Tear Film Research Articles

Effect of the Jiedu Tongluo Shengjin formulation on plasma immunoglobulin G (IgG) levels in patients with primary Sjögren’s syndrome

This study assessed the effect of Jiedu Tongluo Shengjin formulation on plasma IgG levels in pSS patients. 89 pSS patients were randomized into treatment (45 cases; 1 drop-out) and control (44 cases) groups using the random number table method. The control group received hydroxychloroquine sulfate and a placebo dose of Jiedu Tongluo Shengjin. The treatment group received hydroxychloroquine sulfate and the original Jiedu Tongluo Shengjin formulation. The treatment group showed significant decreases in SS disease activity index, TCM syndrome score, plasma IgG, and ESR, and significant increases in tear film break-up time, tear flow rate, salivary flow rate, C3, and C4 levels (p<0.05). No significant changes were observed in the control group (p>0.05). Jiedu Tongluo Shengjin effectively reduced eye and mouth dryness in pSS patients by improving inflammation and immune status.

Blinking characteristics analyzed by a deep learning model and the relationship with tear film stability in children with long-term use of orthokeratology

Blinking characteristics analyzed by a deep learning model and the relationship with tear film stability in children with long-term use of orthokeratology

The effect of water consumption on the aqueous layer of the tear film

The effect of water consumption on the aqueous layer of the tear film

Advances in lacrimal gland organoid development: Techniques and therapeutic applications.

The human lacrimal gland (LG), located above the outer orbital region within the frontal bone socket, is essential in maintaining eye surface health and lubrication. It is firmly anchored to the orbital periosteum by the connective tissue, and it is vital for protecting and lubricating the eye by secreting lacrimal fluid. Disruption in the production, composition, or secretion of lacrimal fluid can lead to dry eye syndrome, a condition characterized by ocular discomfort and potential eye surface damage. This review explores the recent advancements in LG organoid generation using tissues and stem cells, highlighting cutting-edge techniques in biomaterial-based and scaffold-free technologies. Additionally, we shed light on the complex pathophysiology of LG dysfunction, providing insights into the LG physiological roles while identifying strategies for generating LG organoids and exploring their potential clinical applications. Alterations in LG morphology or secretory function can affect the tear film stability and quality, leading to various ocular pathological conditions. This comprehensive review underlines the critical crosslink of LG organoid development with disease modeling and drug screening, underscoring their potential for advancing therapeutic applications.

Pattern of Conjunctival Diseases in North Kordofan State

Background: The conjunctiva is one of the most important elements of the eye because it covers the anterior white sclera and reflects on the eyelids, providing protection and lubrication while also producing mucus, which is an important component of the tear film. It also serves as a protective barrier against germ entry into the eye and aids in immunity. It is highly vascularized and has numerous lymphatic vessels. Some conjunctival disorders are caused by trauma, such as subconjunctival hemorrhage and conjunctival tear, while others are caused by infection, such as trachoma and conjunctivitis. Methodology: The study was carried out at the Ophthalmology Emergency Department of surgery El-Obeid Teaching Hospital and Dr. Khalil's Ophthalmology Center in North Kordofan State, Sudan. It was retrospective, descriptive research. The study sample covered all conjunctival illnesses, data was drawn from the medical record of 1000 patients with varied eye conditions, 175 patients with conjunctival diseases were selected. Results: This study investigated 175 patients with conjunctival abnormalities to determine the frequency of these diseases in North Kordofan state. The findings showed that conjunctival illnesses were more common in men, with 95 out of 175 cases (54%) and 80 out of 175 (46%) being females. The male-to-female ratio was 1.2:1, and the age range of 21-33 years was the most frequent, accounting for 33%. This was followed by the age groups of 33-53 years, 10-20 years, <9 years, and beyond 54 years, with percentages of 20%, 19%, 18%, and 10%, respectively. Subconjunctival hemorrhage was the most common type of conjunctival illness, accounting for 54% of cases, followed by conjunctivitis 17%, pterygium 15%, conjunctival tear 9%, pinguecula 3%, conjunctival nevus 1%, and trachoma. Conclusion: Conjunctival disorders were prevalent in Northern Kordofan state, with the most common being subconjunctival hemorrhage, conjunctivitis, pterygium, and conjunctival tear.

