Factors Predicting the Ocular Surface Response to Desiccating Environmental Stress

Alex, Anastasia; Edwards, Austin W.; Hays, J. Daniel; Kerkstra, Michelle; Shih, Amanda; Paiva, Cintia S. de; Pflugfelder, Stephen C.

doi:10.1167/iovs.12-11322

Cited by 59 publications

(30 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding meteorological conditions, previous studies suggested humidity, wind speed, and sunshine duration as potential risk factors of DED [27-32]. Our results showed that lower humidity and longer sunshine duration were associated with DED before and after adjusting for covariates.…”

Section: Discussionsupporting

confidence: 57%

Spatial epidemiology of dry eye disease: findings from South Korea

Kim

Lee

et al. 2014

Int J Health Geogr

View full text Add to dashboard Cite

BackgroundDED rate maps from diverse regions may allow us to understand world-wide spreading pattern of the disease. Only few studies compared the prevalence of DED between geographical regions in non-spatial context. Therefore, we examined the spatial epidemiological pattern of DED prevalence in South Korea using a nationally representative sample.MethodsWe analyzed 16,431 Korean adults aged 30 years or older of the 5th Korea National Health and Nutrition Examination Survey. DED was defined as previously diagnosed by an ophthalmologist as well as symptoms experienced. Multiple logistic regression analysis was used to assess the spatial pattern in the prevalence of DED, and effects of environmental factors.ResultsAmong seven metropolitan cities and nine provinces, three metropolitan cities located in the southeast of Korea revealed the highest prevalence of DED. After adjusting for sex, age and survey year, people living in urban areas had higher risk of having DED. Adjusted odds ratio for having previously diagnosed DED was 1.677 (95% CI 1.299-2.166) for metropolitan cities and 1.580 (95% CI 1.215-2.055) for other cities compared to rural areas. Corresponding odds ratio for presenting DED symptoms was 1.388 (95% CI 1.090-1.766) for metropolitan cities and 1.271 (95% CI 0.999-1.617) for other cities. Lower humidity and longer sunshine duration were significantly associated with DED. Among air pollutants, SO2 was associated with DED, while NO2, O3, CO, and PM10 were not.ConclusionOur findings suggest that prevalence of DED can be affected by the degree of urbanization and environmental factors such as humidity and sunshine duration.

show abstract

Section: Discussionsupporting

confidence: 57%

Spatial epidemiology of dry eye disease: findings from South Korea

Kim

Lee

et al. 2014

Int J Health Geogr

View full text Add to dashboard Cite

show abstract

“…6,7 This may be a result of the desiccating stress that air drafts, low humidity, and decreased blinking have on the ocular surface. This stress leads to increased tear instability, evaporation and osmolarity, which contributes to a downstream cascade of events that promote production of inflammatory mediators (cytokines and matrix metalloproteinases), epithelial apoptosis and loss of conjunctival goblet cells.…”

Section: Introductionmentioning

confidence: 99%

“…7 Thus, reduced tear production from aging, use of systemic medications with anticholinergic effects or autoimmune conditions such as Sjögren syndrome and rheumatoid arthritis may contribute to development of environmentally induced dry eye. 10,11,12 …”

Section: Introductionmentioning

confidence: 99%

Effects of Dry Eye Therapies on Environmentally Induced Ocular Surface Disease

Moore¹,

Paiva²,

Pflugfelder³

2015

American Journal of Ophthalmology

Self Cite

View full text Add to dashboard Cite

PURPOSE To evaluate the effectiveness of artificial tears and corticosteroids on mitigating the acute ocular surface response to low humidity environments. DESIGN Single-group, crossover clinical trial. METHODS Twenty subjects with aqueous deficient dry eye were enrolled. Subjects meeting inclusion criteria at visit 1 and were exposed to a baseline 90-minute low humidity environment at visit 2. They then used artificial tears for 2 weeks prior to low humidity exposure at visit 3, followed by 0.1% dexamethasone for two weeks prior to the final low humidity exposure at visit 4. Outcome measures included corneal and conjunctival staining, blink rate and irritation symptoms before and after each low humidity exposure. Digital polymerase chain reaction (PCR) was performed to measure HLA-DR RNA transcripts in conjunctival cells taken by impression cytology at each visit. RESULTS There was significantly less corneal and conjunctival epitheliopathy after the low humidity exposure at visit 4 compared to after the low humidity exposure at visit 3 (p= 0.003). Subjects reported significantly less eye irritation during the low humidity exposure after using the dexamethasone (visit 4) compared to artificial tears (visit 3) (p=0.01). HLA-DR transcripts significantly decreased after the stress at visit 4 (post dexamethasone) compared to visit 2. CONCLUSION Our study demonstrates corticosteroid eye drops mitigate the acute adverse effects of an experimental low humidity challenge, likely due to suppression of stress-activated inflammatory pathways. While extended use of corticosteroids is not indicated, other anti-inflammatory therapies with activity against stress-activated pathways may prove as effective.

