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mgr farm. z Apteki Zdrowie Poznań 29 Posts View posts
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Dry eye: from pathophysiology to modern therapies
Introduction
Dry eye disease (DED) poses a serious threat to eye health, leading to numerous complications, including corneal epithelial defects. Over the past two decades, there have been significant advances in the treatment of dry eye syndrome, focusing on tear secretion stimulation, anti-inflammatory therapies, and immune regulation.
Microenvironment of the ocular surface
The ocular surface microenvironment refers to the environmental conditions on the outer surface of the eyeball and its surrounding structures. This includes the eyelid skin, conjunctiva, cornea and tear ducts.
Eyelid skin: The skin of the eyelids contains sebaceous and sweat glands, which can affect the moisture status and overall condition of the eye. Dirt and bacteria can also settle on eyelid skin, which can lead to various problems such as eyelid inflammation and sebaceous gland infection.
Conjunctiva: Microorganisms on the surface of the conjunctiva play an important role in maintaining eye health. This microflora helps protect against pathogens, supports immune processes and maintains the balance of the microbiome.
Cornea: The cornea is the transparent front part of the eyeball. Its surface is important for proper vision. However, the cornea's microenvironment can be susceptible to various problems, such as infections or mechanical damage. By taking care of proper eye hygiene and lubrication, you can help maintain the health of the cornea.
Tear ducts: The tear ducts consist of the lacrimal glands, tear ducts, tear sac and tear ducts. The balance of tear production and proper drainage is crucial to maintaining the microenvironment of the eye. Problems with tear drainage or overproduction can lead to inflammation and irritation.
Associations between DED and systemic diseases
Dry eye syndrome (DED), also known as dry eye syndrome or keratoconjunctivitis sicca, can be associated with various systemic diseases. Here are some diseases that may be associated with dry eye syndrome:
Autoimmune diseases:
- Rheumatoid arthritis (RA): RA is an autoimmune disease in which the immune system attacks the joints.
- People with RA may be more susceptible to developing dry eye syndrome.
- Sjögren's syndrome: This is also an autoimmune disease in which the immune system attacks the lacrimal glands and salivary glands, leading to dry eyes and mouth .
Systemic diseases:
- Systemic scleroderma (scleroderma):
- This disease is characterized by excessive tissue fibrosis, which can affect the tear glands and lead to dry eye syndrome.
- Thyroid diseases: Thyroid abnormalities, such as Hashimoto's disease or hyperthyroidism, can affect eye conditions, including dry eye syndrome .
Inflammatory diseases:
- Inflammatory bowel diseases: Diseases such
- as Crohn's disease or ulcerative colitis can be associated with dry eye syndrome.
- Systemic Lupus
- : Lupus is a chronic autoimmune inflammatory disease that can affect various organs, including the eyes .
Diabetes:
People with diabetes may be more susceptible to eye health problems, including dry eye syndrome.
Taking medications:
Certain medications, such as antihistamines, diuretics, antidepressants, antihistamines and drugs used to treat high blood pressure, can cause dry eyes as a side effect.
Surgical procedures:
Some surgical procedures, especially those that affect the nerves or tear glands, can reduce tear production and lead to dry eye syndrome.
Tear film-oriented diagnosis and therapy
Tear film-oriented diagnosis is a diagnostic approach to assess the quality and quantity of tears to understand the causes of dry eye problems. Therapy focuses on relieving symptoms and improving the patient's quality of life. Here are some aspects of tear film-oriented diagnosis and therapy:
Diagnosis:
Tests to evaluate tear production:
- Schirmer test: Measurement of the amount of tears produced using special absorption papers placed in the lower eyelid.
- Can be performed with or without the use of anesthesia.
- Break-up Time (BUT) Test:
- Determines the amount of time that elapses between the time the eye is closed and the first signs of tear film breakage.
- Dye Test: Involves the application ofdye to
- the eye to assess the integrity of the tear film and identify any damage to the surface of the eye.
Tear film testing:
- Tear Composition
- Assessment: Analysis of tear composition can help understand whether deficiencies in tear components are contributing to tear film problems.
- Microscopic Examination of Ocular Epithelial Cells: Helps identify possible damage to the ocular surface associated with tear film problems .
Topical and general therapies
Dry eye syndrome (Sjögren's) is an autoimmune disease in which the immune system attacks and destroys the tear glands, leading to problems with tear production. Topical and general therapies are used to treat the symptoms of this condition.
Topical therapies:
- Artificial tears:
- The use of artificial tears in the form of drops or gel helps to moisten the surface of the eye and relieve symptoms of dryness.
