Tear film lipid layer increase after diquafosol instillation in dry eye patients with meibomian gland dysfunction: a randomized clinical study

Abstract

Diquafosol promotes secretion of tear fluid and mucin at the ocular surface and is administered for treatment of dry eye (DE). Tear film lipid layer is secreted from meibomian glands and stabilizes the tear film. We recently showed that diquafosol administration increased lipid layer thickness (LLT) for up to 60 min in normal human eyes. We here evaluated tear film lipid layer in DE patients ( n = 47) with meibomian gland dysfunction (MGD) before as well as 30, 60, and 90 min after diquafosol administration. One drop of artificial tears or one drop of diquafosol was applied randomly to the eyes of each patient. Diquafosol significantly increased LLT at 30 ( P < 0.001) and 60 ( P = 0.042) min and noninvasive tear film breakup time for at least 90 min ( P < 0.001 at each assessment point). Artificial tears had no such effect. Diquafosol significantly improved the tear interferometric pattern compared with artificial tears ( P < 0.001 at each assessment point). A single topical administration of diquafosol thus improved LLT and tear film stability in DE patients with MGD, suggesting that diquafosol is a potential treatment not only for aqueous-deficient DE but also for evaporative DE associated with MGD.

Effects of lid debris debridement combined with meibomian gland expression on the ocular surface MMP-9 levels and clinical outcomes in moderate and severe meibomian gland dysfunction

“…Clinical evaluation was performed before initiating the treatment and 4 weeks after the treatment. The parameters used for clinical examination include extracellular MMP-9 levels using the MMP-9 immunoassay device, tear film break-up time (TBUT), corneal and conjunctival staining score (Sjögren’s International Collaborative Clinical Alliance [SICCA] ocular staining and Oxford staining score), Schirmer 1 test performed without topical anesthetics, lid margin abnormalities and meibum grade [ 21 – 24 ].…”

“…The lid margin was examined under slit-lamp microscope and recorded separately for upper and lower lids. We assessed telangiectasia (on a scale of 0–3, with 0 = no findings; 1 = mild telangiectasia; 2 = moderate telangiectasia or redness; and 3 = severe telangiectasia or redness), anterior or posterior replacement of the mucocutaneous junction, and lid abnormalities, including irregularity, thickness, and plugging (on a scale of 0–2, with 0 = no finding; 1 = mild; and 2 = severe) [ 21 – 23 ]. To assess the meibum grade, the degree of digital pressure applied on the upper tarsus during MG expression was recorded by the physician, the grading was as follows: grade 0 = clear meibum easily expressed; grade 1 = cloudy meibum expressed with mild pressure; grade 2 = cloudy meibum expressed with more than moderate pressure; and grade 3 = no meibum expression, even with firm pressure [ 26 ].…”

“…To assess the meibum grade, the degree of digital pressure applied on the upper tarsus during MG expression was recorded by the physician, the grading was as follows: grade 0 = clear meibum easily expressed; grade 1 = cloudy meibum expressed with mild pressure; grade 2 = cloudy meibum expressed with more than moderate pressure; and grade 3 = no meibum expression, even with firm pressure [ 26 ]. The color (on a scale of 1–3, 1 = clear; 2 = cloudy; and 3 = yellow) and consistency of expressed meibum (on a scale of 1–3, 1 = oily; 2 = creamy; and 3 = toothpaste like) were assessed for both upper and lower eyelids using the meibomian gland expressor forceps [ 21 ].…”

Safety and Efficacy of Pilocarpine, Cevimeline and Diquafosol Compared to Artificial Tears for the Treatment of Dry Eye: Protocol for a Systematic Review.

“…Secretagogue therapy suggest advantages over using arti cial tears. Diquafasol solution lowers the corneal uorescein and rose Bengal scores compared to arti cial tears (19), and improves the tear break time (20). Another report suggested the superior e cacy and safety of 3% Diquafosol ophthalmic solution compared to the use of other secretagogue therapies such as Cevimeline and Pilocarpine (18,21).…”

Diquafosol tetrasodium elicits total cholesterol release from rabbit meibomian gland cells via P2Y2 purinergic receptor signalling

“…It is known that meibocyte finally secretes meibum by a holocrine mode after maturation accompanied by intracellular lipid production and accumulation 8 . Recently, several clinical studies 9 – 11 have reported that the lipid layer in tears thickened significantly after instilling DQS eye drops in patients with dry eyes and healthy volunteers. The meibomian gland epithelial cells (meibocytes) also express the P2Y 2 receptor 12 .…”