Effects of autologous serum and artificial tears on corneal sensation and tear film stability in patients with mild to moderate xerophthalmia after cataract surgery.

We aimed to evaluate the effects of autologous serum plus artificial tears on corneal sensation and tear film stability in patients with mild to moderate xerophthalmia after cataract surgery. A total of 150 patients with mild to moderate xerophthalmia after one-time cataract surgery from March 2022 to September 2023 were selected and randomly divided into a control group (n = 75) and a study group (n = 75). The control group was treated with artificial tears (polyvinyl alcohol eye drops), while the study group was given autologous serum plus artificial tears. The treatment lasted for four weeks in both groups. The clinical efficacy was observed and adverse reactions were recorded. The clinical effective rate of the study group was higher than that of the control group (96.00% versus 86.67%) (χ2 = 4.127, P < 0.05). After four weeks of treatment, the corneal sensation was superior to that before treatment in both groups, and it was better in the study group than that in the control group (Z = 2.053, P < 0.05). In comparison with the pre-treatment period, the tear film break-up time (BUT) increased, while the corneal fluorescein staining (FL) score and levels of inflammatory factors tumor necrosis factor-α, interleukin-6 (IL-6) and IL-1β dropped in both groups after treatment, and the study group had longer BUT and a lower FL score than those of the control group (t = 6.492, 7.033, 7.140, 4.709 and 3.059, P < 0.05). The incidence rates of adverse reactions were similar between the two groups (χ2 = 0.132, P > 0.05). Autologous serum plus artificial tears can improve the corneal sensation and tear film stability and alleviate inflammatory responses without increasing adverse reactions in patients with mild to moderate xerophthalmia after cataract surgery.

Disclosing long-term tolerance, efficacy and penetration properties of hyaluronic acid-coated latanoprost-loaded liposomes as chronic glaucoma therapy.

Frequent topical administration of hypotensive eye drops in glaucoma patients may lead to the development of dry eye disease (DED) symptoms, because of tear film destabilization and the adverse effects associated with antiglaucoma formulations. To address all this, in the current study preservative-free latanoprost-loaded (0.005% w/v) synthetic phosphatidylcholine (1,2-dioleoyl-sn-glycero-3-phosphocholine 0.75% w/v, 1,2-dimyristoyl-sn-glycero-3-phosphocholine 0.25% w/v) liposomes dispersed in the mucoadhesive polymer hyaluronic acid (0.2% w/v), containing the osmoprotective ingredients betaine (0.40% w/v) and leucine (0.90% w/v) (LAT-HA-LIP), have been prepared and further characterised. Permeation and retention evaluations on a validated ex vivo porcine eye model revealed that the active metabolite latanoprost acid was quantified only starting from LAT-HA-LIP once passing conjunctiva, sclera and choroid compared to the marketed latanoprost (0.005% w/v) benchmark (MF). The liposomal formulation outperformed MF when applied to the corneal tissue. Additionally, distribution and interactions within corneal and scleral tissues were investigated by means of two-photon microscopy with liposomal formulations containing coumarin-6. Furthermore, acute and chronic tolerance studies on rabbits revealed no signs of discomfort or ocular damage. Schirmer's test, tear osmolarity, tear breakup time (TBUT) and fluorescence staining evaluated through the Oxford grading scale, were assessed as DED diagnostic parameters over a 25-day monitoring period; LAT-HA-LIP consistently maintained levels comparable to physiological solution (0.9% w/v NaCl) used as control, with a slight increase of TBUT values from day 15 (6.00±0.63s for control, 7.00±0.78s for LAT-HA-LIP at day 15, p=0.0066). A daily topical application of LAT-HA-LIP for 15 consecutive days, effectively lowered IOP in a sustained way (2.51-3.88mmHg mean IOP reduction over the 5-15-day period). These results highlight the clinical relevance of the proposed technological platform, able to provide IOP reduction during the simulated long-term administration and simultaneous ocular surface protection with potential for the treatment of glaucoma.

