Increased Tear Film Osmolarity Research Articles

Treatment of Dry Eye Disease (DED) in Asia: Strategies for Short Tear Film Breakup Time-Type DED.

Dry eye disease (DED) is a multifactorial disorder in which tear fluid homeostasis is lost, resulting in increased tear film osmolarity and ocular surface irritation. In Asia, the short tear film breakup time-type DED, which has become a global problem in recent years, is common. While the mainstay of DED treatment in the West is the suppression of inflammation, the first goal of treatment is the stabilization of the tear film in Asia. To date, artificial tears and steroid eye drops have been the main treatment for DED. However, artificial tears require frequent administration of eye drops and thus pose adherence problems, while steroids have problems with side-effects (cataracts, increased intraocular pressure). This review evaluates the new generation therapies in Asia based on what is known about them and demonstrates that they are more effective for DED than traditional therapies such as artificial tears and steroids. Based on considerations, it is proposed that the optimal treatment for the short tear film breakup time-type DED is the initial application of mucin-secretion-enhancing eye drops (long-acting diquafosol) and oral supplements; and if additional treatment is needed, cyclosporine eye drops and the adjunctive therapies presented in this review are added.

Restoration of Meibomian Gland Functionality with Novel Mesenchymal Stem Cell-Derived Product “Derived-Multiple Allogeneic Proteins Paracrine Signaling (d-MAPPS)”: A Case Report

Abstract Meibomian gland dysfunction (MGD) results in the increased tear film osmolarity and leads to the development of dry eye disease. Results obtained in several experimental and clinical studies suggested that mesenchymal stem cells (MSCs) could promote repair and regeneration of injured meibomian glands. We recently developed a new biological product “derived-Multiple Allogeneic Proteins Paracrine Signaling (d-MAPPS)” which activity was based on the effects of immunosuppressive and trophic factors secreted by MSCs. Herewith, we report a case of MGD treated by d-MAPPS containing eye drops, demonstrating therapeutic potential of d-MAPPS in regeneration of injured meibomian glands and in the attenuation of MGD. D-MAPPS containing eye drops significantly attenuated MGD-related symptoms (foreign body sensation, burning, pain in the eye and eye fatigue) and remarkably improved quality of life. The analysis of meibomian glands demonstrated restoration of meibomian gland morphology, structure and function, after the 3-weeks of d-MAPPS based therapy. MGD patient did not report any adverse effects related to the d- MAPPS administration, indicating that d-MAPPS containing eye drops were safe for intraocular application.

Functional and Morphological Evaluation of Meibomian Glands in the Assessment of Meibomian Gland Dysfunction Subtype and Severity

To classify subtypes of meibomian gland dysfunction (MGD) and evaluate the dependency of dry eye signs, symptoms, and parameters on MGD subtype. Cross-sectional study. the right eyes of 447 patients with MGD of various subtypes and 20 healthy volunteers. Patients were divided into 4 subtypes of MGD based on meibum expression, meibum quality, and MG loss on meibography images (meibograde of 0-6). Subtypes were patients with high meibum delivery (hypersecretory and nonobvious MGD) and those with low meibum delivery (hyposecretory and obstructive MGD). Additional clinical tests included tear film break-up time (TFBUT), ocular staining, osmolarity, Schirmer I, blink interval timing and the Ocular Surface Disease Index (OSDI) questionnaire. A total of 78 eyes had hypersecretory MGD; 49 eyes had nonobvious MGD; 66 eyes had hyposecretory MGD; and 254 eyes had obstructive MGD. Increased tear film osmolarity and lower TFBUT were found in the low-delivery groups; hyposecretory (P=0.006, P= 0.016) and obstructive MGD (P=0.008, P= 0.006) relative to high-delivery MGD (hypersecretory and nonobvious groups, respectively). Worse ocular symptoms and ocular staining were also found in low-delivery MGD groups than the high delivery MGD groups (P < 0.01 and P < 0.006, respectively). Patients with low-delivery MGD had worse dry eye parameters and ocular symptoms than those with high meibum delivery, indicating the pivotal role of meibum secretion in ocular surface health that should be targeted in MGD therapy. Furthermore, nonobvious MGD cannot be diagnosed using conventional dry eye tests and requires morphologic assessment of meibography images to confirm MG loss.

Associated risk factors with the presence of the symptoms of dry eye syndrome among residents of Al Ahsa, Saudi Arabia

Purpose: Dry eye syndrome (DES) results in potential damage to the ocular surface accompanied by increased tear film osmolarity and inflammation of the ocular surface. Dry eye can be a result of different habits, chronic diseases, and some medications. Hence, we designed the study to have a rough estimation of dry eye in smokers. Methodology: The cross-sectional study was conducted for the duration of 1 month in Al Ahsa Saudi Arabia. Data collection has been carried by a validated questionnaire “McMonnies Questionnaire V2.” Consequently, Chi-square test was performed using SPSS version 21. Results: This study showed that females have more likely to develop DES symptoms compared to males, i.e., 51.4% and 48.6%, respectively. Among the individuals having DES symptoms, the individual who does not smoke, smoke 1 pack/day, there were no significant results (P = 0.211). Moreover, individuals having DES symptoms were significantly associated with dusty and sunny weather, and perfume (P Conclusion: This study observed a significant association of symptoms of DES with various risk factors other than smoking. Therefore, further longitudinal clinical studies will be helpful in evaluating the risk factors of DES in Al Ahsa, Saudi Arabia.