- Protective gels or ointments: Some preparations in the form of gels or ointments can be used at night to protect the surface of the eye and keep it moist while sleeping.
- Inflammatory treatments :
- Corticosteroid eye drops can be used for symptoms of inflammation.
- Immunosuppressive treatment
- :
- For severe symptoms, your doctor may prescribe topical immunosuppressants to help control the autoimmune response.
General therapies:
- Omega-3 supplementation: Supplements containing omega-3 fatty acids, such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), may help improve tear quality.
- Anti-inflammatory drugs
- :
- Non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce inflammation and pain.
- Immunomodulatory drugs :
- Disease-modifying drugs (DMARDs), such as hydroxychloroquine, may be used to control the autoimmune response.
- Hormonal treatment :
- Hormone replacement therapies, especially in menopausal women, can be used to alleviate dryness symptoms. Avoiding
- smoke, wind and air conditioning, using contact lenses as directed, and proper eye hygiene can help alleviate symptoms
- .
The future of DED treatment
The future of Dry Eye Syndrome (DED) treatment promises innovative approaches based on modern technology and more precise methods. Several research areas point to potential developments in the treatment of Dry Eye Syndrome:
- Gene and cell therapies: Research into the use of gene and cell therapies is expanding.
- This may include the introduction of healthy genes or stem cells to regenerate damaged tear cells or ocular surface cells.
- Biological drugs: Biological drugs that are specifically designed to interact with specific molecular targets may offer a more precise and effective treatment for Dry Eye Syndrome, particularly in the context of autoimmune diseases.
- Smart technologies: The development of wearable technologies
- ,
- such as smart contact lenses and eyeglasses, may enable real-time monitoring and regulation of ocular conditions
- .
- These technologies can provide diagnostic data and adjust delivered lubricants as needed.
- Enzyme inhib itors
- : Research into enzyme inhibitors that can control the activity of enzymes responsible for tear film breakdown could lead to new therapeutic approaches.
- Light therapy :
- Light is being investigated as a potential therapeutic agent for Dry Eye Syndrome.
- Light therapy may help regulate the diurnal rhythm of tear production and improve the eye's ability to maintain a proper tear film.
- Monoclonal antibody drugs
- : Monoclonal antibody
- drugs that target specific molecules associated with Dry Eye Syndrome pathology may be a promising area of research.
- Anti-reflux drugs: Innovative drugs that affect tear outflow and regulate the balance of tear production and outflow may be key to treating Dry Eye Syndrome.
- Microbiota research :
- Research into the impact of the microbiota on eye health and the tear film may lead to new treatment strategies, including the use of probiotics to improve eye health.
New developments in the treatment of eye diseases
Recent years have brought many advances in the treatment of eye diseases, including dry eye. Below are some new developments in the treatment of these conditions, but it is always important to consult an eye doctor for accurate information and recommendations.
Pharmacological treatment of dry eye:
New eye drops: New eye drop formulations have emerged that contain moisturizing ingredients, irritation-relieving substances and retinoids. These substances are designed to improve the hydration of the eye and relieve the symptoms of dry eye.
Innovative therapies:
Biological therapies: Biological therapies are used in some cases, especially in autoimmune diseases associated with dry eye. Examples include drugs that affect the immune system to reduce inflammation.
Laser treatment:
Laser therapies for retinal diseases: Various laser techniques are increasingly being used to treat eye diseases such as diabetic retinopathy and macular degeneration, which can improve blood circulation in the eye and reduce damage.
Contact lens development:
Contact lenses with wetting technology: Contact lens manufacturers have succeeded in introducing new technologies that provide better lubrication to the eye, reducing the discomfort associated with dry eye.
Gene therapy research:
Gene therapies for treating retinal diseases: Clinical trials conducted around the world are exploring the possibility of using gene therapy to treat various eye diseases, including inherited retinal disorders.
Summary
As research and technological advancements continue, the treatment of Dry Eye Syndrome can be expected to become more precise, effective and tailored to individual patients' needs. The introduction of innovative therapies can significantly improve the quality of life for those affected by Dry Eye Syndrome, especially for patients who do not respond satisfactorily to current standard forms of treatment.
Bibliography
- Smith J. et al, "Advances in Dry Eye Disease Treatment: A Review,"
- Current Opinion in Ophthalmology, 2019.
- Chen Y. et al., "Oxidative Stress and Dry Eye: A Review,"
- Current Eye Research, 2015.
- Stevenson W. et al., "Dry Eye Disease: An Immune-Mediated Ocular Surface Disorder," Archives of Ophthalmology, 2012 .