Cationic Emulsion-Based Artificial Tears as a Mimic of Functional Healthy Tear Film for Restoration of Ocular Surface Homeostasis in Dry Eye Disease

Abstract

Dry eye disease (DED) is a complex multifactorial disease that affects an increasing number of patients worldwide. Close to 30% of the population has experienced dry eye (DE) symptoms and presented with some signs of the disease during their lifetime. The significant heterogeneity in the medical background of patients with DEs and in their sensitivity to symptoms renders a clear understanding of DED complicated. It has become evident over the past few years that DED results from an impairment of the ocular surface homeostasis. Hence, a holistic treatment approach that concomitantly addresses the different mechanisms that result in the destabilization of the tear film (TF) and the ocular surface would be appropriate. The goal of the present review is to compile the different types of scientific evidence (from in silico modeling to clinical trials) that help explain the mechanism of action of cationic emulsion (CE)-based eye drop technology for the treatment of both the signs and the symptoms of DED. These CEbased artificial tear (AT) eye drops designed to mimic, from a functional point of view, a healthy TF contribute to the restoration of a healthy ocular surface environment and TF that leads to a better management of DE patients. The CE-based AT eye drops help restore the ocular surface homeostasis in patients who have unstable TF or no tears.

Could contact lens dryness discomfort symptoms sometimes have a neuropathic basis?

“…Hyperalgesia in early or mild dry eye disease cases is probably due to this mechanism [ 61 ]. In dry eye disease, ocular surface inflammation results in changes in corneal nerve structure and altered responses to mechanical or chemical stimuli [ 62 ]. Abnormal morphological changes detected by confocal microscopy (Nidek: ConfoScan 2.0) can be observed in the corneal nerves of patients with aqueous deficient dry eye, with a strong correlation between the morphology changes and degree of aqueous deficiency [ 63 ].…”

Dry eye disease and its treatment in women over 45 years

“…Для коррекции симптомов ССГ уже при начальной стадии заболевания необходимо комплексное лечение, которое одновременно воздействует на различные механизмы, приводящие к дестабилизации СП [28,29]. В связи с этим важно не только восстановить водную фракцию СП, но и защитить ее от быстрого испарения.…”

“…Полярные липиды -это амфифильные молекулы, обладающие гидро-фобной частью (высокое сродство к маслянистым средам) и гидрофильной головкой (высокое сродство к водным средам), что делает их поверхностно-активными и позволяет полярным липидам естественным образом распределяться на границе раздела масло -вода [30]. Создание слезозаместительного средства на основе катионной эмульсии как имитация функциональной здоровой СП для восстановления гомеостаза глазной поверхности при ССГ позволило комплексно воздействовать на проблему [29,31,32].…”

“…Катионорм содержит комбинацию минеральных масел, цеталкония хлорида, полоксамера, тилоксапола, глицерина и очищенной воды [29]. Каждый компонент в его составе неслучаен.…”

Improving Stability of Tear Film Lipid Layer via Concerted Action of Two Drug Molecules: A Biophysical View

“…In MGD patients, both the quality and the quantity of the secreted lipids are altered, resulting in a thinner and instable TFLL, hence in an unstable TF characterized by short tear film breakup times (TFBUTs). Oil-in-water emulsions supplying nonpolar lipids [ 10 ] and surface-active agents at the air/tear surface were demonstrated to improve the clinical signs and symptoms of DED [ 11 , 12 ] and MGD patients [ 13 ] with significant improvements of TFBUTs. A specific role of surfactant species in such oil-in-water emulsions was found to be responsible for their favorable interactions with meibomian gland secretion (MGS) [ 14 ].…”