Meibomian gland dysfunction and keratopathy are associated with dry eye disease in aniridia

AimsTo investigate the aetiology and characteristics of dry eye disease (DED) in a Nordic cohort of patients with congenital aniridia.MethodsThirty-four Norwegian and one Danish subject with congenital aniridia and 21...

Increased Tear Film Osmolarity in Systemic Lupus Erythematosus

Purpose: To evaluate tear film osmolarity in patients with systemic lupus erythematosus (SLE). Methods: A total of 55 eyes from 55 patients with SLE and 47 eyes from 47 age- and gender-matched healthy individuals were included in this study. Tear film osmolarity was evaluated with a lab-on-a-chip technique (TearLab; TearLab Corporation, San Diego, CA) in SLE patients in comparison with healthy individuals, and results were correlated to clinically available diagnostic tests for dry eye, such as tear film break-up time (BUT), Schirmer’s test, and Ocular Surface Disease Index (OSDI). Results: The mean tear film osmolarity in the SLE patients and healthy individuals was 306.02 ± 13.27 mOsm/L and 300.74 ± 9.11 mOsm/L, respectively, which made for a statistically significant difference (p = 0.020). In the SLE group, tear film osmolarity was negatively correlated with the Schirmer’s test score and the BUT value (r = −0.295 p = 0.029 and r = 0.347 p = 0.009, respectively), whereas tear film osmolarity was not correlated with OSDI score (r = −0.182 p = 0.183). Conclusions: This study revealed that tear film hyperosmolarity and abnormal tear film function are associated with SLE.

In pursuit of objective dry eye screening clinical techniques.

Dry eye is a multifactorial, progressive, and chronic disease of the tears and ocular surface. The disease is multi-factorial and has intermittent symptoms. Discomfort, visual disturbance, tear film instability with potential damage to the ocular surface, and increased tear film osmolarity are known associates.Dry eye is a common clinical problem for eye-care providers worldwide and there is a large number of clinical investigative techniques for the evaluation of dry eye. Despite this, however, there is no globally accepted guideline for dry eye diagnosis and none of the available tests may hold the title of the ‘gold standard’. The majority of the techniques involved in the diagnosis of the disease, particularly for its early stages, has a large degree of subjectivity.The purpose of this article is to review existing dry eye investigative techniques and to present a new objective dry eye screening technique based on optical coherence tomography.

Ocular surface disease incidence in patients with open-angle glaucoma

Ocular surface disease (OSD) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbances, tear film instability with potential damage to the ocular surface, accompanied by increased tear film osmolarity and inflammation of the ocular surface. It is a consequence of disrupted homeostasis of lacrimal functional unit. The main pathogenetic mechanism stems from tear hyperosmolarity and tear film instability. The etiological classification is hyposecretory (Sy-Sjögren and non-Sjögren) and evaporative (extrinsic and intrinsic) form. Delphi panel classification grades disease stages. Antiglaucoma topical therapy causes exacerbation or occurrence of symptoms of dry eye due to main ingredients or preservatives (benzalkonium chloride – BAK), which are dose- and time-dependent. BAK reduces the stability of the lipid layer of tears, the number of goblet cells, induces apoptosis and inflammatory infiltration. The aim of this study was the analysis of the OSD incidence in open-angle glaucoma patients caused by topical medicamentous therapy. Retrospective analysis of examined patients with open-angle glaucoma was used. Increased incidence of moderate and advanced OSD Index degrees in the group of primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma. According to the Delphi Panel Scale the most common grade is IIb (POAG and pseudoexfoliative glaucoma). Evaporative form of OSD prevailed in all treatment groups. High percentage of dry eye in patients with higher concentrations of preservatives applied was noticed. OSD should be timely diagnosed and treated. Dry eye has an impact on surgical outcome and postoperative visual acuity, and in order to improve patient compliance and quality of life, symptoms of dry eye should be addressed and medications with lower concentrations of preservatives should be applied.

