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Dry Eye pp 51–66Cite as

Medical Management of Dry Eye

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Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Despite numerous remarkable advances in our understanding of the mechanisms behind the development of dry eye, medical treatment frequently continues to be frustrating. Often, patient symptoms and measurable clinical signs do not correlate. Moreover, due largely to an imperfect understanding of dry eye, today’s treatments can often seem inadequate and unpredictable. However, it is nonetheless possible to have rational therapy based on a systematic approach to the recognition of the disease and establishment of treatment objectives based on currently recognized hallmarks of dry eye. In addition to this, with a better understanding of the properties and actions of currently available pharmacologic agents, good clinical outcomes may consistently be obtained.

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References

  • Andresen JL, Ledet T, Ehlers N (1997) Keratocyte migration and peptide growth factors: the effect of PDGF, bFGF, EGF, IGF-I, aFGF and TGF-beta on human keratocyte migration in a collagen gel. Curr Eye Res 16:605–613

    Article  CAS  PubMed  Google Scholar 

  • Aronowicz JD, Shine WE, Oral D et al (2006) Short term oral minocyclinetreatment of meibomianitis. Br J Ophthalmol 90:856–860

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Barber LD, Pflugfelder SC, Tauber J, Foulks GN (2005) Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years. Ophthalmology 112:1790–1794

    Article  PubMed  Google Scholar 

  • Behrens A, Doyle JJ, Stern L et al (2006) Dysfunctional tear syndrome. A Delphi approach to treatment recommendations. Cornea 25:90–97

    Article  Google Scholar 

  • Berdy GJ, Abelson MB, Smith LM, George MA (1992) Preservative-free artificial tear preparations: assessment of corneal epithelial toxic effects. Arch Ophthalmol 110:528–532

    Article  CAS  PubMed  Google Scholar 

  • Bilgihan K, Adiguzel U, Sezer C, Akyol G, Hasanreisoglu B (2001) Effects of topical vitamin E on keratocyte apoptosis after traditional photorefractive keratectomy. Ophthalmologica 215:192–196

    Article  CAS  PubMed  Google Scholar 

  • Brignole F, Pisella PJ, De Saint Jean M, Goldschild M, Goguel A, Baudouin C (2001) Flow cytometric analysis of inflammatory markers in KCS: 6-month treatment with topical cyclosporin A. Invest Ophthalmol Vis Sci 42:90–95

    CAS  PubMed  Google Scholar 

  • Carsons S (2001) A review and update of Sjögren’s syndrome: manifestations, diagnosis, and treatment. Am J Manag Care 7(14 Suppl):S433–S443

    CAS  PubMed  Google Scholar 

  • Chandrasekher G, Kakazu AH, Bazan HE (2001) HGF- and KGF-induced activation of PI-3K/p70 s6 kinase pathway in corneal epithelial cells: its relevance in wound healing. Exp Eye Res 73:191–202

    Article  CAS  PubMed  Google Scholar 

  • Choi JA, Chung SH (2011) Combined application of autologous serum eye drops and silicone hydrogel lenses for the treatment of persistent epithelial defects. Eye Contact Lens 37(6):370–373

    Article  PubMed  Google Scholar 

  • Collins MK, Perkins GR, Rodriguez Tarduchy G et al (1994) Growth factors as survival factors: regulation of apoptosis. Bioessays 16:133–138

    Article  CAS  PubMed  Google Scholar 

  • Daull P, Feraille L, Elena P, Baudouin C, Garrigue JS (2012) Comparison of the anti-inflammatory effects of artificial tears in a rat model of corneal scraping. Acta Ophthalmologica 90:0. doi:10.1111/j.1755-3768.2012.4446.x

  • De Paiva CS, Corrales RM, Villarreal AL, Farley WJ, Li DQ, Stern ME et al (2006) Corticosteroid and doxycycline suppress MMP-9 and inflammatory cytokine expression, MAPK activation in the corneal epithelium in experimental dry eye. Exp Eye Res 83:526–535

