Comparative evaluation of efficacy and safety of Carboxymethylcellulose either alone or in combination with Non-Steroidal Anti-inflammatory drug in the treatment of Dry eye in a Tertiary care Teaching Hospital

Abstract

INTRODUCTIONDry eye is a multifactorial disease of the ocular surface and tear fi lm which results in ocular discomfort, visual disturbances, and tear instability with potential damage to the cornea and conjunctiva. It has been defi ned by The National Eye Institute/Industry Workshop on Clinical Trials in dry eyes as "a disorder of the tear fi lm due to tear defi ciency or excessive tear evaporation, which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort."1 The overall prevalence of dry eye syndrome is estimated to be 5-35% in various population and the symptoms increase with age. 2 The treatment of dry eyes has traditionally involved hydrating and lubricating the ocular surface which include usage of artifi cial tear drops (carboxymethylcellulose [CMC]).2,3 As infl ammation is a key component in the pathogenesis of dry eye, non-steroidal anti-infl ammatory drugs (NSAIDs) have recently been evaluated in dry eye clinical trials and in animal models. 4,5 Dry eye disorder results in a diminished quality of life for those affected. In a study, it was found that patients with dry eye were signifi cantly more likely to report ABSTRACT Background: Dry eye produces discomfort and reduced vision. The treatment of dry eyes has traditionally involved hydrating and lubricating artifi cial tears. The newer medications include non-steroidal anti-infl ammatory drugs (NSAIDs) for the treatment of dry eye disorders. This study was designed to compare the effect of topical carboxymethylcellulose (CMC) alone or in combination with topical NSAID for the treatment of dry eye in a tertiary care teaching hospital. Methods: A total of 60 patients diagnosed with dry eye were enrolled for a study period of 1 year. Patient of either sex (male/female), age between 18 and 70 years, and all diagnosed cases of dry eye in ophthalmology outpatient department were selected. Patients (n=60) were stabilized on CMC for 2 weeks and thereafter divided into two groups. Group I (n=30) received only topical CMC; Group II (n=30) received CMC+NSAID. The patients were followed up to 12 weeks. Diagnostic tests included Schirmer's test and tear break up time (TBUT). Ocular Surface Disease Index (OSDI) was used for assessing the Quality of Life. Analysis was done using GraphPad InStat software. p<0.05 was considered signifi cant. Results:This was an open-label study revealing a mean age of 46.0±1.79 years. Females (56.67%) showed a signifi cantly higher prevalence of dry eye symptoms compared to males (43.33%). The mean duration of illness was 1.95±0.16 years. Schirmer's test, TBUT test values and OSDI score in Group I and Group II at 0 and 12 weeks revealed signifi cant intragroup difference (p<0.0001). At 12 weeks intergroup comparison in Schirmer's test value (p>0.05) and TBUT test value (p>0.05) showed no signifi cant difference while OSDI score revealed signifi cant difference (p<0.05). Burning, stinging, blurring of vision, photophobia, and hyperemia were among the common adverse effects seen. Concl...