show abstract

“…While this approach allows for detailed analysis of the timing and pattern of orbicularis oculi electromyographic (OOemg) activity, electrical stimuli necessarily by-pass normal sensory transduction mechanisms. Tear osmolarity is a key factor in predicting severity in dry eye disease (Sullivan et al, 2010, Alex et al, 2013), while abnormal light sensitivity is a common symptom in dry eye (Pflugfelder, 2011) and blepharospasm (Adams et al, 2006, Hallett et al, 2008), conditions well associated with abnormal control of eyeblinks. Trigeminal sensory nerves that supply the eye and periocular tissues project centrally to terminate in two spatially discrete regions, the trigeminal subnucleus interpolaris/caudalis transition (Vi/Vc) and the trigeminal subnucleus caudalis/upper cervical cord junction (Vc/C1) regions (Marfurt, 1981, Marfurt and Del Toro, 1987, Marfurt and Echtenkamp, 1988, Panneton et al, 2010).…”

mentioning

confidence: 99%

Trigeminal pathways for hypertonic saline- and light-evoked corneal reflexes

et al. 2014

View full text Add to dashboard Cite

Cornea-evoked eyeblinks maintain tear film integrity on the ocular surface in response to dryness and protect the eye from real or potential damage. Eyelid movement following electrical stimulation has been well studied in humans and animals; however, the central neural pathways that mediate protective eyeblinks following natural nociceptive signals are less certain. The aim of this study was to assess the role of the trigeminal subnucleus interpolaris/caudalis (Vi/Vc) transition and subnucleus caudalis/upper cervical cord (Vc/C1) junction regions on orbicularis oculi electromyographic (OOemg) activity evoked by ocular surface application of hypertonic saline or exposure to bright light in urethane anesthetized male rats. The Vi/Vc and Vc/C1 regions are the main sites of termination for trigeminal afferent nerves that supply the ocular surface, while hypertonic saline (saline = 0.15-5M) and bright light (light = 5-20k lux) selectively activate ocular surface and intraocular trigeminal nerves, respectively, and excite second-order neurons at the Vi/Vc and Vc/C1 regions. Integrated OOemg activity, ipsilateral to the applied stimulus, increased with greater stimulus intensities for both modalities. Lidocaine applied to the ocular surface inhibited OOemg responses to hypertonic saline, but did not alter the response to light. Lidocaine injected into the trigeminal ganglion blocked completely the OOemg responses to hypertonic saline and light indicating a trigeminal afferent origin. Synaptic blockade by cobalt chloride of the Vi/Vc or Vc/C1 region greatly reduced OOemg responses to hypertonic saline and bright light. These data indicate that OOemg activity evoked by natural stimuli known to cause irritation or discomfort in humans depends on a relay in both the Vi/Vc transition and Vc/C1 junction regions.

show abstract

Factors Predicting the Ocular Surface Response to Desiccating Environmental Stress

Abstract: Ocular surface dye staining increases in response to desiccating stress. Baseline ocular surface dye staining, tear meniscus height, and blink rate predict severity of ocular surface dye staining following exposure to a desiccating environment.

Cited by 59 publications

References 20 publications

Spatial epidemiology of dry eye disease: findings from South Korea

Spatial epidemiology of dry eye disease: findings from South Korea

Effects of Dry Eye Therapies on Environmentally Induced Ocular Surface Disease

Trigeminal pathways for hypertonic saline- and light-evoked corneal reflexes

Contact Info

Product

Resources

About