Epidemiology of discordance between symptoms and signs of dry eye

Ong, Erin; Felix, Elizabeth R.; Levitt, Roy C.; Feuer, William J.; Sarantopoulos, Constantine; Galor, Anat

doi:10.1136/bjophthalmol-2017-310633

Cited by 83 publications

(57 citation statements)

References 24 publications

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“…5 Understanding this discordance may provide useful information to guide the eye care practitioner in diagnosing and developing individualized treatment plans. 6,7 Recommendations for Management and Therapy TFOS DEWS II recommends individualized management of DED based on the relative contribution of aqueousdeficient and evaporative pathophysiology (to the extent that this can be determined), as well as disease severity. 1 Treatment for DED progresses in a stepwise approach starting with education, dietary modification, lid hygiene, the use of lubricating eye drops, and modification of environmental factors, and progresses to nonpharmacologic and pharmacological management ( Table 1).…”

Section: Etiology and Nature Of Dedmentioning

confidence: 99%

<p>Managing Dry Eye Disease and Facilitating Realistic Patient Expectations: A Review and Appraisal of Current Therapies</p>

Lee¹,

Kabat²,

Bacharach³

et al. 2020

OPTH

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Dry eye disease (DED) is a multifactorial disease of the ocular surface characterized by loss of homeostasis of the tear film and accompanied by ocular signs and symptoms such as corneal and conjunctival damage, patient discomfort, and visual disturbance. The prevalence of DED ranges from 5%−33%. Patients with DED may have a reduced quality of life due to their discomfort and visual disturbances. The multifactorial nature of DED requires a multi-targeted treatment approach to address the signs and symptoms. Treatment for DED should follow a stepwise approach beginning with education, dietary modification, and lid and lash hygiene, and progressing to pharmacologic and nonpharmacologic interventions. Ocular lubricants, a mainstay of DED therapy, provide temporary symptomatic relief for the patient, but do not address the underlying pathophysiology. Some currently available pharmacologic treatments that address the underlying pathophysiology of DED may have a delay of 3−6 months in the onset of therapeutic effect; however, these treatment options may also have tolerability issues. These challenges highlight the need for newer pharmacologic treatments with an earlier onset of observable clinical effect and the potential for improved tolerability profile. Patient education is vital to DED management and should convey the complex and chronic nature of DED. It is important for the eye care practitioner to set realistic expectations with the patient when managing DED to help improve treatment success. This helps the patient understand the need for ongoing treatment and that results will likely not be seen immediately. This review covers the current management of DED, focusing on pharmacologic management, and offers recommendations for the practitioner to help facilitate realistic patient expectations for the treatment of DED.

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Section: Etiology and Nature Of Dedmentioning

confidence: 99%

<p>Managing Dry Eye Disease and Facilitating Realistic Patient Expectations: A Review and Appraisal of Current Therapies</p>

Lee¹,

Kabat²,

Bacharach³

et al. 2020

OPTH

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“…In particular, the discomfort or pain in DED cannot solely be explained by tear film metrics due to the lack of concordance between signs and symptoms in patients. 14,15 A subset of patients without major abnormalities in tear parameters still present with ocular surface grittiness, pain, discomfort, or irritation and may not respond to conventional treatment. 2,16,17 Hence, there is an absolute need to further our understanding pertaining to the status of additional factors in DED patients that can impact nociception or neurosensory components resulting in ocular surface discomfort.…”

mentioning

confidence: 99%

Dysregulated Tear Fluid Nociception-Associated Factors, Corneal Dendritic Cell Density, and Vitamin D Levels in Evaporative Dry Eye

Khamar

Nair

Shetty

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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Citation: Khamar P, Nair AP, Shetty R, et al. Dysregulated tear fluid nociception-associated factors, corneal dendritic cell density, and vitamin D levels in evaporative dry eye. Invest Ophthalmol Vis Sci. 2019;60:2532-2542. https://doi.org/10.1167 PURPOSE. The purpose of this study was to study the status and association among tear-soluble factors, corneal dendritic cell density, vitamin D, and signs and symptoms in dry eye disease (DED). METHODS.A total of 33 control subjects and 47 evaporative dry eye patients were included in the study. DED diagnosis and classification was based on the 2017 Report of the Tear Film & Ocular Surface Society International Dry Eye Workshop (TFOS DEWS II). DED workup, including tear film break-up time (TBUT), Schirmer's test I (STI), corneal and conjunctival staining, ocular surface disease index (OSDI) scoring, and in vivo confocal microscopy (to assess corneal dendritic cell density [cDCD] and subbasal nerve plexus [SBNP] features) was performed in the study subjects. Tear fluid using Schirmer's strip and serum were collected from the subjects. Multiplex ELISA or single analyte ELISA was performed to measure 34 tearsoluble factors levels including vitamin D.RESULTS. Significantly higher OSDI discomfort score, lower TBUT, and lower STI were observed in DED patients. cDCD was significantly higher in DED patients. No significant difference was observed in SBNP features. Tear fluid IL-1b, IL-17A, MMP9, MMP10, MMP9/ TIMP ratio, and VEGF-B were significantly higher in DED patients. Significantly lower tear fluid IL-2, IP-10, NPY, VEGF-A, and vitamin D was observed in DED patients. These dysregulated tear factors showed significant associations with DED signs and symptoms.CONCLUSIONS. Altered tear fluid soluble factors with potential to modulate nociception exhibited a distinct association with ocular surface discomfort status, TBUT, STI, and cDCD. This implies a functional relationship between the various tear-soluble factors and dry eye pathogenesis, indicating new molecular targets for designing targeted therapies.

