Dry Eye Syndrome Pathophysiology, Optimizing Diagnostics, Grouping, Treatment and Prevention

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (20 June 2022) | Viewed by 13872

Special Issue Editor

Special Issue Information

Dear Colleagues,

In today’s world's medicine, ocular surface complaints have become very frequent. Aside from being often temporary issues such as after the most common surgeries, i.e. cataract and glaucoma operations, dry eye complaints are amongst the most frequent single ocular symptoms the general practitioner or ophthalmic caretaker encounters. Diagnosis and treatment of this condition are, on the other hand, often puzzling and time-consuming. One feature of the dry eye syndrome is the dissociation between complaints (symptoms) and objective signs, which can make diagnosis and treatment difficult and vague. Dry eye disease also affects visual acuity and visual performance and, consequently, the performance and functionality of an individual. A clear definition of dry eye syndrome is a key issue for the ophthalmologist and ocular care provider. The distinction between a complaint and a disease is essential, as it is decisive for establishing treatment and further care. Any postponement of the efficient treatment of a disease to later stages could enhance the risk of transforming a complaint into disease. “Dry eye” as a condition requires a well-defined updated definition. Considering the wealth of increasing documentation reporting new clues and insights in its pathophysiology, we invite our colleagues to share their recent results to optimize the diagnosis of dry eye disease and the grouping of patients according to disease severity, as well as to suggest treatment regimens. With the introduction of a plethora of new topical agents, even preservative-free compositons, new risk factors for dry eye disease have been identified, such as osmotic stress. Therefore, any therapy could alter the the ocular surface homeostasis and in that even preventive care can impose a risk. It is the intention of this Special Issue to gather data on the most actual, and relevant insights in order to create easily applicable models of dry eye disease, which could facilitate the diagnosis and treatment of this condition, thus alleviating the suffering of patients.

Assoc. Prof. Gysbert van Setten, MD PhD
Guest Editor

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Keywords

  • Definition of Dry eye
  • Key indicators
  • ocular surface diagnostics
  • Staining indices

Published Papers (4 papers)

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Research

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10 pages, 1467 KiB  
Article
Evaluation of Ocular Surface after Cataract Surgery—A Prospective Study
by Agne Sidaraite, Lina Mikalauskiene, Andrzej Grzybowski and Reda Zemaitiene
J. Clin. Med. 2022, 11(15), 4562; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11154562 - 4 Aug 2022
Cited by 3 | Viewed by 2087
Abstract
This study evaluated tear film and ocular surface parameters in patients after cataract surgery. Methods: a prospective clinical study included 48 eyes of 48 patients who underwent uncomplicated phacoemulsification performed by one surgeon. Tear break-up time (TBUT), Schirmer’s I test, Cochet–Bonnet esthesiometry and [...] Read more.
This study evaluated tear film and ocular surface parameters in patients after cataract surgery. Methods: a prospective clinical study included 48 eyes of 48 patients who underwent uncomplicated phacoemulsification performed by one surgeon. Tear break-up time (TBUT), Schirmer’s I test, Cochet–Bonnet esthesiometry and in vivo laser scanning confocal microscopy was carried out and the OSDI questionnaire was filled out. All tests were assessed before and 1 month after the surgery. Results: there were 32 (66.7%) women; 16 (33.3%) men, mean age was 74.08 ± 5.37. Mean TBUT at baseline was 8.6 ± 1.9 s, after the surgery, it was 7.7 ± 2.7 s, p = 0.004. Schirmer’s I test was 8.7 ± 3.9 mm versus 8.1 ± 3.7 mm, p = 0.002. Mean corneal nerve density at baseline was 15.70 ± 2.34 and at the first postoperative month 14.94 ± 1.48 mm/mm2, p = 0.02. The OSDI questionnaire score increased from 12.15 ± 10.34 before the surgery to 13.79 ± 10.88 in the first postoperative month, p = 0.001. Conclusions: the ocular surface was affected 1 month after the cataract surgery: TBUT was shorter, Schirmer’s I test and corneal nerve density were decreased while the OSDI score increased. Full article
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8 pages, 559 KiB  
Article
Changes in Dry Eye Status after Steroid Pulse and Orbital Radiation Therapies in Active Thyroid Eye Disease
by Yasuhiro Takahashi, Aric Vaidya and Hirohiko Kakizaki
J. Clin. Med. 2022, 11(13), 3604; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133604 - 22 Jun 2022
Cited by 2 | Viewed by 1470
Abstract
This prospective, observational study examined changes in dry eye status after steroid pulse and orbital radiation therapies in 16 patients (32 eyes) with active thyroid eye disease (TED). TED status was evaluated through clinical activity score (CAS), margin reflex distance (MRD)-1 and 2, [...] Read more.
This prospective, observational study examined changes in dry eye status after steroid pulse and orbital radiation therapies in 16 patients (32 eyes) with active thyroid eye disease (TED). TED status was evaluated through clinical activity score (CAS), margin reflex distance (MRD)-1 and 2, presence or absence of Graefe’s sign/lid lag, and Hertel exophthalmometric value. Dry eye status was quantified through presence or absence of superior limbic keratoconjunctivitis, corneal fluorescein staining (AD score), tear break-up time, Schirmer test I results, tear meniscus height, and dry eye-related quality of life score. Meibomian gland dysfunction (MGD) was evaluated through Marx line score, eyelid abnormalities (MGD score), meibum expression score, and meibomian gland loss score. Those items were measured before and 6 months after treatment, and the results were statistically compared. Consequently, CAS significantly improved, and MRD-1 significantly decreased after treatment (p < 0.050). Although a part of MGD status improved (p < 0.050), all items regarding dry eye status did not change significantly after treatment (p > 0.050). Steroid pulse and orbital radiation therapies did not largely alter most items regarding dry eye and MGD status. Full article
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12 pages, 1515 KiB  
Article
OSDI Questions on Daily Life Activities Allow to Detect Subclinical Dry Eye in Young Contact Lens Users
by José Ángel Pastor-Zaplana, Fernando Borrás, Juana Gallar and M. Carmen Acosta
J. Clin. Med. 2022, 11(9), 2626; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11092626 - 6 May 2022
Cited by 4 | Viewed by 1917
Abstract
Dry eye disease (DED) is difficult to detect in young contact lens (CL) wearers, who usually have no signs, mild symptoms and an ocular surface disease index (OSDI) below the DED diagnosis values (OSDI ≥ 13). We investigate if some of the 12 [...] Read more.
Dry eye disease (DED) is difficult to detect in young contact lens (CL) wearers, who usually have no signs, mild symptoms and an ocular surface disease index (OSDI) below the DED diagnosis values (OSDI ≥ 13). We investigate if some of the 12 OSDI questions (OSDI A—ocular symptoms; OSDI B—vision-related functionality; OSDI C—environmental triggers) contribute the most to classify young CL as symptomatic. TBUT and tear volume are also measured. Age, gender and refraction error-matched eye glasses (EG) wearers participated as the control. CL and EG data were compared with t-test and z-test. Confusion matrices and logistic correlation analyses were performed to define the contribution of each OSDI question to classify symptomatic subjects. OSDI classified symptomatic CL better than the tear volume or TBUT values. In CL, only OSDI B and C values were significantly higher in symptomatic vs. asymptomatic subjects (p < 0.001), while values of all twelve OSDI questions were significantly higher in symptomatic vs. asymptomatic EG (p < 0.05–0.001). All OSDI questions contribute equally to identify symptomatic EG, while only OSDI B questions on daily life visual functions are significant to classify symptomatic CL wearers at risk to develop DED or at a subclinical stage. CL wearers scoring ≥ 2 on the OSDI B questions should be considered for preventive treatments, even if their clinical sings are scarce or absent. Full article
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Review