Contact Lenses in Therapeutic Care: A Comprehensive Review of Past Innovations, Present Applications, and Future Directions.

Contact lenses have become integral tools in the realm of ocular therapeutics, extending beyond their primary function of refractive correction to encompass a diverse array of therapeutic applications. This review explores the evolving role of contact lenses in managing various ocular conditions, highlighting their efficacy in enhancing patient outcomes. Initially developed to correct refractive errors, contact lenses now serve as effective vehicles for delivering medications directly to the ocular surface, offering targeted treatment for conditions such as dry eye syndrome and corneal ulcers. Their ability to provide sustained moisture and facilitate drug absorption makes them indispensable in promoting corneal healing and managing chronic ocular surface diseases. Specialized contact lenses designed for irregular corneas, such as those affected by keratoconus, provide both optical correction and structural support, significantly improving visual acuity and patient comfort. Additionally, orthokeratology lenses have shown promise in controlling myopia progression in children by reshaping the cornea overnight, thereby reducing reliance on corrective eyewear during waking hours. In post-surgical settings, therapeutic contact lenses aid in epithelial regeneration and minimize discomfort, accelerating recovery and improving surgical outcomes. They also play a crucial role in protecting the cornea from external irritants and promoting a stable tear film, crucial for maintaining ocular health. Looking ahead, ongoing advancements in contact lens materials and designs promise further innovation in ocular therapeutics, paving the way for personalized treatment strategies and improved patient care. As such, contact lenses continue to evolve as essential therapeutic tools, offering tailored solutions for a spectrum of ocular conditions and contributing to enhanced quality of life for patients worldwide.

Evaluation of dry eye parameters and meibomian gland function using the Lipiscan system in male androgenetic alopecia patients

ABSTRACT Clinical relevance The prevalence of male androgenetic alopecia is increasing worldwide. Evaluation of dry eye parameters and meibomian glands of male androgenetic alopecia patients may help to better understand the effect of this disease on dry eye and to provide appropriate treatment for these patients. Background The aim of this work is to evaluate the relationship between male androgenetic alopecia, dry eye, and meibomian gland function. Method A total of 80 eyes of 80 patients, 40 eyes of 40 patients diagnosed with male androgenetic alopecia, and 40 eyes of 40 healthy men were included. The presence of dry eye was evaluated with the Schirmer I test, invasive tear film break-up time (TBUT), Oxford scale scoring (cornea and conjunctiva staining), and the Ocular Surface Disease Index score. Evaluation of the eyelid meibomian glands was performed using the LipiScan System, and the descending meibomian glands for each eyelid were scored proportionally. Results The average age of patients with androgenetic alopecia and the control group is 41.93 ± 6.65 and 40.75 ± 7.32 years, respectively (p = 0.413). The mean Schirmer I test score was statistically significantly lower in the androgenetic alopecia group (p = 0.001), and the mean Ocular Surface Disease Index score was significantly higher in the androgenetic alopecia group compared to the control group (p = 0.001). In the androgenetic alopecia group, mean TBUT was lower (p = 0.001) and mean Oxford scale score was higher (p = 0.009). Total, upper, and lower meibomian gland scores were statistically significantly higher in the androgenetic alopecia group (p = 0.001, p = 0.001, and p = 0.001, respectively). Conclusion There may be an association between male androgenetic alopecia and dry eye and meibomian gland dysfunction. Male individuals with androgenetic alopecia should be closely followed for dry eye and meibomian gland dysfunction.

