The Utility of Oral Vitamin B1 and Mecobalamin to Improve Corneal Nerves in Dry Eye Disease: An In Vivo Confocal Microscopy Study

Abstract

Our purpose is to demonstrate the changes in cornea nerve parameters and symptoms and signs in dry eye disease (DED) patients after oral vitamin B1 and mecobalamin treatment. In this randomized double-blind controlled trial, DED patients were randomly assigned to either the treatment group (oral vitamin B1 and mecobalamin, artificial tears) or the control group (artificial tears). Corneal nerve parameters via in vivo confocal microscopy (IVCM), DED symptoms, and signs were assessed at baseline and 1 and 3 months post-treatment. In total, 398 eyes from 199 patients were included. In the treatment group, there were significant improvements in corneal nerve length, width, and neuromas, the sign of conjunctival congestion score (CCS), symptoms of dryness, pain, photophobia, blurred vision, total symptom score, and OSDI (OSDI) at 1/3 months post-treatment (all p < 0.05). Patients who received vitamin B1 and mecobalamin showed greater improvement in CCS, dryness scores at 1 month (p < 0.05), corneal fluorescein staining (CFS) (p = 0.012), photophobia (p = 0.032), total symptom scores (p = 0.041), and OSDI (p = 0.029) at 3 months. Greater continuous improvement in CFS (p = 0.045), dryness (p = 0.033), blurred vision (p = 0.031) and total symptom scores (p = 0.023) was demonstrated at 3 months than at 1 month post-treatment in the treatment group. We found that oral vitamin B1 and mecobalamin can improve corneal nerve length, width, reflectivity and the number of neuromas in IVCM, thereby repairing epithelial cells and alleviating some ocular symptoms. Thus, vitamin B1 and mecobalamin are potential treatment options for patients with DED.

The impact of dry eye disease on corneal nerve parameters: A systematic review and meta‐analysis

“…52 While evidence for the diagnostic accuracy of in vivo corneal confocal microscopy for DED is limited, there have been several studies that investigated the potential for corneal nerve imaging in monitoring the improvement in nerve morphology in both human clinical studies and animal models of DED. Recent randomised controlled trials of interventions including oral vitamin B1 and mecobalamin, 53 homologous serum eyedrops 54 and oral omega-3 essential fatty acid supplements 55 have demonstrated improvements in corneal nerve parameters as assessed with laser scanning confocal microscopy. However, each study involved different follow-up times, varying image selection and analysis and different sample sizes.…”

Pharmaceutical Screening of Bat Feces and Their Traditional Medical Application

“…B vitamins in the distal intestine also play a crucial role in maintaining intestinal microbiota homeostasis and host health through multiple mechanisms. Vitamin B1 is currently widely used to treat neuropathic pain [15], and past studies have shown that food supplements containing vitamin B1 can improve dry eye symptoms in glaucoma patients [16][17]. Vitamin B2 can act as an antioxidant in the body, and its deficiency can cause visual disorders, such as conjunctivitis and cataracts [18].…”

Association Between Vitamin Deficiencies and Ophthalmological Conditions

“… 30 There was a randomized control trial by Ren et al, in 2022 which looked at the use of oral vitamin B1 in treatment for dry eye disease (DED). 31 They found that in their treatment group (oral vitamin B1, mecobalamin and artificial tears), patients with DED significantly (p < 0.05) improved in the following outcomes: corneal nerve length, width and neuromas, conjunctival congestion score, symptoms of dryness, pain, photophobia, blurred vision, and total symptoms. They concluded that vitamin B1 is a potential treatment option for DED.…”