    Article  PubMed  Google Scholar 

  • De Paiva CS, Villarreal AL, Corrales RM, Rahman HT, Chang VY, Farley WJ et al (2007) Dry eye-induced conjunctival epithelial squamous metaplasia is modulated by interferon-gamma. Invest Ophthalmol Vis Sci 48(6):2553–2560

    Article  PubMed  Google Scholar 

  • Djalilian AR, Nagineni CN, Mahesh SP, Smith JA, Nussenblatt RB, Hooks JJ (2006) Inhibition of inflammatory cytokine production in human corneal cells by dexamethasone, but not cyclosporin. Cornea 25(6):709–714

    Article  PubMed  Google Scholar 

  • Dougherty JM, Mcculley JP, Silvany RE et al (1991) The role of tetracycline in chronic blepharitis. Invest Ophthalmol Vis Sci 32:2970–2975

    CAS  PubMed  Google Scholar 

  • Endres S, Ghorbani R, Kelley VE, Georgilis K, Lonnemann G, van der Meer JW et al (1989) The effect of dietary supplementation with omega-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells. N Engl J Med 320(5):265–271

    Article  CAS  PubMed  Google Scholar 

  • Ervin AM, Wojciechowski R, Schein O (2010) Punctal occlusion for dry eye syndrome. Cochrane Database Syst Rev (9):CD006775

    Google Scholar 

  • Foulks GN, Borchman D, Yappert M, Kim SH, McKay JW (2010) Topical azithromycin therapy for meibomian gland dysfunction: clinical response and lipid alterations. Cornea 29(7):781–788

    Article  PubMed  PubMed Central  Google Scholar 

  • Fredj-Reygrobellet D, Plouet J, Delayre T et al (1987) Effects of aFGF and bFGF on wound healing in rabbit corneas. Curr Eye Res 6:1205–1209

    Article  CAS  PubMed  Google Scholar 

  • Gilbard JP, Rossi SR (1992) An electrolyte-based solution that increases corneal glycogen and conjunctival goblet-cell density in a rabbit model for keratoconjunctivitis sicca. Ophthalmology 99:600–604

    Article  CAS  PubMed  Google Scholar 

  • Goto E, Shimmura S, Shimazaki J et al (2001) Treatment of superior limbic keratoconjunctivitis by application of autologous serum. Cornea 20:807–810

    Article  CAS  PubMed  Google Scholar 

  • Green K, MacKeen DL, Slagle T, Cheeks L (1992) Tear potassium contributes to maintenance of corneal thickness. Ophthalmic Res 24:99–102

    Article  CAS  PubMed  Google Scholar 

  • Hoeprich PD, Warshauer DM (1974) Entry of four tetracyclines into saliva and tears. Antimicrob Agents Chemother 5:330–336

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hori Y, Spurr-Michaud S, Russo CL, Argüeso P, Gipson IK (2004) Differential regulation of membrane-associated mucins in the human ocular surface epithelium. Invest Ophthalmol Vis Sci 45(1):114–122

    Article  PubMed  Google Scholar 

  • IMS MIDAS (Retail and Hospital) and OTCims (Retail Sales), FY 2012, Alcon Dry Eye Custom Market Definition, Extracted from Q4 2012 database

    Google Scholar 

  • Iyer JV, Lee SY, Tong L (2012) The dry eye disease activity log study. ScientificWorldJournal 2012:589875. doi:10.1100/2012/589875. Epub 2012 Oct 24

    Article  PubMed  PubMed Central  Google Scholar 

  • James MJ, Gibson RA, Cleland LG (2000) Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr 71(1 Suppl):343S–348S

    CAS  PubMed  Google Scholar 

  • Kaido M, Ishida R, Dogru M, Tsubota K (2012) Visual function changes after punctal occlusion with the treatment of short BUT type of dry eye. Cornea 31(9):1009–1013

