The Subtle Role of Para-inflammation in Modulating the Progression of Dry Eye Disease

Rolando, Maurizio; Barabino, Stefano

doi:10.1080/09273948.2021.1906908

Cited by 13 publications

(8 citation statements)

References 54 publications

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“…Macrophages and monocytes are activated to promote epithelial cell recovery, and autophagy to maintain ocular surface homeostasis is decreased [116]. This indicates a state of ongoing inflammation of the ocular surface and its damage has not recovered [117,118]. Therefore, additional treatment is suggested with cyclosporine eye drops.…”

Section: Discussionmentioning

confidence: 99%

Management of Dry Eye Disease in Asia: A Review

Kawahara¹

2023

Preprint

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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 is common, and stabilization of the tear film is the first goal of treatment. Treatment of DED begins with eye drops. Until now, 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 of DED 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 these considerations, it is proposed that the optimal treatment for DED in Asia 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.

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Section: Discussionmentioning

confidence: 99%

Management of Dry Eye Disease in Asia: A Review

Kawahara¹

2023

Preprint

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“…A number of studies have investigated how para-inflammatory responses become dysregulated in diseases affecting various tissues and organs, including the eyes [ 7 , 8 , 9 , 10 ], and there is some evidence that dysregulated para-inflammation is involved also in DED, which is a disease that affects the quality of life of more than 170 million people worldwide [ 11 ].…”

Section: Hormesis and Para-inflammation—an Adaptive Means Of Reacting...mentioning

confidence: 99%

“…The simultaneous appearance of dysregulated homeostasis and chronic sub-clinical inflammation is the starting point for the development of a stable, chronic inflammatory disease that leads to clearly evident ocular surface damage ( Figure 1 ) [ 11 ]. The oxidative process negatively affects not only the ocular surface but also the lipid layer of the tear film that, if oxidated, loses its fluidity and its ability to spread quickly over the mucosal-aqueous phase of the film, thus making it permeable to water and so eliminating its capacity to hinder tear film water evaporation.…”

Section: Para-inflammation As An Adaptive Response To Tissue Stressmentioning

confidence: 99%

Dealing with the Persistent Pathogenic Issues of Dry Eye Disease: The Importance of External and Internal Stimuli and Tissue Responses

Rolando¹,

Barabino

Giannaccare

et al. 2023

JCM

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The immune system plays a central role in protecting the ocular surface from exogenous and endogenous insults, maintaining tissue homeostasis thanks to the mechanism of para-inflammation. This physiological adaptive response may induce resident macrophages/monocytes to produce cytokines and growth factors in order to promote epithelial cell recovery. In case of well-controlled para-inflammation, caused by a low amount of stress, cell viability and function are maintained. When stress becomes too intense, there is a response characterized by the activation of autophagic pathways and consequent cell death. Dysregulated homeostasis and chronic sub-clinical inflammation are the starting points for the development of a stable, chronic inflammatory disease, which leads to ocular surface damage, and, in turn, to the onset or progression of chronic dry eye disease (DED). The long-term management of DED should consider all of the pathogenic issues involved in the disease, including the control of persistent external or internal stresses that are capable of activating and maintaining the para-inflammatory adaptive mechanisms, potentially leading to full-blown inflammation. Dysregulated para-inflammation can be corrected by means of the prolonged use of tear substitutes containing minimal doses of safe corticosteroids or other anti-inflammatory molecules (e.g., corticosteroid, cyclosporine) in order to re-equilibrate ocular surface homeostasis.

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“…Other products contain carboxymethylcellulose and polyethylene glycol [ 4 ]. However, traditional lubricating eye drops can relieve the symptoms of DED but are poorly effective in counteracting specifically the main underlying pathological mechanism, namely dysregulated parainflammation, which has recently been recognized as an important pathogenetic step in the progression of tear dysfunction in DED [ 27 , 28 ]. Therefore, to act on this pathological factor as well, an innovative HA-based eye drops formulation has recently been placed on the market (Idroflog ® , Alfa Intes, Italy; class III medical device) [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a New Active Tear Substitute Containing 0.2% Hyaluronic Acid and 0.001% Hydrocortisone on Signs and Symptoms of Dry Eye Disease by Means of Low- and High-Tech Assessments

Fogagnolo,

Giannaccare,

Mencucci

et al. 2023

Ophthalmol Ther

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Introduction An innovative eye drops formulation containing 0.2% hyaluronic acid and a low concentration of hydrocortisone (0.001%; hereafter HALH) has been recently placed on the market (Idroflog ® , Alfa Intes, Italy) to manage the dysregulated parainflammation in patients with dry eye disease (DED). In the present paper, the effectiveness of HALH on the signs and symptoms of DED was retrospectively evaluated and compared with that one obtained using standard tear substitutes (STS) by means of low- and high-tech (Keratograph ® ) assessments. Methods This was a multicenter retrospective study carried out between February and April 2023, involving adult patients with DED diagnosis owing to post-cataract surgery, meibomian gland dysfunction, allergy, or glaucoma medications. The primary aim was to compare the changes induced by different therapies on Keratograph ® parameters (noninvasive Keratograph tear breakup time [NIKBUT], tear meniscus height [TMH], eyelid meibography, conjunctival hyperemia, and conjunctivochalasis) or collected by traditional low-tech measures (tear breakup time [TBUT], Schirmer test, Efron score, and epithelial alterations) and the Ocular Surface Disease Index score. Results Data from 155 patients were analyzed. The effectiveness of HALH and STS was reported by both high- and low-tech measures. NIKBUT-first showed a significant improvement in the HALH group versus the STS one at 15 days (6.4 ± 3.6 vs 5.4 ± 3.7 s, p = 0.02), whereas this difference was latent with low-tech TBUT until 45 days (6.8 ± 2.6 vs 5.6 ± 2.3 s, p = 0.03). Patients with DED occurring after cataract surgery reported an enhanced activity of HALH versus STS, particularly for NIKBUT-first, TMH, Schirmer test, and hyperemia stage. Conclusion These findings highlighted the effectiveness of HALH in all DED subtypes, especially in patients with post-cataract surgery, as well as its superiority versus STS in terms of tear film stability improvement. We recommend longer observation (i.e., 3–6 months) to fully ascertain whether the early improvement detected by high-tech measures will be confirmed in subsequent time points even using low-tech tests. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-023-00833-7.

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The Subtle Role of Para-inflammation in Modulating the Progression of Dry Eye Disease

Cited by 13 publications

References 54 publications

Management of Dry Eye Disease in Asia: A Review

Management of Dry Eye Disease in Asia: A Review

Dealing with the Persistent Pathogenic Issues of Dry Eye Disease: The Importance of External and Internal Stimuli and Tissue Responses

Effectiveness of a New Active Tear Substitute Containing 0.2% Hyaluronic Acid and 0.001% Hydrocortisone on Signs and Symptoms of Dry Eye Disease by Means of Low- and High-Tech Assessments

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