genes related to retinal development. These findings suggest that M2-EVs could serve as a promising noninvasive therapeutic approach for human DED, targeting ocular surface inflammation.

Autologous serum eye drops for patients with dry eye disease: a systematic review and meta-analysis of randomized controlled trials

Background

Dry eye disease (DED) is highly prevalent worldwide, leading to increased medical costs, economic burdens on families and society, and a diminished quality of life for patients. The utilization of autologous serum eye drops (ASEDs) for the treatment of DED is progressively rising.

Objective

To further evaluate the efficacy and safety of ASEDs in the treatment of DED.

Methods

A thorough search for randomized controlled trials (RCTs) was conducted across eight databases, including PubMed, EMBASE, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, SinoMed, and VIP. This search encompassed the inception of each database up to April 1, 2024, with a specific focus on identifying RCTs evaluating the efficacy and safety of ASEDs for the treatment of DED. Data analysis was conducted utilizing Stata 15.0 software and the Cochrane Risk of Bias Assessment Tool was utilized to appraise the literature's quality.

Results

The study encompassed 12 RCTs. In comparison to the use of artificial tears (AT), patients diagnosed with DED who utilized ASEDs displayed elevated the Schirmer test (ST) scores [WMD = 2.35, 95% CI (1.45, 3.24), p < 0.001] and tear-film breakup time (TBUT) scores [WMD = 2.83, 95% CI (2.27, 3.39), p < 0.001], decreased Corneal fluorescence staining (CFS) scores [SMD = -2.11, 95% CI (-3.07, -1.15), p < 0.001] and the Ocular Surface Disease Index (OSDI) scores [WMD = -10.54, 95% CI (-13.31, -7.77), p < 0.001], and experienced a reduced frequency of adverse events [RR = 0.36, 95% CI (0.13, 0.99), p = 0.048].

Conclusion

In this study, ASEDs had been shown to enhance tear secretion, extend tear film break-up time, mitigate corneal epithelial damage, ameliorate OSDI scores, and exhibit greater safety compared to AT.

Multifaceted mitochondrial as a novel therapeutic target in dry eye: insights and interventions

Dry eye, recognized as the most prevalent ocular surface disorder, has risen to prominence as a significant public health issue, adversely impacting the quality of life for individuals across the globe. Despite decades of extensive research into the chronic inflammation that characterizes dry eye, the intricate mechanisms fueling this persistent inflammatory state remain incompletely understood. Among the various cellular components under investigation, mitochondria-essential for cellular energy production and homeostasis-have attracted increasing attention for their role in dry eye pathogenesis. This involvement points to mechanisms such as oxidative stress, apoptosis, and sustained inflammation, which are central to the progression of the disease. This review aims to provide a thorough exploration of mitochondrial dysfunction in dry eye, shedding light on the critical roles played by mitochondrial oxidative stress, apoptosis, and mitochondrial DNA damage. It delves into the mechanisms through which diverse pathogenic factors may trigger mitochondrial dysfunction, thereby contributing to the onset and exacerbation of dry eye. Furthermore, it lays the groundwork for an overview of current therapeutic strategies that specifically target mitochondrial dysfunction, underscoring their potential in managing this complex condition. By spotlighting this burgeoning area of research, our review seeks to catalyze the development of innovative drug discovery and therapeutic approaches. The ultimate goal is to unlock promising avenues for the future management of dry eye, potentially revolutionizing treatment paradigms and improving patient outcomes. Through this comprehensive examination, we endeavor to enrich the scientific community's understanding of dry eye and inspire novel interventions that address the underlying mitochondrial dysfunctions contributing to this widespread disorder.

Environmental and Occupational Triggers of Dry Eye Symptoms in the Ahsa Region of Saudi Arabia: A Cross-Sectional Study

Objective

This cross-sectional study aimed to investigate the associations between environmental and occupational factors and the prevalence of dry eye symptoms among participants from the Ahsa region of Saudi Arabia.

Methods

Participants from urban, rural, and suburban areas seeking medical care at primary health centers were recruited through systematic random sampling. Data on demographics, exposures, and ocular health were captured using a structured questionnaire. Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI), Impact of Dry Eye on Everyday Life (IDEEL), and Symptom Assessment in Dry Eye (SANDE) questionnaires. Logistic regression analysis examined the relationships between environmental/occupational factors and the prevalence of dry eye symptoms.