The influence of time spent viewing Video Display Terminal, sleep, anxiety and depression on tear film lipid layer thickness

The influence of time spent viewing Video Display Terminal, sleep, anxiety and depression on tear film lipid layer thickness

Clinical efficacy of 0.1% cyclosporine A in dry eye patients with inadequate responses to 0.05% cyclosporine A: a switching, prospective, open-label, multicenter study

PurposeTo assess the clinical efficacy of 0.1% cyclosporine A (CsA) in dry eye patients who have shown inadequate responses to previous treatment with 0.05% CsA.DesignThis study was designed as a switching, prospective, multicenter, 12-week, open-label study.MethodsPatients with dry eye disease (DED), who experienced inadequate responses to at least 3 months of treatment with 0.05% cyclosporine, were enrolled in this study. Clinical evaluations included the National Eye Institute (NEI) corneal and conjunctival staining scores, tear film break-up time (TF-BUT), Symptom Assessment in Dry Eye (SANDE), ocular discomfort scale (ODS), and tear volume. These parameters were assessed at baseline, and again at 4, 8, and 12 weeks after switching to 0.1% CsA.ResultsNinety-one patients were enrolled in the study, and 70 patients completed the trial. Statistical analysis was performed on the full analysis set (FAS) using the Markov Chain Monte Carlo (MCMC) method to account for missing data. After switching to 0.1% CsA, subjective symptoms assessed by the Symptom Assessment in Dry Eye (SANDE) and Ocular Discomfort Scale (ODS) showed improvement (p < 0.0001). Objective signs of dry eye, including the National Eye Institute (NEI) score, tear film break-up time (TF-BUT), and tear volume also improved (p < 0.0001).ConclusionsIn patients with dry eye disease (DED) who exhibited inadequate responses to 0.05% cyclosporine A (CsA), switching to 0.1% CsA resulted in significant improvements in both subjective symptoms and objective clinical signs. This finding suggests that higher concentrations of CsA may be more effective in treating individuals with moderate to severe DED.

Investigating the Relative Importance of Tear Homeostatic Signs for the Diagnosis of Dry Eye Disease.

Disease misdiagnosis is more likely if standardised diagnostic criteria are not used. This study systematically examined the effect on diagnosing dry eye disease (DED), when tests for evaluating tear film homeostasis were included/excluded from a multi-test protocol. For 1427 participants across five sites, data for the full suite of diagnostic tests defined in the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Diagnostic Methodology report algorithm were evaluated; diagnostic sensitivity was calculated when individual signs were removed, and when different combinations of signs were required. Evaluating just one of the three TFOS DEWS II homeostatic signs resulted in between 12.3% and 36.2% of patients who met the DED diagnostic criteria not being assigned this diagnosis. While comprehensive ocular surface staining evaluation, including corneal, conjunctival and lid margin staining, in combination with symptoms had the highest sensitivity (87.7%) of the three markers, the sensitivity dropped to 44.6% if only corneal staining was evaluated. Omitting either non-invasive tear breakup time or osmolarity each dropped the sensitivity by <5%. The prevalence of DED was substantially reduced if a diagnosis required symptoms and two of the three signs to be present (by 43.7% to 61.2%) and by 65.9% if all three signs indicating a loss of tear film homeostasis were required. The analysis did not change significantly across differing severities of DED symptoms. The TFOS DEWS II diagnostic algorithm of symptoms plus assessing for a tear film or ocular surface sign can be considered a robust and appropriate approach for DED diagnosis.

Mucin1 N-domain variant contributes to dry eye syndrome in diabetes by increasing immature mucus secretory granules.

