Variability of Tear Osmolarity in Patients With Dry Eye

Bunya, Vatinee Y.; Fuerst, Nicole; Pistilli, Maxwell; McCabe, Bridgette E.; Salvo, Rebecca; Macchi, Ilaria; Ying, Gui‐Shuang; Massaro-Giordano, Mina

doi:10.1001/jamaophthalmol.2015.0429

Cited by 76 publications

(55 citation statements)

References 25 publications

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“…It would be expected that those participants with high osmolarity readings using the lubricant eye drop in this study containing a hypo-osmolarity component would have decreased osmolarity over time. A previous study showed that higher variability was attributed to blepharitis and Sjögren's syndrome dry eye compared to normals 35 . In our study, we had found that the standard deviations in our osmolarity measurements remained similar over time (12.6 at baseline, 11.1 at 1 month, 11.1 at 3 months) even though we observed improvements in many other areas (e.g.…”

Section: Discussionsupporting

confidence: 54%

The relief of dry eye signs and symptoms using a combination of lubricants, lid hygiene and ocular nutraceuticals

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Srinivasan

Houtman³

et al. 2017

Journal of Optometry

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PurposeTo determine the combined effect of TheraTears® Lubricant Eye Drops, TheraTears® SteriLid Eyelid Cleanser, and TheraTears® Nutrition on dry eye signs and symptoms.MethodsThis prospective study enrolled 28 dry eye participants. Participants were instructed to use the Lubricant Eye Drops at least 2–4× a day, SteriLid 1–2× a day, and Nutrition 3 gel caps once a day. Participants were followed up at baseline, 1 month and 3 months. Outcome variables were the Ocular Surface Disease Index (OSDI), Symptom Assessment iN Dry Eye (SANDE) questionnaire, non-invasive tear break-up time (NIBUT), osmolarity, number of meibomian glands blocked (#MG blocked), meibum quality, eyelid margin features, Schirmer's test, tear film lipid layer thickness (LLT), meniscus height, corneal and conjunctival staining.ResultsTwenty participants (mean age = 43, from 23 to 66, 17F, 3M) completed the study. Participants reported having used, on average, the Lubricant Eye Drop 2.4×/day, the SteriLid 1.1×/day, and the Nutrition 3 gel caps 1×/day. There was a significant change over time (p < 0.05) for OSDI (−21.2 points), SANDE (−32.4 points), NIBUT (+0.43 s), eyelid margin features (−1.1 grade), meibum quality (−1.0 grade), and #MG blocked (−4.0 glands).ConclusionBy using a combination of TheraTears® Lubricant Eye Drop, SteriLid, and Nutrition, patients experience significant relief in both dry eye symptoms and signs.

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Section: Discussionsupporting

confidence: 54%

The relief of dry eye signs and symptoms using a combination of lubricants, lid hygiene and ocular nutraceuticals

Ngo

Srinivasan

Houtman³

et al. 2017

Journal of Optometry

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“…Extensive clinical and basic research on tear osmolarity in humans found a wide range of osmolarities in normal (approximately 290–330 mOsm/L 12,13 ) and DE patients (approximately 315–365 mOsm/L 31–34 ), even 675 mOsm/L in one study. 35 Many factors, such as the measurement system used (freezing point to TearLab Corporation), repeated measurements, 13 and the time of day, and even changes within an individual, such as intereyes differences and environmental disparities, 36 are thought to contribute to these variabilities.…”

Section: Discussionmentioning

confidence: 91%

“…36 Clinical and methodologic issues associated with the tear measurement systems have been raised recently by many investigators. 12,13,37–39 These do not, however, invalidate the importance of tear hyperosmolarity to the pathophysiology of DED. 38 …”

Section: Discussionmentioning

confidence: 96%

“…35 Many factors, such as the measurement system used (freezing point to TearLab Corporation), repeated measurements, 13 and the time of day, and even changes within an individual, such as intereyes differences and environmental disparities, 36 are thought to contribute to these variabilities. It has been noted that these factors in clinical settings have not been standardized and will have to be addressed in the future.…”

Section: Discussionmentioning

confidence: 99%

“…11 However, the results using the latter method have been a source of controversy for producing great variability among the DE patient population. 12,13 More importantly, because the samples are collected from tears in the lower meniscus in all these studies, the measurements do not fully reflect the values of tear osmolarities present on large parts of the corneal surface, where dynamic and more significant effects are presumed to be taking place. The changes in tear film instability directly over the ocular surface are thought to have a significant role in inducing the major dry eye symptoms, like discomfort and pain.…”

mentioning

confidence: 99%

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Estimating the Osmolarities of Tears During Evaporation Through the “Eyes” of the Corneal Nerves

Hirata

Mizerska

Dallacasagrande

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PurposeA population of corneal neurons in rats preferentially sense and monitor the hyperosmolar conditions of tears when the tears begin to evaporate during corneal dryness. The present study exploited this ability in an effort to estimate tear osmolarities by comparing the responses to corneal dryness to their responses to hyperosmolar stimuli.MethodsExtracellular recordings were performed from single neurons in the trigeminal ganglia innervating the corneas of rats. To determine the extent to which the corneal neurons' responses to drying of the cornea were induced via the activation by hyperosmolar stimuli, we assessed the responses to ocular instillation of 500 and 600 mOsm/L, and a graded series of hyperosmolar stimuli ranging from 350 to 1000 mOsm/L.ResultsThe magnitudes of the responses to drying of the cornea were matched almost exactly to those induced by the ocular instillation of the 600 mOsm/L stimuli but not the 500 mOsm/L solutions. The response magnitudes to a graded series of hyperosmolar solutions were nearly linear from the 350 to the 600 mOsm/L stimuli, but reached a plateau or declined slightly thereafter.ConclusionsOur results demonstrate that the tear osmolarity in rats could reach 600 to 1000 mOsm/L during ocular dryness. Furthermore, a spontaneous eye blink could be generated at a tear osmolarity of approximately 400 mOsm/L if the blink is solely determined by hyperosmolar tears, but ocular surface cooling also can become a major factor if hyperosmolar tears occurring during ocular dryness lower the threshold of activation of the neurons.

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