Results

Key exposures included particulate matter (PM) (60%), low humidity (55%), wind/dust (50%), prolonged computer use (65%), and chemical irritants (45%). These factors were significantly associated with an increased prevalence of dry eye symptoms, with the following odds ratios (ORs): PM (1.85, 95% CI: 1.35-2.52), low humidity (1.45, 95% CI: 1.05-2.00), wind and dust (1.60, 95% CI: 1.20-2.14), prolonged computer use (2.10, 95% CI: 1.55-2.85), and chemical irritants (1.75, 95% CI: 1.30-2.35). All associations were statistically significant (p < 0.05). The use of protective equipment was associated with reduced odds of dry eye symptoms (OR 0.60, 95% CI: 0.42-0.85, p = 0.03).

Conclusion

This study identifies significant associations between specific environmental and occupational exposures and the prevalence of dry eye symptoms. Reducing modifiable exposures through policy, workplace enhancements, and clinical preventative strategies is essential to mitigate the burden of dry eye symptoms related to modern lifestyles and technology.

Protective effects of insulin on dry eye syndrome via TLR4/NF-κB pathway: based on network pharmacology and in vitro experiments validation

Dry eye syndrome (DES) is a multifactorial ocular surface disease and represents one of the most prevalent ophthalmic disorders. Insulin is an important metabolism-regulating hormone and a potential antioxidant with critical biological roles as anti-inflammatory and anti-apoptotic. However, its mechanism of action remains unknown. In this study, we used network pharmacology techniques and conducted cell experiments to investigate the protective effect of insulin on human corneal epithelial cells (HCECs). Eighty-seven common targets of insulin and DES were identified from the database. KEGG pathway enrichment analysis suggested that insulin may be crucial in regulating the toll-like receptor (TLR) signaling pathway by targeting key targets such as IL-6 and TNF. In cell experiments, insulin promoted HCECs proliferation, improved their ability to migrate, and inhibited apoptosis. Western blot and enzyme-linked immunosorbent assay (ELISA) also confirmed the upregulation of the expression of inflammatory factors such as IL-1β, IL-6, and proteins related to the TLR4/NF-κB signaling pathway. However, the expression of these proteins was inhibited by insulin administration. Our results preliminarily verified insulin may exert a protective role on HCECs under hyperosmotic condition, which offered a novel perspective for the clinical management of this condition.

The Usage of Different Hyaluronic-Acid-Containing Artificial Tears and the Treatment Outcome of Intense Pulsed Light Therapy for Dry Eye Disease: A Retrospective Cohort Study

In this study, we aimed to investigate the effect of different hyaluronic acid (HA)-containing artificial tears on dry eye disease (DED) treatment in combination with intense pulsed light (IPL) therapy. A retrospective cohort study was conducted, and the participants received IPL therapy and HA-containing artificial tears. There were 42 and 40 eyes in the 0.10% and 0.15% HA groups after selection, respectively. The main outcomes were the postoperative non-invasive tear break-up time (NITBUT), Schirmer II test results, ocular surface stain, and numbers of DED-related symptoms. A generalized linear model was utilized to produce the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the main outcomes between groups. At the three-month follow-up, the NITBUT was significantly higher in the 0.15% HA group (p = 0.023), and the NITBUT recovery was also significantly better in the 0.15% HA group compared to the 0.10% HA group (p = 0.039). The multiple DED-related symptoms significantly correlated with no DED symptom improvement in both the 0.10% and 0.15% HA groups (both p < 0.05), while the low pre-treatment NITBUT was marginally related to no DED symptom improvement in the 0.10% HA group (p = 0.047). A low NITBUT and Schirmer II test result correlated with no DED symptom improvement in both the groups (all p < 0.05). In conclusion, the application of 0.10% and 0.15% HA-containing artificial tears revealed similar effects to IPL therapy for DED.

The shared mechanism and potential diagnostic markers for premature ovarian failure and dry eye disease

Premature ovarian failure (POF), which is often comorbid with dry eye disease (DED) is a key issue affecting female health. Here, we explored the mechanism underlying comorbid POF and DED to further elucidate disease mechanisms and improve treatment. Datasets related to POF (GSE39501) and DED (GSE44101) were identified from the Gene Expression Omnibus (GEO) database and subjected to weighted gene coexpression network (WGCNA) and differentially expressed genes (DEGs) analyses, respectively, with the intersection used to obtain 158 genes comorbid in POF and DED. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analyses of comorbid genes revealed that identified genes were primarily related to DNA replication and Cell cycle, respectively. Protein-Protein interaction (PPI) network analysis of comorbid genes obtained the 15 hub genes: CDC20, BIRC5, PLK1, TOP2A, MCM5, MCM6, MCM7, MCM2, CENPA, FOXM1, GINS1, TIPIN, MAD2L1, and CDCA3. To validate the analysis results, additional POF- and DED-related datasets (GSE48873 and GSE171043, respectively) were selected. miRNAs-lncRNAs-genes network and machine learning methods were used to further analysis comorbid genes. The DGIdb database identified valdecoxib, amorfrutin A, and kaempferitrin as potential drugs. Herein, the comorbid genes of POF and DED were identified from a bioinformatics perspective, providing a new strategy to explore the comorbidity mechanism, opening up a new direction for the diagnosis and treatment of comorbid POF and DED.