    Article  PubMed  Google Scholar 

  • Kloppenburg M, Brinkman BM, de Rooij-Dijk HH, Miltenburg AM, Daha MR, Breedveld FC, Dijkmans BA, Verweij C (1996) The tetracycline derivative minocycline differentially affects cytokine production by monocytes and T lymphocytes. Antimicrob Agents Chemother 40(4):934–940

    CAS  PubMed  PubMed Central  Google Scholar 

  • Korb DR, Herman JP, Greiner JV et al (2005) Lid wiper epitheliopathy and dry eye symptoms. Eye Contact Lens 31(1):2–8

    Article  PubMed  Google Scholar 

  • Korb DR, Herman JP, Blackie CA, Scaffidi RC, Greiner JV, Exford JM, Finnemore VM (2010) Prevalence of lid wiper epitheliopathy in subjects with dry eye signs and symptoms. Cornea 29(4):377–383. doi:10.1097/ICO.0b013e3181ba0cb2

    Article  PubMed  Google Scholar 

  • Krakauer T, Buckley M (2003) Doxycycline is anti-inflammatory and inhibits staphylococcal exotoxin-induced cytokines and chemokines. Antimicrob Agents Chemother 47(11):3630–3633

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kunert KS, Tisdale AS, Stern ME, Smith JA, Gipson IK (2000) Analysis of topical cyclosporine treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. Arch Ophthalmol 118:1489–1496

    Article  CAS  PubMed  Google Scholar 

  • Kunert KS, Tisdale AS, Gipson IK (2002) Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. Arch Ophthalmol 120:330–337

    Article  CAS  PubMed  Google Scholar 

  • Ledeboer A, Sloane EM, Milligan ED, Frank MG, Mahony JH, Maier SF, Watkins LR (2005) Minocycline attenuates mechanical allodynia and proinflammatory cytokine expression in rat models of pain facilitation. Pain 115(1–2):71–83

    Article  CAS  PubMed  Google Scholar 

  • Lemp MA (2008) Management of dry eye. Am J Manag Care 14:S088–S101, Accessed March 11, 2013

    Google Scholar 

  • Li DQ, Zhou N, Zhang L, Ma P, Pflugfelder SC (2010) Suppressive effects of azithromycin on zymocin-induced production of proinflammatory mediators by human corneal epithelial cells. Invest Ophthalmol Vis Sci 51(11):5623–5629

    Article  PubMed  PubMed Central  Google Scholar 

  • Liou LB (2001) Serum and in vivo production of IL-1 receptor antagonist correlate with C-reactive protein levels in newly diagnosed, untreated lupus patients. Clin Exp Rheumatol 19:515–523

    CAS  PubMed  Google Scholar 

  • Liu L, Hartwig D, Harloff S, Herminghaus P, Wedel T, Geerling G (2005) An optimised protocol for the production of autologous serum eyedrops. Graefes Arch Clin Exp Ophthalmol 243(7):706–714

    Article  CAS  PubMed  Google Scholar 

  • Lu Y, Fukuda K, Nakamura Y, Kimura K, Kumagai N, Nishida T (2005) Inhibitory effect of triptolide on chemokine expression induced by proinflammatory cytokines in human corneal fibroblasts. Invest Ophthalmol Vis Sci 46(7):2346–2352

    Article  PubMed  Google Scholar 

  • Luchs J (2008) Efficacy of topical azithromycin ophthalmic solution 1% in the treatment of posterior blepharitis. Adv Ther 25:858–870

    Article  CAS  PubMed  Google Scholar 

  • Matsuda S, Koyasu S (2000) Mechanisms of action of cyclosporine. Immunopharmacology 47(2–3):119–125

    Article  CAS  PubMed  Google Scholar 

  • McCann LC, Tomlinson A, Pearce EI, Papa V (2012) Effectiveness of artificial tears in the management of evaporative dry eye. Cornea 31(1):1–5. doi:10.1097/ICO.0b013e31821b71e610.1097/ICO.0b013e31821b71e6

