Study of Association of Dry Eye Syndrome with Low Vitamin D Levels and Effect of Supplementation

Abstract

BACKGROUND Dry eye disease, though common, is a frequently under-recognized clinical state whose aetiology and management are challenging. Many external and internal factors have been studied, which affects the stability of tear film. This study aims at determining the association between serum 25(OH) Vitamin D and Dry Eye Syndrome (DES) incidence and how treatment with supplementation affects the outcome. METHODS This is a case-control study with 75 DES cases and 75 healthy controls. The main parameter to detect the level of vitamin D was Serum 25(OH)D. The DES parameters included ocular surface disease index (OSDI) scales, tear film breakup time (TBUT), fluorescein staining score (FSS), eyelid margin hyperemia, tear secretion test and Schirmer test. The differences in each parameter between case and control groups were detected and the association of serum 25(OH) D and DES parameter were studied. Deficient patients were given vitamin D-supplementation. The DES parameters were followed up after 8 and 12 weeks. Comparison was done between pre-treatment and post-treatment values. RESULTS 25(OH) D levels were lower in patients with DES than in healthy controls. Vitamin D deficiency was more common in the DES cases. Parameters were measured before treatment and after 8 and 12 weeks of vitamin D supplementation. Mean serum 25(OH)D level was 10.52 ± 4.61 ng/mL. TBUT, and tear secretion test showed an improvement at 8 and 12 weeks after vitamin D supplementation compared to pre-treatment values (p <0.05 for all, paired t-test). Eyelid margin hyperemia and the severity of symptoms showed improvement at 8 and 12 weeks after vitamin D supplementation (p <0.05). CONCLUSIONS A significant association between serum 25(OH)D level and DES incidence was detected in this study. It was found that vitamin D deficiency decreases the TBUT and Schirmer test values. Vitamin D supplementation promoted tear secretion, reduced tear instability, and reduced inflammation at the ocular surface and eyelid margin. Considering the effect of vitamin D on the immune system, it could be assumed that the immuno-regulatory effect of vitamin D might be influencing the development of DES.

Can IgE Level Influence the Ocular Surface Disease Index Score of Patients with Dry Eye Syndrome?

“…In severe group of DES in the present study, the mean age was younger (35.75± 20.79 years) than in mild group (50.48±9.72 years) and moderate group (51.92± 8.252 years), with a high statistical signifi cant diff erence (p<0.0001). This is in consistence with many studies in India by Nanda et al [21], and Jain et al [22], in Türkiye by Yildirim et al [23] and Kurtul et al [24] and in Iran by Hashemi et al [25] while disagree with other studies such as Shah and Jani [26], Jin et al [27] and Demirci et al [28].…”

“…Among BMI and severity, there was no signifi cant diff erence, (p=0.842). In our literature of the previous studies, we did not fi nd any relation between BMI and DES [21,[29][30][31][32].…”