Reticulated Retinoic Acid Synthesis is Implicated in the Pathogenesis of Dry Eye in Aqp5 Deficiency Mice

Purpose

Abnormalities in aquaporins are implicated in the pathological progression of dry eye syndrome. Retinoic acid (RA) regulates cellular proliferation, differentiation, and apoptosis in the cornea, thereby being associated with dry eye disease (DED). The objective of this study is to explore the underlying mechanisms responsible for RA metabolic abnormalities in corneas lacking aquaporin 5 (AQP5).

Methods

Dry eye (DE) models were induced via subcutaneous scopolamine hydrobromide. Aqp5 knockout (Aqp5-/-) mice and DE mice were utilized to assess corneal epithelial alterations. Tear secretion, goblet cell counts, and corneal punctate defects were evaluated. The impact of Aqp5 on RA-related enzymes and receptors was investigated using pharmacological RA or SR (A JunB inhibitor), a transcription factor JunB inhibitor, treatment in mouse corneal epithelial cells (CECs), or human corneal epithelial cells (HCECs). The HCECs and NaCl-treated HCECs underwent quantitative real-time PCR (qRT-PCR), immunofluorescent, Western blot, and TUNEL assays. The regulation of transcription factor JunB on Aldh1a1 was explored via ChIP-PCR.

Results

Aqp5 and Aldh1a1 were reduced in both CECs of DE mice and NaCl-induced HCECs. Aqp5-/- mice exhibited DE phenotype and reduced Aldh1a1. RA treatment reduced apoptosis, promoted proliferation, and improved the DE phenotype in Aqp5-/- mice. JunB enrichment in the Aldh1a1 promoter was identified by ChIP-PCR. SR significantly increased Aldh1a1 expression, Ki67, and ΔNp63-positive cells, and decreased TUNEL-positive cells in CECs and HCECs.

Conclusions

Our findings demonstrated the downregulation of Aqp5 expression and aberrant RA metabolism in DE conditions. Knockout of Aqp5 resulted in reduced production of RA through activation of JunB, subsequently leading to the manifestation of DE symptoms.

Gender-Related Differences in Dry Eye Symptoms Following Involutional Ectropion and Entropion Surgery

This prospective case-control study investigated gender-related differences in dry eye symptoms following surgery for involutional ectropion and entropion. A total of 109 patients, aged between 65 and 89, were categorized by eyelid condition and gender. Postoperative assessments included the Tear Film Break-Up Time (TBUT) test, Schirmer I test results, corneal and conjunctival staining, eyelid margin characteristics, and scores from the Ocular Surface Disease Index (OSDI) questionnaire. The analysis revealed notable gender-related differences in dry eye manifestations. Initially, men exhibited lower TBUT scores but higher Schirmer test readings compared to women; however, these disparities diminished over time. No significant gender differences were detected in corneal and conjunctival staining, indicating similar levels of ocular surface damage across genders. Males showed significantly higher values in several eyelid margin characteristics (LMI, LMT) at various postoperative time points. According to the OSDI questionnaire, women experienced more severe symptoms of dry eye both pre- and post-operatively, suggesting a greater subjective symptom burden. When comparing surgical outcomes for ectropion and entropion, both conditions showed improvement in eyelid positioning and dry eye symptoms post-surgery. Despite these improvements, women with either condition reported more severe dry eye symptoms compared to men throughout the postoperative period. This study highlights the gender-specific variations in dry eye symptoms following eyelid malformation surgery and emphasizes the importance of adopting gender-sensitive approaches in postoperative care to improve outcomes and ocular health.

Different concentrations of hyaluronic acid eye drops for dry eye syndrome: a systematic review and Meta-analysis

AIM

To compare high or low concentration of hyaluronic acid eye drops (HY) for dry eye syndromes (DES).

METHODS

Randomized controlled trials (RCTs) comparing various concentrations of HY were searched in PubMed, Embase, Web of Science, Cochrane, SinoMed, CNKI, Wanfang Database, CQVIP, and Chinese journals databases between inception and July 2023. Pooled standardized mean differences (SMD) or weighted mean difference (WMD) with 95% confidence intervals (CI) from RCTs evaluating Schirmer's I test (SIT), corneal fluorescein staining score (CFS), tear breakup time (TBUT), DES score (DESS), and Ocular Surface Disease Index (OSDI) were calculated. Sensitivity analysis, Egger's test and Meta-regression analysis were performed for all indicators.