Diabetes-associated dry eye syndrome (DMDES) affects 20-54 % of diabetes, leading to ocular irritation and blurry vision. Decreased conjunctival goblet cell mucus secretion is one of the major pathological processes of DMDES. This study aims to investigate the mechanism of mucus granule maturation and secretion disturbance in DMDES. Tear samples from diabetic patients with and without dry eye syndrome were analyzed by mass spectrometry to identify proteins associated with ocular mucous layer reduction. The N-terminal domain fragment of Mucin1 (MUC1-ND) was transfected into the mouse conjunctiva to investigate alterations in goblet cell mucus secretion. Protein localization and granule morphology were explored through transmission electron microscopy with colloidal gold labeling and immunohistochemistry. Immunofluorescence, co-immunoprecipitation, and integrative computational modeling of protein interactions were employed to explore protein-protein interactions. Tear proteomic analysis revealed significantly elevated MUC1-ND levels in tears from DMDES patients, which correlated with reduced goblet cell mucus secretion and tear film instability. Upregulation of MUC1-ND in mice conjunctiva inhibited the maturation of secretory mucus granules, contributing to tear mucous layer reduction. Protein docking and co-immunoprecipitation analysis demonstrated that the binding of MUC1-ND and Syntaxin6 prevents granule fusion and maintains the immature state of secretory granules, which leads to reduced mucus secretion. In DMDES, MUC1-ND binds with Syntaxin6 to disrupt the fusion and maturation of secretory mucus granules in conjunctival goblet cells, which provides a new insight into DMDES pathophysiology.

Diagnostic and Therapeutic Utility of Extracellular Vesicles in Ocular Disease.

Extracellular vesicles (EVs) are lipid bilayer particles released by virtually all cells, with prominent roles in both physiological and pathological processes. The size, number, and molecular composition of released EVs correlate to the cells of origin, modulated by the cell's environment and pathologic state. The proteins, DNA, RNA, and protein cargo carried by EVs are protected by degradation, with a prominent role in targeted intercellular signaling. These properties make EVs salient targets as both carriers of biomarkers and potential therapeutic delivery vehicles. The majority of EV research has focused on blood, urine, saliva, and cerebrospinal fluid due to easy accessibility. EVs have also been identified and studied in all ocular biofluids, including the vitreous humor, the aqueous humor, and the tear film, and the study of EVs in ocular disease is a new, promising, and underexplored direction with unique challenges and considerations. This review covers recent advances in the diagnostic and therapeutic use of ocular EVs, with a focus on human applications and key preceding in vitro and in vivo animal studies. We also discuss future directions based on the study of EVs in other organ systems and disease sates.

N-acetylcysteine and chitosan conjugate modified dexamethasone nanostructured lipid carriers: Enhanced permeability, precorneal retention and lower inflammation for the treatment of dry eye syndrome.

Dexamethasone (Dex) is a primary medication for treating dry eye syndrome, and tobramycin-dexamethasone eye drops are commercially available. However, the eye's complex physiological environment reduces its bioavailability, and repeated use can lead to significant systemic toxicity and side effects. This study introduces a novel conjugate of chitosan (CS) and N-acetylcysteine (NAC), a bioadhesive material, which was grafted onto the surface of a Dex-supported nanostructured lipid carrier (NLC) to develop an innovative nanoparticle lipid ocular drug delivery system (CS-NAC@Dex-NLC). The enhancements afforded by CS-NAC, such as adhesion, osmotic, and targeting properties, address the limitations of traditional eye drops. NMR characterization confirmed the successful synthesis of the copolymer (CS-NAC). Particle size (PS), zeta potential, and transmission electron microscopy (TEM) verified the proper formation of the CS-NAC@Dex-NLC system. Cytotoxicity tests confirmed its excellent biocompatibility and safety. Cellular uptake studies showed that CS-NAC@Dex-NLC achieved the highest efficiency. Pharmacokinetic assessments revealed a significant increase in Dex's bioavailability in tears and aqueous humor. In vitro corneal penetration and in vivo imaging experiments demonstrated effective corneal penetration and retention, enhancing the drug's duration on the ocular surface and overcoming the barrier effect. Pharmacodynamic studies in rabbits with dry eye syndrome indicated that CS-NAC@Dex-NLC effectively alleviates symptoms, repairs corneal damage, and stabilizes the tear film. ELISA results showed a reduction in inflammation caused by dry eye. These findings suggest that CS-NAC@Dex-NLC is a promising vector for dry eye treatment, offering significant clinical relevance.

Diagnostic Cut-Off Values Based on Lipid Layer Pattern for Dry Eye Disease Subtypes Assessment.