    Article  PubMed  Google Scholar 

  • Meyer AE, Baier RE, Chen H, Chowhan M (2007) Differential tissue-on-tissue lubrication by ophthalmic formulations. J Biomed Mater Res B Appl Biomater 82B:74–88

    Article  CAS  Google Scholar 

  • Miljanovic B, Trivedi KA, Dana MR, Gilbard JP, Buring JE, Schaumberg DA (2005) Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women. Am J Clin Nutr 82(4):887–893

    CAS  PubMed  PubMed Central  Google Scholar 

  • Montés-Micó R (2007) Role of the tear film in the optical quality of the human eye. J Cataract Refract Surg 33(9):1631–1635

    Article  PubMed  Google Scholar 

  • Ogawa Y, Okamoto S, Mori T et al (2003) Autologous serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease. Bone Marrow Transplant 31:579–583

    Article  CAS  PubMed  Google Scholar 

  • Paugh JR, Nguyen AL, Ketelson HA, Christensen MT, Meadows DL (2008) Precorneal residence time of artificial tears measured in dry eye subjects. Optom Vis Sci 85:725–731

    Article  PubMed  Google Scholar 

  • Pflugfelder SC, Huang AJ, Feuer W, Chuchovski PT, Pereira IC, Tseng SC (1990) Conjunctival cytologic features of primary Sjögren’s syndrome. Ophthalmology 97(8):985–991

    Article  CAS  PubMed  Google Scholar 

  • Pflugfelder SC, Gerd Geerling G, Shigero Kinoshita S, Lemp MA, McCulley J, Nelson D, Novack GN, Shimazaki J, Wilson C (2007) Management and therapy of dry eye disease: report of the Management and Therapy Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 5(2):163–178

    Article  Google Scholar 

  • Phan TM, Foster CS, BoruchoV SA et al (1987) Topical fibronectin in the treatment of persistent corneal epithelial defects and trophic ulcers. Am J Ophthalmol 104:494–501

    Article  CAS  PubMed  Google Scholar 

  • Pinazo-Durán MD, Galbis-Estrada C, Pons-Vázquez S, Cantú-Dibildox J, Marco-Ramírez C, Benítez-Del-Castillo J (2013) Effects of a nutraceutical formulation based on the combination of antioxidants and ?-3 essential fatty acids in the expression of inflammation and immune response mediators in tears from patients with dry eye disorders. Clin Interv Aging 8:139–148

    Article  PubMed  PubMed Central  Google Scholar 

  • Roberts CW, Carniglia PE, Brazzo BG (2007) Comparison of topical cyclosporine, punctal occlusion, and a combination for the treatment of dry eye. Cornea 26(7):805–809

    Article  PubMed  Google Scholar 

  • Sall K, Stevenson OD, Mundorf TK, Reis BL (2000) Two multi- center, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. Ophthalmology 107:631–639

    Article  CAS  PubMed  Google Scholar 

  • Schein OD, Tielsch JM, Munõz B, Bandeen-Roche K, West S (1997) Relation between signs and symptoms of dry eye in the elderly. A population-based perspective. Ophthalmology 104(9):1395–1401

    Article  CAS  PubMed  Google Scholar 

  • Small DS, Acheampong A, Reis B, Stern K, Stewart W, Berdy G, Epstein R, Foerster R, Forstot L, Tang-Liu DD (2002) Blood concentrations of cyclosporin A during long-term treatment with cyclosporin A ophthalmic emulsions in patients with moderate to severe dry eye disease. J Ocul Pharmacol Ther 18:411–418

    Article  CAS  PubMed  Google Scholar 

  • Solomon A, Rosenblatt M, Li DQ, Liu Z, Monroy D, Ji Z et al (2000) Doxycycline inhibition of interleukin-1 in the corneal epithelium. Invest Ophthalmol Vis Sci 41(9):2544–2557

