Patients undergoing long-term treatment with antihypertensive eye drops responded positively with respect to their ocular surface disorder to oral supplementation with antioxidants and essential fatty acids

Abstract

BackgroundGlaucoma and dry eye disorders (DEDs) are frequent comorbidities. The antioxidant and anti-inflammatory properties of essential polyunsaturated fatty acids have been extensively studied in relation to eye diseases.ObjectiveOur objective was to determine the effects of oral supplementation with a combined formulation of antioxidants and essential polyunsaturated fatty acids on expression of cytokines and chemokines in tears from patients with DEDs or primary open-angle glaucoma (POAG).MethodsParticipants (n = 97) were distributed into three groups: (1) individuals with nonsevere DEDs (DEDG), (2) individuals with nonadvanced POAG (POAGG), and (3) healthy controls. These groups were randomized into two subgroups: one received a daily antioxidant and essential polyunsaturated fatty acid supplement (two pills) for 3 months (+S), and the other did not (−NS). Participants were interviewed and ophthalmologically examined. Concentrations of specific cytokines and chemokines in reflex tears were determined by multiplexed particle-based flow cytometry. The data were analyzed statistically (SPSS version 15.0).ResultsComparison of the results from the DEDG and POAGG patients showed significant differences in tear expression of granulocyte-macrophage colony-stimulating factor (P = 0.008), tumor necrosis factor α (P = 0.005), vascular endothelial growth factor (P = 0.038), interleukin-4 (P = 0.030), and interleukin-6 (P = 0.044). The main signs and symptoms of dry eyes such as dryness, burning, photophobia, eye heaviness, and blurred vision, as well as positive changes in eyelashes, hair, nails and skin, were significantly improved in DEDG +S and POAGG +S patients relative to unsupplemented patients.ConclusionInflammation biomarkers were differentially expressed in glaucomatous tears, but the differences changed upon antioxidant/essential polyunsaturated fatty acid supplementation. Chronic instillation of antihypertensive eye drops must be considered for integrating protocols to glaucoma standards of care.

Oxidative stress and its downstream signaling in aging eyes

“…Significantly increased levels of cytokines/chemokines have been detected in the tear fluid and conjunctiva of people with DED compared to normal eyes 46–50. Certain cytokines, such as interleukin 6, may induce cells to produce other compounds that play a role in the development of inflammation, such as prostaglandins, enzymes, and ROS 51. Tsubota et al52 recently suggested a new approach to the aging process and DED through controlling levels of calories and/or ROS in order to prevent DED.…”

Kinetic Profiles of Inflammatory Mediators in the Conjunctival Sac Fluid of Patients upon Photorefractive Keratectomy

“…Therefore, any alteration of the tear film may have direct consequences on the ocular surface integrity leading to pathological condition such as dry eye [ 7 , 8 ]. However, at the same time, any changes on the composition of the conjunctival sac fluid might have a potential as clinical biomarker to monitor the onset-evolution of ocular surface diseases [ 9 – 11 ] and the response to pharmacological and/or surgical interventions [ 12 – 14 ].…”

Effectiveness and tolerability of dietary supplementation with a combination of omega-3 polyunsaturated fatty acids and antioxidants in the treatment of dry eye symptoms: results of a prospective study

“…In a randomized, double-blind trial of 45 patients with dry eye syndrome assigned to two capsules/day of omega-3 (each containing 180 mg eicosapentaenoic acid and 120 mg DHA) (n=33) or placebo (n=31) for 30 days, consumption of omega-3 fatty acids was associated with a decrease in the rate of tear evaporation, an improvement in dry eye symptoms, and an increase in tear secretion 14. In a study of patients on long-term treatment with antihypertensive eye drops with glaucoma and dry eye disorders, in which the oral supplement was Brudysec 1.5 g (the same as used in our patients), the main signs and symptoms of dry eye were significantly improved after 3 months of treatment as compared to unsupplemented patients 17. In a study by Oleñik et al22 in which the effect of Brudysec 1.5 g for 3 months was assessed in the treatment of dysfunction of the meibomian gland, the mean OSDI, tear breakup time, lid margin inflammation, and meibomian gland expression showed significant improvement from baseline values.…”

“…This study has been preceded by three other clinical trials 15,17,22. These clinical trials included limited samples of patients suffering OSD due to dry eye.…”