Abstract
Background: Dry eye disease (DED) is a multifactorial inflammatory disease of the ocular surface. It is hypothesized that dysbiosis of the conjunctival microbiota contributes to the development of DED. However, species-level compositions of the conjunctival microbiota in DED and the potential dysbiosis involving microorganisms other than bacteria remain largely uncharacterized. Methods: We collected conjunctival impression samples from a cohort of 95 individuals, including 47 patients with DED and 48 healthy subjects. We examined the conjunctival microbiota of these samples using shotgun metagenomic sequencing and analyzed microbial dysbiosis in DED at the species level. Results: The conjunctival microbiota in DED exhibited a decreased α-diversity and an increased inter-individual variation. The α-diversity of female patients with DED was higher than that of male patients. Despite a decreased prevalence in DED, 23 microbial species were identified to show abnormally high abundance in DED samples positive for the species. Among these species, a fungal species Malassezia globosa was enriched female patients. In addition, distinct patterns of associations with disease status were observed for different species of the same genus. For DED subtypes, Staphylococcus aureus and S. capitis were associated with meibomian gland dysfunction (MGD), whereas S. hominis was enriched in patients solely with aqueous tear deficiency (ATD). The microbiota of patients with a mixed type of diagnosis was more similar to MGD patients than ATD patients. Conclusion: We demonstrated that the conjunctival microbiota dysbiosis in DED is characterized by significant heterogeneity. Microbial signatures may offer novel insights into the complicated etiology of DED and potentially promote the development of personalized treatment for DED in the future.
Highlights
Dry eye disease (DED) is a multifactorial ocular surface disease with a prevalence ranging from 5 to 50% worldwide (Craig et al, 2017; Stapleton et al, 2017)
Aqueous deficient dry eye is featured by decreased tear secretion, whereas evaporative dry eye is featured by increased tear evaporation caused by meibomian gland dysfunction (MGD)
For healthy individuals and patients with different subtypes of DED, Actinobacteria, Firmicutes, Proteobacteria, and Bacteroidetes accounted for the majority of the conjunctival microbiota
Summary
Dry eye disease (DED) is a multifactorial ocular surface disease with a prevalence ranging from 5 to 50% worldwide (Craig et al, 2017; Stapleton et al, 2017). There are two major types of dry eye, including aqueous deficient and evaporative dry eye (Craig et al, 2017). Aqueous deficient dry eye is featured by decreased tear secretion, whereas evaporative dry eye is featured by increased tear evaporation caused by meibomian gland dysfunction (MGD). A hybrid form of dry eye (i.e., a mixed type diagnosis of ATD and MGD) has been proposed (Craig et al, 2017). Dry eye disease (DED) is a multifactorial inflammatory disease of the ocular surface. Species-level compositions of the conjunctival microbiota in DED and the potential dysbiosis involving microorganisms other than bacteria remain largely uncharacterized
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