    CAS  PubMed  Google Scholar 

  • Souchier M, Joffre C, Grégoire S, Bretillon L, Muselier A, Acar N, Beynat J, Bron A, D’Athis P, Creuzot-Garcher C (2008) Changes in meibomian fatty acids and clinical signs in patients with meibomian gland dysfunction after minocycline treatment. Br J Ophthalmol 92(6):819–822

    Article  CAS  PubMed  Google Scholar 

  • Stone DU, Chodosh J (2004) Oral tetracyclines for ocular rosacea: an evidence-based review of the literature. Cornea 23:106–109

    Article  PubMed  Google Scholar 

  • Strong B, Farley W, Stern ME, Pflugfelder SC (2005) Topical cyclosporine inhibits conjunctival epithelial apoptosis in experimental murine keratoconjunctivitis sicca. Cornea 24(1):80–85

    Article  PubMed  Google Scholar 

  • Ta CN, Shine WE, McCulley JP, Pandya A, Trattler W, Norbury JW (2003) Effects of minocycline on the ocular flora of patients with acne rosacea or seborrheic blepharitis. Cornea 22:545–548

    Article  PubMed  Google Scholar 

  • Tamargo RJ, Bok RA, Brem H (1991) Angiogenesis inhibition by minocycline. Cancer Res 51:672–675

    CAS  PubMed  Google Scholar 

  • Torkildsen G (2009) The effects of lubricant eye drops on visual function as measured by the Inter-blink interval Visual Acuity Decay test. Clin Ophthalmol 3:501–506

    Article  PubMed  PubMed Central  Google Scholar 

  • Tsubota K, Goto E, Fujita H, Ono M, Inoue H, Saito I, Shimmura S (1999a) Treatment of dry eye by autologous serum application in Sjögren’s syndrome. Br J Ophthalmol 83(4):390–395

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tsubota K, Goto E, Shimmura S et al (1999b) Treatment of persistent corneal epithelial defect by autologous serum application. Ophthalmology 106:1984–1989

    Article  CAS  PubMed  Google Scholar 

  • Turner K, Pflugfelder SC, Ji Z, Fener WJ, Stern M, Reis BL (2000) Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclo- sporine ophthalmic emulsion. Cornea 19:492–496

    Article  CAS  PubMed  Google Scholar 

  • Ubels JL, McCartney MD, Lantz WK, Beaird J, Dayalan A, Edelhauser HF (1995) Effects of preservative-free artificial tear solutions on corneal epithelial structure and function. Arch Ophthalmol 113(3):371–378

    Article  CAS  PubMed  Google Scholar 

  • Veldman P, Colby K (2011) Current evidence for topical azithromycin 1% ophthalmic solution in the treatment of blepharitis and blepharitis-associated ocular dryness. Int Ophthalmol Clin 51(4):43–52

    Article  PubMed  Google Scholar 

  • Yoo SE, Lee DC, Chang MH (2005) The effect of low-dose doxycycline therapy in chronic meibomian gland dysfunction. Korean J Ophthalmol 19:258–263

    Article  PubMed  Google Scholar 

  • Yung YH, Toda I, Sakai C, Yoshida A, Tsubota K (2012) Punctal plugs for treatment of post-LASIK dry eye. Jpn J Ophthalmol 56(3):208–213

    Article  PubMed  Google Scholar 

  • Zimmerman TJ, Kooner KS, Kandarakis AS, Ziegler SP (1984) Improving the therapeutic index of topically applied ocular drugs. Arch Ophthalmol 102(4):551–553

    Article  CAS  PubMed  Google Scholar 

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Informed consent and animal studies disclosures are not applicable to this review.

I have received speaker’s honoraria from Alcon and Allergan. I do not own any stock in either company.

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Correspondence to Victor L. Caparas MD, MPH .

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Caparas, V.L. (2015). Medical Management of Dry Eye. In: Chan, C. (eds) Dry Eye. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44106-0_5

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