The role and treatment of inflammation in dry eye disease

Abstract

Dry eye syndrome is a common ocular surface problem, affects 10-30 % of the population, especially in those who are older than 40 years. As a consequence of the demographic pressure created by the aging population, its prevalence is expected to increase as well as its burden on ophthalmologic practices. Thus, understanding the complex underlying mechanisms and development of thoughtful, effective strategies that involve these mechanisms are critical. Many factors causing ocular surface damage and inflammation have been shown to contribute to the etiopathogenesis. Increased osmolarity induces ocular surface inflammation leading to disruption of both the quality and quantity of tears. Pathologic tear function and the ocular surface inflammation affects the neural arcade and increases apoptosis in the ocular surface cells thus creating a viscous cycle for dry eye by causing unstable and hyperosmolar tears. Thus, the treatment objective is to prevent severe dry eye complications via preventing inflammation and apoptosis of the ocular surface cells. The ultimate target is a normalized ocular surface, increased tear stability, and decreased osmolarity of the tear film. In the light of current literature, this review aims to elucidate the role of inflammation as the main etiological factor in dry eye disease and discuss current therapeutic approaches to overcome it.

Modern Therapeutic Approaches for Noninfectious Ocular Diseases Involving Inflammation

“…[149] Overall, Tregs are naturally tuned to regulate the proliferation of pathogenic effector T cells, and maintain immunological homeostasis in the ocular tissue. [151] …”

Ocular Manifestations in Systemic Lupus Erythematosus

“…Complications of corticosteroid eye drops should be taken into consideration since dry eye is a chronic problem. Therefore, they should be used as an acute phase treatment option in patients who are not relieved by other treatments [42]. The first topical cyclosporine eye drop, RestasisTM 0.05%, received FDA approval in 2002 for the treatment of inflammation in dry eye syndrome.…”

“…They also decrease lipase activity, regulate meibomian lipids, and decrease MMP-8 levels [49]. Oral tetracycline can be used 250 mg 4 times daily, or as doxycycline or minocycline 100 mg once or twice daily [42]. Autologous serum is rich in epitheliotropic factors, neurotrophin, vitamin A, immunoglobulin, and extracellular matrix proteins.…”

“…Autologous serum is rich in epitheliotropic factors, neurotrophin, vitamin A, immunoglobulin, and extracellular matrix proteins. They support epithelial cell proliferation and the normal morphology of corneal epithelial cells with this rich context [42]. In severe dry eye secondary to inflammatory conditions, systemic immunosuppressive agents can be considered [50].…”

Vitamin D in Dry Eye and Myopia

“…While a number of cancers are associated with inflammatory responses (Arthur et al, 2012;Bishayee, 2014;Elinav et al, 2013;Gomes et al, 2014;Sfanos et al, 2014), the preventive characteristics of vitamin D have been tested in cancers and it has been shown that vitamin D deficiency is a risk factor (Krishnan & Feldman, 2011). Similarly, inflammation component appears to play a key role in the etiopathogenesis of ocular surface dryness (Wei & Asbell, 2014;Yagci & Gurdal, 2014). Galor and colleagues (2014) surveyed 247 elder males and investigated the effects of diet and vitamin D levels on dry eye.…”