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“…1 However, there are a group of patients who have severe symptoms but with no observable signs of DED or in whom the symptoms continue to persist despite resolution of clinical signs. 5,6 This group presents a major challenge as they do not always respond favorably with the current management strategies and pose a significant psychological and economic burden. Hence, the lacunae in treatment modalities for such patients suggests a need for additional disease mechanism-specific strategies to alleviate morbidity associated with DED, irrespective of the type of etiopathological factors, such as aging, autoimmune disease, contact lens use, refractive surgery, medication, nutritional status, occupation and environment.…”

Section: How Might This Change Clinical Pharmacol-ogy or Translationamentioning

confidence: 99%

Genistein‐Calcitriol Mitigates Hyperosmotic Stress‐Induced TonEBP, CFTR Dysfunction, VDR Degradation and Inflammation in Dry Eye Disease

Panigrahi

D’Souza

Shetty

et al. 2020

Clinical Translational Sci

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Dry eye disease (DED) signs and symptoms are causally associated with increased ocular surface (OS) inflammation. Modulation of key regulators of aberrant OS inflammation is of interest for clinical management. We investigated the status and the potential to harness key endogenous protective factors, such as cystic fibrosis transmembrane conductance regulator (CFTR) and vitamin D receptor (VDR) in hyperosmotic stress-associated inflammation in patients with DED and in vitro. Conjunctival impression cytology samples from control subjects (n = 11) and patients with DED (n = 15) were used to determine the status of hyperosmotic stress (TonEBP/NFAT5), inflammation (IL-6, IL-8, IL-17A/F, TNFα, MMP9, and MCP1), VDR, and intracellular chloride ion (GLRX5) by quantitative polymerase chain reaction and/or immunofluorescence. Human corneal epithelial cells (HCECs) were used to study the effect of CFTR activator (genistein) and vitamin D (calcitriol) in hyperosmotic stress (HOs)-induced response in vitro. Western blotting was used to determine the expression of these proteins, along with p-p38. Significantly, higher expression of inflammatory factors, TonEBP, GLRX5, and reduced VDR were observed in patients with DED and in HOs-induced HCECs in vitro. Expression of TonEBP positively correlated with expression of inflammatory genes in DED. Increased TonEBP and GLRX5 provides confirmation of osmotic stress and chloride ion imbalance in OS epithelium in DED. These along with reduced VDR suggests dysregulated OS homeostasis in DED. Combination of genistein and calcitriol reduced HOs-induced TonEBP, inflammatory gene expression, and p-p38, and abated VDR degradation in HCECs. Henceforth, this combination should be further explored for its relevance in the management of DED. Dry eye disease (DED) is a chronic multifactorial condition of the ocular surface (OS), often associated with pain, discomfort and blurring of vision. 1 DED is characterized by tear-film instability, hyperosmolarity, OS inflammation and damage, and neurosensory abnormalities. 1 DED has evolved into one of the common public health concerns with a worldwide prevalence ranging up to 50%.

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Epidemiology of discordance between symptoms and signs of dry eye

Cited by 83 publications

References 24 publications

<p>Managing Dry Eye Disease and Facilitating Realistic Patient Expectations: A Review and Appraisal of Current Therapies</p>

<p>Managing Dry Eye Disease and Facilitating Realistic Patient Expectations: A Review and Appraisal of Current Therapies</p>

Dysregulated Tear Fluid Nociception-Associated Factors, Corneal Dendritic Cell Density, and Vitamin D Levels in Evaporative Dry Eye

Genistein‐Calcitriol Mitigates Hyperosmotic Stress‐Induced TonEBP, CFTR Dysfunction, VDR Degradation and Inflammation in Dry Eye Disease

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