RESULTS

We conducted a Meta-analysis of 10 RCTs that met the inclusion criteria, involving 1796 cases. High-concentrations group significantly improved the outcome of CFS according to random effects modelling (SMD, -3.37; 95%CI, -5.25 to -1.48; P=0.0005). The rest of the results were not statistically significant, including indicators such as SIT, TBUT, DESS and OSDI.

CONCLUSION

For dry eyes with positive corneal staining, a high concentration of HY is recommended, whereas in other cases, a high concentration of HY does not offer a more pronounced advantage over a low concentration of HY in the treatment of dry eyes.

Ocular Manifestation in Systemic Sclerosis-A Literature Review

Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disease that affects more than 2 million people worldwide. It manifests through vasculopathy, an abnormal immunological response, and fibrosis leading to dysfunction of the multiple organs. The disease is categorized into two subtypes: limited cutaneous SSc and diffuse cutaneous SSc. Scleroderma can affect vital organs with respiratory, cardiac, renal, ocular, and dermatological complications. The ocular manifestations of the disease can occur in the anterior and posterior segments of the eye. Changes in the anterior segment related to the disease include eyelid skin remodeling, dry eye syndrome, and conjunctival abnormalities. The disease's impact on the posterior segment of the eye mostly causes pathologies in the retinal microcirculatory system and abnormalities in the optic nerve. This review provides detailed insights into ocular complications associated with scleroderma.

A novel multi-ingredient supplement significantly improves ocular symptom severity and tear production in patients with dry eye disease: results from a randomized, placebo-controlled clinical trial

Introduction

Dry eye disease (DED) is multifactorial and characterized by a loss of tear film homeostasis that causes a cycle of tear film instability, tear hyperosmolarity, and inflammation. While artificial tears are the traditional mainstay of treatment, addressing the underlying pathophysiology could relieve symptoms and prevent progression. Increasing evidence indicates a role for oral nutritional supplementation in multiple ophthalmic diseases, including DED. Lutein, zeaxanthin, curcumin, and vitamin D3 have demonstrated protective and anti-inflammatory properties in ocular models. This prospective, randomized, double-blind, parallel, placebo-controlled study evaluated the efficacy and safety of a proprietary blend of lutein, zeaxanthin isomers, curcumin, and vitamin D3 (LCD) as a daily supplement in adult participants with DED.

Methods

Participants were randomized to receive one LCD supplement capsule (lutein 20 mg, zeaxanthin isomers 4 mg, curcumin 200 mg curcuminoids, and vitamin D3 600 IU) or placebo per day for 8 weeks (LCD, n=77; placebo, n=78). Primary outcomes were changes in tear volume (Schirmer's test) and ocular symptoms (Ocular Surface Disease Index [OSDI]).

Results

The study met its primary endpoints: the LCD group demonstrated significantly better Schirmer's test scores and improvement in overall OSDI score, versus placebo, at Day 56 (p<0.001 for both). Scores for total OSDI, and symptoms and vision domains, significantly improved by Day 14 for LCD versus placebo, (p<0.05 for all) and were maintained to Day 56 (p<0.001). In addition, the LCD group demonstrated significantly improved tear film break-up time (TBUT) and tear film osmolarity, versus placebo, by Day 56 (p<0.001), along with significant improvements in corneal and conjunctival staining (p<0.001 for both), and inflammation (matrix metalloproteinase-9; p<0.001 for each eye). Total Standard Patient Evaluation of Eye Dryness (SPEED) score, and scores for the frequency and severity domains, were significantly improved by Day 14 for LCD versus placebo (p<0.05 for all) and maintained to Day 56 (p<0.001). There was no difference between groups for artificial tear usage. The supplement was well-tolerated.

Discussion

Once-daily LCD supplementation significantly improved tear production, stability and quality, reduced ocular surface damage and inflammation, and improved participants' symptoms. LCD supplementation could offer a useful adjunct to artificial tears for patients with DED (NCT05481450).

Novel treatments for dry eye syndrome

Dry eye syndrome (DES) is a prevalent and multifactorial disease that leads to a self-perpetuating cycle of inflammation and damage to the ocular surface. This results in symptoms such as redness, burning, and blurred vision, which can negatively affect a patient's quality of life. While treatments are available to manage DES, they only temporarily relieve symptoms. Furthermore, long-term use of certain medications can cause harm to the ocular surface. Therefore, there is a need for safer and effective treatments for DES. This review highlights the latest advancements in DES therapy, providing valuable insights into ongoing efforts to improve patient outcomes.