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15 pages, 3857 KiB  
Review
Lifitegrast Ophthalmic Solution 5% Is a Safe and Efficient Eyedrop for Dry Eye Disease: A Systematic Review and Meta-Analysis
by Jing-Xing Li, Yi-Yu Tsai, Chun-Ting Lai, You-Ling Li, Ying-Hsuen Wu and Chun-Chi Chiang
J. Clin. Med. 2022, 11(17), 5014; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11175014 - 26 Aug 2022
Cited by 12 | Viewed by 7418
Abstract
Dry eye disease (DED) is a multifactorial disease that causes ocular discomfort and visual impairment on a damaged ocular surface. Lifitegrast, a novel T-cell integrin antagonist, was approved in the United States in July 2016 as a 5% (50 mg/mL) ophthalmic solution for [...] Read more.
Dry eye disease (DED) is a multifactorial disease that causes ocular discomfort and visual impairment on a damaged ocular surface. Lifitegrast, a novel T-cell integrin antagonist, was approved in the United States in July 2016 as a 5% (50 mg/mL) ophthalmic solution for DED management. Currently, no meta-analysis and systemic review based on relevant studies have been conducted. This study aimed to evaluate the efficacy and safety of lifitegrast in patients with DED. We systematically searched Embase, Medline, PubMed, and Web of Science for randomized controlled trials (RCTs) and nonrandomized studies evaluating lifitegrast effects on symptomatic DED. Then, inferior corneal staining score, total corneal staining score (TCSS), nasal lissamine staining score (NLSS), total lissamine staining score, ocular discomfort score (ODS), eye discomfort score (visual analog scale (VAS) score), eye dryness score (EDS), ocular surface disease index score (OSDI-S), and tear break-up time (TBUT) were assessed. Clinical global impression and safety profiles were also evaluated. The studies were pooled in a random-effects model. We included five RCTs, one case–control study, and four longitudinal or retrospective studies, comprising 3197 participants. In the meta-analysis, lifitegrast was superior to the placebo because it improved TCSS, NLSS, TBUT, ODS, eye discomfort score, EDS, and OSDI-Sin DED. However, lifitegrast showed higher risks for ocular and non-ocular treatment-emergent adverse events (TEAEs) overall or at a mild or moderate level. Nonetheless, its incidence of adverse events slightly differed from that in the placebo, especially instillation site discomforts and dysgeusia, thereby considered safe and tolerable. Claims of withdrawal during follow-up caused by TEAEs were extremely rare. Lifitegrast improves DED, although dysgeusia, installation site pain, and irritation may be a concern for some. Overall, most of the adverse events are tolerable. Lifitegrast can alleviate refractory DED and improves patients’ quality of life. Full article
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