Alternative therapies for dry eye disease

Abstract

Purpose of reviewDry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited to, lacrimal gland hypofunction, meibomian gland dysfunction (MGD), ocular surface inflammation, and corneal nerve dysfunction. Current DED treatments target some facets of the disease, such as ocular surface inflammation, but not all individuals experience adequate symptom relief. As such, this review focuses on alternative and adjunct approaches that are being explored to target underlying contributors to DED. Recent findingsNeuromodulation, stem cell treatments, and oral royal jelly have all been studied in individuals with DED and lacrimal gland hypofunction, with promising results. In individuals with MGD, devices that provide eyelid warming or intense pulsed light therapy may reduce DED symptoms and signs, as may topical Manuka honey. For those with ocular surface inflammation, naturally derived anti-inflammatory agents may be helpful, with the compound trehalose being farthest along in the process of investigation. Nerve growth factor, blood-derived products, corneal neurotization, and to a lesser degree, fatty acids have been studied in individuals with DED and neurotrophic keratitis (i.e. corneal nerve hyposensitivity). Various adjuvant therapies have been investigated in individuals with DED with neuropathic pain (i.e. corneal nerve hypersensitivity) including nerve blocks, neurostimulation, botulinum toxin, and acupuncture, although study numbers and design are generally weaker than for the other DED sub-types. SummarySeveral alternatives and adjunct DED therapies are being investigated that target various aspects of disease. For many, more robust studies are required to assess their sustainability and applicability.

Differential Effects of Treatment Strategies in Individuals With Chronic Ocular Surface Pain With a Neuropathic Component

“…Generally, nociceptive pain is targeted through use of topical therapies, while neuropathic pain can be treated with oral agents or adjunctive therapies if treatment of nociceptive pain fails and/or a neuropathic component is highly suspected. While many studies have examined treatment outcomes for nociceptive sources of ocular pain ( Dermer et al, 2020 ; Mittal et al, 2021 ), fewer have examined outcomes after treatment of neuropathic ocular pain. Furthermore, available literature typically report on the effects of one therapeutic modality in a limited number of patients ( Ozmen et al, 2020 ).…”

Effect of Intense Pulsed Light Therapy in Dry Eye Disease Caused by Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis

“…27,28 IPL may alleviate MGD and dry eye symptoms for abnormal vascular thrombosis of eye skin, heating meibomian gland with the liquefaction meibomian gland secretion, reducing skin update of epithelial cell, activating fibroblasts and collagen synthesis, eradicating creep mite to reduce bacterial load, adjusting the antiinflammatory agent and matrix metalloproteinases, interfering with the inflammation period, and reducing the level of active oxide. 29,30 In recent years, similar meta-analyses exist concerning IPL therapy in MGD-related dry eye disease. Leng et al 31 found that IPL combined with MGX showed superiority regarding the TBUT (SMD 2.33, 95% CI 1.04;3.61) and OSDI scores (WMD 11.93, 95% CI: 17.10;6.77).…”

Current Advances in Mechanisms and Treatment of Dry Eye Disease: Toward Anti-inflammatory and Immunomodulatory Therapy and Traditional Chinese Medicine

“…The complications of dryness in DED may vary from a serious abnormal feeling sensation to contact lens intolerance ( 85 ). Currently, the methods of treating DED worldwide mainly include the application of ocular surface lubricants to protect the mucous membrane and the use of anti-ocular surface inflammation drugs, punctual plug placement to reduce tear loss, and physical therapy of the eyelids to restore the meibomian glands ( 86 ). However, various methods can only reduce but not completely eliminate the symptoms of DED.…”