Abstract
Concomitant exotropia have obvious symptoms of eye discomfort in adults, and the presence of ocular surface inflammation in patients may be important mediators between concomitant exotropia and dry eye. Oculus Keratograph eye comprehensive analyzer was performed to detect noninvasive tear break time, noninvasive tear height, and eye red index, while the ocular surface disease index and schirmer I testing were made. The levels of IL-6, IL-10, IL-17A, IL-12P70, INF-γ, and TNF-α were detected in tears in patients with concomitant exotropia and healthy controls matched by age and gender through the Simoa technology. IL-6 was significantly higher in patients with concomitant exotropia (4.683 ± 1.329) pg/mL than that in normal group (1.455 ± 0.391) pg/mL, p = 0.0304. TNF-α was also significantly higher in patients (0.2095 ± 0.0703) pg/mL than normal group (0.0513 ± 0.0149) pg/mL, p = 0.0397. The levels of inflammatory factors in strabismic patients vs. normal controls were as follows: IL-17A (0.1551 pg/mL︰0.0793 pg/mL), IL-10 (0.3358 pg/mL︰0.0513 pg/mL), IL-12p70 (0.0253 pg/mL︰0.0099 pg/mL), and INF-γ (0.0284 pg/mL︰0.009 pg/mL) were detected, and the median of them in concomitant strabismus was 1.96-6.55-fold as much as the control group. High levels of inflammatory cytokines in tears of patients with concomitant exotropia, which may be a potentially factor promoted the occurrence of dry eye in the patients with concomitant exotropia.
Highlights
Strabismus is a disease of eye deviation caused by the imbalance of external eye muscles in both eyes
The ocular surface disease index (OSDI), the height of the river of tears, the tear film rupture time, the Schirmer I testing, and the eye red index were measured in 66 patients with concomitant exotropia including adults and children
We found that adults had obvious dry eyerelated symptoms in concomitant exotropia, while children had no significant difference compared to the control group
Summary
Strabismus is a disease of eye deviation caused by the imbalance of external eye muscles in both eyes. Previous study had found that the height of the river of tears is reduced and the tear film is unstable, and the eye red index is increased in concomitant exotropia [1]. Giannaccare et al hypothesized that long-term deviation of the eyeball from its primary location could lead to chronic changes in the ocular surface, which could result in dry eyes through two possible mechanisms [2]. Abnormal anatomical and functional relationships between the eyelids and the eyeball increase mechanical friction to the conjunctival epithelium, leading to microtrauma associated with blinking [2]. Mechanical damage to the conjunctival epithelium caused by tear film instability further activates a series of inflammatory events, and long-term
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