Background: The aim of the present study was to establish a cut-off value of the Lipid Layer Pattern (LLP) between participants with different subtypes of Dry Eye Disease (DED) including Deficient Dry Eye (ADDE), Evaporative Dry Eye (EDE), and Mixed Dry Eye (MDE). Methods: 240 participants diagnosed with DED according to the Tear Film and Ocular Surface Society in the Dry Eye Workshop II guidelines were included in the study. Tear Meniscus Height (TMH) using the Tearscope illumination and Meibomian Gland Loss Area (MGLA) using the Keratograph 5M were assessed to categorize the participants into an ADDE group, EDE group, or MDE group. Then, the LLP was assessed using the Tearscope following the Guillon (LLP-G) and Colour (LLP-C) schemes. Results: Receiver Operating Characteristics (ROC) showed that both LLP-G and LLP-C have no diagnostic potential in distinguishing between ADDE and EDE participants (both p ≥ 0.724). However, to differentiate the ADDE participants from the MDE, ROC procedures showed a good diagnostic potential with cut-off values of Closed Meshwork-Wave (AUC ± SD = 0.609 ± 0.049, p = 0.038, sensitivity: 23.9%; specificity: 76.1%) and Grey-White (AUC ± SD = 0.611 ± 0.050, p = 0.034, sensitivity: 40.7%; specificity: 73.9%) for LLP-G and LLP-C, respectively. Also, a significant potential to distinguish between the EDE from MDE participants was found, with cut-off values of Closed Meshwork (AUC ± SD = 0.604 ± 0.049, p = 0.043, sensitivity: 40.8%; specificity: 76.1%) and Grey-White (AUC ± SD = 0.604 ± 0.051, p = 0.038, sensitivity: 44.7%; specificity: 73.9%) for LLP-G and LLP-C, respectively. Conclusions: Using the Tearscope, both LLP-G and LLP-C has diagnostic potential to distinguish MDE participants from the other subtypes of DED.

Repeatability of lipid layer thickness using LipiView® following removal of contact lenses and its relationship to comfort.

To assess the repeatability of lipid layer thickness (LLT) measurement using the LipiView® interferometer after daily disposable contact lens (CL) wear and correlation with ocular comfort in soft contact lens wearers. A prospective study was conducted over two consecutive months, wherein CL wearers (n = 20) wore either Somofilcon A or Verofilcon A daily disposable CLs in a crossover design, switching lenses after 1 month. The pre-corneal tear film LLT was measured at the end of each month after CLs had been worn for at least 6 h. Using the LipiView® interferometer, three measurements of the LLT (average, maximum and minimum) were recorded. Subjects' symptoms were evaluated with the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) and correlations sought between post-lens pre-corneal tear film LLT and symptoms. The average, maximum and minimum intraclass correlation coefficients (ICC) of LLT measurements at baseline were 0.57, 0.39 and 0.66, respectively, indicating poor (ICC < 0.4) to moderate (≥0.4, <0.75) repeatability. Coefficients of repeatability (CR) were 20.4, 24.8 and 20.8, respectively. After daily disposable CL wear, the ICC values were 0.66, 0.72 and 0.63 (indicating moderate repeatability), with CR values of 25.7, 32.0 and 23.3, respectively. Although all the ICC values of the pre-corneal LLT increased after daily disposable lens wear indicating improved repeatability, the CR values also increased, indicating larger spread of data. However, in both cases, these increases were not significantly different from baseline. There were no significant differences in pre-corneal LLT between the two lens types and no significant correlation with comfort scores (baseline: r = -0.11, p = 0.67; Verofilcon A lenses: r = 0.19, p = 0.45; Somofilcon A lenses r = 0.13, p = 0.62) for either lens. The repeatability of average, maximum and minimum LLT measurements performed by LipiView remained stable during CL wear. There was no significant correlation between LLT and comfort scores.

