Topical Fluorometholone Protects the Ocular Surface of Dry Eye Patients from Desiccating Stress

Pinto-Fraga, José; López-Miguel, Alberto; González-García, María J.; Fernández, Itziar; Rosa, Alberto López-de la; Salamanca, Andrés Bordalí; Stern, Michael E.; Calonge, Margarita

doi:10.1016/j.ophtha.2015.09.029

Cited by 74 publications

(50 citation statements)

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“…Topical steroids have a role for treating keratoconjunctivitis sicca (KCS), as outlined in the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) report . This report summarizes the currently available evidence on managing dry eye disease, including results from several RCTs, and concluded that short courses of corticosteroid are effective in improving symptoms of KCS. However, this is not an effective long‐term strategy due to potential side effects.…”

Section: Uses Of Locally Administered Steroidsmentioning

confidence: 99%

Local delivery of corticosteroids in clinical ophthalmology: A review

Fung

Tran

Lim

et al. 2020

Clinical Exper Ophthalmology

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Locally administered steroids have a long history in ophthalmology for the treatment of inflammatory conditions. Anterior segment conditions tend to be treated with topical steroids whilst posterior segment conditions generally require periocular, intravitreal or systemic administration for penetration. Over recent decades, the clinical applications of periocular steroid delivery have expanded to a wide range of conditions including macular oedema from retino-vascular conditions. Formulations have been developed with the aim to provide practical, targeted, longer-term and more efficacious therapy whilst minimizing side effects. Herein, we provide a comprehensive overview of the

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Section: Uses Of Locally Administered Steroidsmentioning

confidence: 99%

Local delivery of corticosteroids in clinical ophthalmology: A review

Fung

Tran

Lim

et al. 2020

Clinical Exper Ophthalmology

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“…172–174 Therapies targeting the acute effects of desiccation would likely provide more rapid relief of eye irritation and prevent the effects of a dry, drafty environment such as an airplane cabin. Corticosteroids have shown efficacy in treating chronic dry eye and preventing irritation and cornea barrier disruption in response to a desiccating environmental challenge 175–178 ; however, long-term use of corticosteroids carries risks of cataract formation and glaucoma, and therapies with steroid-like inhibitory effects on innate inflammatory pathways would represent a major advance.…”

Section: Future Directions For Researchmentioning

confidence: 99%

The Pathophysiology of Dry Eye Disease

2017

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Clinical and laboratory studies performed over the past few decades have discovered that dry eye is a chronic inflammatory disease that can be initiated by numerous extrinsic or intrinsic factors that promote an unstable and hyperosmolar tear film. These changes in tear composition, in some cases combined with systemic factors, lead to an inflammatory cycle that causes ocular surface epithelial disease and neural stimulation. Acute desiccation activates stress signaling pathways in the ocular surface epithelium and resident immune cells. This triggers production of innate inflammatory mediators that stimulate the production of matrix metalloprotease, inflammatory cell recruitment, and dendritic cell maturation. These mediators combined with exposure of autoantigens can lead to an adaptive T-cell mediated response. Cornea barrier disruption develops by protease-mediated lysis of epithelial tight junctions leading to accelerated cell death, desquamation, an irregular poorly lubricated cornea surface and exposure and sensitization of epithelial nociceptors. Conjunctival goblet cell dysfunction and death are promoted by the T helper 1 cytokine interferon gamma (IFN-γ). These epithelial changes further destabilize the tear film, amplify inflammation and create a vicious cycle. Cyclosporine and lifitegrast, the two FDA-approved therapies inhibit T cell activation and cytokine production. While these therapies represent a major advance in dry eye therapy, they are not effective in improving discomfort and corneal epithelial disease in all patients. Preclinical studies have identified other potential therapeutic targets, biomarkers and strategies to bolster endogenous immunoregulatory pathways. These discoveries will hopefully lead to further advances in diagnostic classification and treatment.

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“…110,111 Topical treatment with 0.1% dexamethasone for 2 weeks prior to a low-humidity exposure stress using specially designed goggles significantly decreased corneal and conjunctival staining, improved blink rate and decreased Human leukocyte antigen -D related (HLA-DR) RNA levels in conjunctiva of patients with aqueous deficient dry eye. 112 Significant improvement in signs and symptoms of dry eye were observed after 3 weeks of topical 0.1% fluorometholone therapy in dry eye patients subjected to a 2-hour challenge in a controlled adverse environment exposure, 113 which increases the concentrations of MMP-9 and other inflammatory markers in tears. 114 …”

Section: Corticosteroidsmentioning

confidence: 99%

Matrix metalloproteinase-9 in the pathophysiology and diagnosis of dry eye syndrome

Pflugfelder¹,

Bian²,

Paiva³

2017

MNM

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Dry eye and tear dysfunction are common ocular disorders that cause cornea barrier disruption resulting in a poorly lubricated and irregular cornea epithelium, eye irritation and blurred vision. Increased levels and activities of matrix metalloproteinases (MMPs), particularly MMP-9, have been detected in the tears and ocular surface epithelial and inflammatory cells in dry eye. MMPs have been found to participate in disruption of tight junctions in the apical cornea epithelium leading to their accelerated desquamation and barrier disruption. This review summarizes evidence showing the contribution of MMPs to dry eye pathogenesis and their roles as biomarkers and therapeutic targets. Keywords: matrix metalloproteinase, dry eye, keratitis sicca, cornea, barrier function, Sjögren syndrome Dry eye overviewDry eye and tear dysfunction are common ocular disorders that cause cornea barrier disruption resulting in a poorly lubricated and irregular cornea epithelium, eye irritation and blurred vision. It affects millions of people worldwide and is one of the most frequent conditions for which patients seek eye care.1 Aging and female sex are significant risk factors for dry eye which increases in prevalence around the fifth decade, with further increase every decade thereafter.2-13 Prevalence of dry eye varies from 2% to 50%, depending on the population studied and the diagnostic criteria for dry eye (symptom questionnaire vs. objective signs). [1][2][3]6,7,[9][10][11][14][15][16][17][18][19][20][21][22][23] There is scarce information about the natural history of dry eye, but there is a recognized disconnection between signs and symptoms; patients tend to be more symptomatic at early stages.24,25 Dry eye causes corneal irregularity [26][27][28] and decreases functional vision by altering contrast sensitivity [29][30][31] and, therefore, decreases quality of life with a significant burden on the individual as well as the society. 23,[32][33][34][35] A meta-analysis of 22 published studies showed increased odds ratio for depression and anxiety in patients with ocular Sjögren syndrome (SS). 36 There is increased evidence that dry eye is an inflammatory disease, and this review will focus on matrix metalloproteinases (MMPs) and their role in the pathogenesis of dry eye. Cornea barrier disruption is a feature of dry eyeAs the principal lens of the eye, the cornea has unique features to maintain its transparency and smooth surface that include a lack of blood vessels and a multilayered stratified, non-cornifying epithelium. The differentiated apical epithelial cells produce

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Topical Fluorometholone Protects the Ocular Surface of Dry Eye Patients from Desiccating Stress

Abstract: Three-week topical 0.1% fluorometholone therapy is effective not only in reducing ocular surface signs in DED patients, but also especially in preventing exacerbation caused by exposure to a desiccating stress.

Cited by 74 publications

References 35 publications

Local delivery of corticosteroids in clinical ophthalmology: A review

Local delivery of corticosteroids in clinical ophthalmology: A review

The Pathophysiology of Dry Eye Disease

Matrix metalloproteinase-9 in the pathophysiology and diagnosis of dry eye syndrome

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