Short‐time reproducibility of tearfilm osmolarity measurement assessed with electrical impedance

AbstractPurpose There is compelling evidence that increased tearfilm osmolarity is a key pathogenetic mechanism for the development of Dry Eye Syndrom (DES) and its related complications. The current study was performed to assess the short‐time and day‐to‐day reproducibility of an electrical impedance based system for the measurement of tear film osmolarity.Methods 20 patients with moderate DES and a control group of 20 age and sex matched healthy subjects were included in the study. Tear film osmolarity was measured using a commercially available electrical impedance based “lab on a chip” system (TearLab OcuSens). To measure short‐time reproducibility 3 consecutive measurements were performed. To assess day‐to‐day reproducibility this procedure was repeated on three consecutive study days. Schirmer I test and break up time was performed on each study day. Coefficient of variation (CV) was calculated as a measure of reproducibility.Results Tear film osmolarity was higher in patients with DES compared to healthy control subjects on all three study days (p&lt;0.05). Short time CV of tearfilm osmolarity on the three study days was 3.18%±2.89%, 2.81%±2.08% and 2.23%±1.85%, respectively. Day‐to‐day variability based on the CV of the three study days was 3.47%±1.69%. As expected, Schirmer I test and BUT was lower in patients with DES compared to healthy subjects on all three study days (p&lt;0.05).Conclusion Electrical impedance based measurements of tear film osmolarity show good short time and day‐to‐day reproducibility. Whether tear film osmolarity is a suitable clinical parameter to assess severity and to monitor treatment success in patients with DES has yet to be investigated.

L-Carnitine and Short Chain Ester in Tears from Patients with Dry Eye

The tear film is essential for the integrity of the ocular surface. In ocular diseases such as dry eye syndrome (DES), tear film osmolarity is increased relative to normal physiological conditions. DES can be caused by deficiency in lachrymation, hyperevaporation, or surface alterations. Carnitines, shown to have osmoregulatory properties, are thought to regulate tear film osmolarity, thus protecting the corneal surface from damage. We investigated the presence of carnitine in tears, compared tear carnitine concentrations in healthy subjects and in DES patients and speculate on carnitine's potential role as a protective agent in the tear film. Tears were collected from 10 healthy subjects and 10 DES patients. Carnitine levels were assessed by high performance liquid chromatography-mass spectrometry. Carnitine and its derivatives were detected in the tear samples. In DES patients, concentrations were substantially lower than in healthy subjects; the mean concentrations were L-carnitine, 3.27 +/- 0.80 and 8.94 +/- 0.50 microMol/L; L-acetylcarnitine, 1.66 +/- 0.50 and 3.05 +/- 0.65 microMol/L; and L-propionylcarnitine, 0.30 +/- 0.11 and 0.57 +/- 0.13 microMol/L, in DES patients and healthy subjects, respectively. Although increased tear film osmolarity has been previously observed in DES patients, our study showed lower carnitine levels in DES patients than in healthy subjects, rather than the increased levels expected, although a causal relationship between carnitine levels and hyperosmolarity has not been established. The damage to ocular surface cells because of exposure to hypertonic tear film observed in DES may be partially because of an imbalance in the concentration of carnitine molecules in the tear film relative to the ocular surface cells. We propose, therefore, that carnitine solutions may have a role in preventing the adverse effects of observed hyperosmolarity and suggest that further studies are now warranted to investigate the clinical application of carnitine in the treatment of DES.

Stress-activated Protein Kinase Signaling Pathways in Dry Eye and Ocular Surface Disease

Inflammation is recognized as a key component in the pathogenesis of dry eye and a variety of ocular surface diseases. Stress-activated protein kinases have been identified as pathways signaling ocular surface stresses, such as increased tear film osmolarity and ultraviolet light exposure. Activation of these stress pathways results in transcription of stress related genes, including inflammatory cytokines (e.g. interleukin-1 and tumor necrosis factor (TNF)-α and matrix metalloproteinases (MMPs), such as MMP-9. Treatment of osmo-stressed cultured corneal epithelia with inhibitors of the stress associated kinase c-jun N-terminal kinases was found to decrease production of MMPs by these cells. These findings suggest that SAPKs may be key therapeutic targets for dry eye and ocular surface diseases.

Tear Film and Ocular Surface Changes after Closure of the Meibomian Gland Orifices in the Rabbit

To determine whether meibomian gland dysfunction can increase tear film osmolarity and produce ocular surface changes analogous to those seen with lacrimal gland disease (keratoconjunctivitis sicca [KCS]), the authors closed the meibomian gland orifices in the right eyes of 11 rabbits by light cautery and studied the changes for 20 weeks. Tear film osmolarity was increased throughout the observation period. Conjunctival goblet cell density and corneal epithelial glycogen levels declined progressively. Closure of the meibomian gland orifices thus increased tear film osmolarity in the presence of normal lacrimal gland function and caused ocular surface abnormalities similar to KCS.

Mechanisms for Increased Tear Film Osmolarity

Mechanisms for Increased Tear Film Osmolarity

A Proposed Mechanism for Increased Tear-Film Osmolarity in Contact Lens Wearers

Contact lenses decrease corneal sensitivity and increase tear-film osmolarity. To determine whether the decrease in corneal sensitivity is responsible for the increase in tear-film osmolarity, we studied tear-film osmolarity in normal rabbits and rabbits with surgically induced keratoconjunctivitis sicca before and after the instillation of 0.5% proparacaine. Instillation of proparacaine resulted in a significant increase in tear-film osmolarity. Decreased corneal sensitivity, with a resultant decrease in tear secretory rates, is the most likely cause for increased tear-film osmolarity in wearers of hard contact and extended-wear soft contact lenses.