Tear film lipid layer thickness and blink dynamics in patients with blepharospasm

BackgroundThis study investigates the effect of botulinum toxin A on lipid layer thickness (LLT) and blink dynamics in patients with benign essential blepharospasm (BEB) compared to dry eye disease (DED) patients.MethodsWe reviewed the medical records of patients with dry eye disease (DED) and BEB treated with botulinum toxin A (BoT A) injections. Data on demographics, lipid layer thickness (LLT), meiboscore, and blink dynamics measured using a LipiView II interferometer before and 2 months after BoT A were collected.ResultsEach 28 eyes from 28 patients with BEB and age- and sex-matched patients with DED were included. When comparing blink dynamics, complete blink rate was significantly higher in the pre-injection BEB group compared to the DED group (5.25 ± 4.32 times/20 s vs. 2.43 ± 2.82 times/20 s, p = 0.0055). In tear film lipid profiles analyzed in BEB patients at pre-injection and 2-month follow-up after injection, average LLT significantly increased after injection (72.4 ± 22.7 nm to 83.0 ± 22.2 nm, p = 0.0215). Diabetes and young age were associated factors influencing the LLT increase. Significant increase in LLT was observed post-injection, with specific demographic factors, including diabetes and age, associated with this improvement. Additionally, blink dynamics showed a decrease in complete blink rate post-injection.ConclusionsThese findings suggest that BoT-A may alleviate BEB symptoms, but ophthalmologists should carefully interpret LLT and blink patterns in BEB patients due to potential overestimations of blink efficacy by the interferometer.

Multicomponent Dietary Supplementation: Impact on Tear Secretion and Ocular Surface Inflammation in Dry Eye Syndrome Patients.

Dry eye syndrome (DES) is a prevalent ocular condition characterized by tear film instability, inflammation, and discomfort, affecting millions worldwide. DES is related to oxidative stress imbalance and ocular surface inflammation, which are important factors in the development of the condition. Recent studies have demonstrated that fish oil, lutein, and zeaxanthin possess anti-inflammatory and antioxidant properties. This study investigated the efficacy of a multicomponent dietary supplement in improving tear secretion and mitigating ocular surface inflammation in patients with DES. It was an open-label intervention trial. In total, 52 participants were randomly assigned to control (n = 23) and supplement (45 mg/day eicosapentaenoic acid, 30 mg/day docosahexaenoic acid, 30 mg/day lutein, and 1.8 mg/day zeaxanthin; n = 29) groups for 12 weeks. The participants were evaluated using Schirmer's test and the ocular surface disease index (OSDI) as ocular surface parameters. Moreover, blood or tear oxidative stress, antioxidant capacities, and tear inflammatory indicators were measured at weeks 0 and 12. The results indicated a significant increase in tear secretion and a significant reduction in OSDI scores in the supplement group. Additionally, inflammatory markers, such as interleukin (IL)-6 and IL-8, significantly decreased after the intervention. However, the OSDI of the supplement group significantly improved by 6.60 points (β = -6.60, p = 0.01). These findings support the potential of targeted nutritional supplementation as a safe and effective strategy for alleviating DES symptoms, offering an alternative to conventional treatments that exclusively focus on symptom management. This study highlights the role of specific nutrients in modulating tear production and inflammation, thereby providing a foundation for dietary approaches to DES treatment. Future research should explore the long-term benefits of such interventions and their impact on overall ocular health.

Therapeutic benefits of glycerol in dry eye disease

Dry eye disease (DED) is one of the most commonly diagnosed eye disorders, with a prevalence ranging from 5 to 50%, depending on the geographic location. DED is a multifactorial disorder of the tears and ocular surface, which results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is also accompanied by increased osmolarity of the tear film and inflammation of the surface of the eye. Multiple therapeutic agents have been used to treat DED, with glycerol emerging as a promising component of ophthalmic preparations, due to its humectant, lubricant, demulcent, and osmoprotective properties. This review aims to evaluate the current evidence concerning the therapeutic benefits of glycerol in managing DED, focusing on its possible mechanisms of action, clinical efficacy, and potential advantages over other treatments.