Abstract
Dry eye disease (DED) is the most common ocular surface disease, characterized by insufficient production and/or instability of the tear film. Tear substitutes are usually the first line of treatment for patients with DED. Despite the large variety of tear substitutes available on the market, few studies have been performed to compare their performance. There is a need to better understand the specific mechanical and pharmacological roles of each ingredient composing the different formulations. In this review, we describe the main categories of ingredients composing tear substitutes (e.g., viscosity-enhancing agents, electrolytes, osmo-protectants, antioxidants, lipids, surfactants and preservatives) as well as their effects on the ocular surface, and we provide insight into how certain components of tear substitutes may promote corneal wound healing, and/or counteract inflammation. Based on these considerations, we propose an approach to select the most appropriate tear substitute formulations according to the predominant etiological causes of DED.
Highlights
Dry eye disease (DED) is a condition that may affect between 5% and 50% of the population, depending on age, sex and ethnicity [1]
According to the TFOS DEWS II report, DED is defined as “ocular surface disease characterized by a loss of homeostasis of the tear film, and accompanied by ocular signs, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles” [1]
This study showed that the tear substitutes preferred by a patient do not consistently match with the ATs providing the greatest improvement on objective clinical signs
Summary
Dry eye disease (DED) is a condition that may affect between 5% and 50% of the population, depending on age, sex and ethnicity [1]. According to the TFOS DEWS II report, DED is defined as “ocular surface disease characterized by a loss of homeostasis of the tear film, and accompanied by ocular signs, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles” [1]. This disease causes ocular discomfort, fatigue and visual disturbance, which significantly affect the quality of life of patients [1]. We will review the preclinical and clinical outcomes of the variety of ingredients composing tear substitutes, and we will describe how these ingredients may target one or several of the underlying mechanisms of DED
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