Abstract
Background The ocular surface changes of keratoconjunctivitis sicca (KCS) could be the result of the effect of an altered tear film on the epithelial environment.
Purpose To evaluate the possibility of improving the environmental conditions of the ocular surface by lowering tear osmolarity, increasing tear film volume and stabilising the tear film. Also, to study the effect of such an improvement on the epithelial cells of the ocular surface.
Methods One hundred and thirty-five patients with a diagnosis of KCS were treated on a randomised basis with either unpreserved hypotonic 0.4% hyaluronic acid (HHA) eye drops or 0.3% hydroxypropylmethylcellulose plus 0.1% Dextran 70 (HPMC) eye drops 6 times a day for 60 or 90 days. In all patients a Schirmer I test, break-up time (BUT), ocular surface staining with 1% Bengal Rose, or 2% fluorescein, as well as subjective symptoms, were recorded before and 15, 30 and 60 days after the beginning of the study. Patients were divided into three subgroups and the effect of the treatment was studied using three different techniques: the tear ferning test, conjunctival impression cytology and tear osmolarity measurement.
Results Improvements in BUT, vital staining, Schirmer I and symptoms were recorded in both groups of treatment, with significant differences for patients treated with 0.4% HHA. On day 60, 30 min after installation: tear ferning patterns changed from 100% pathological (types III–IV) to 93% physiological (types I–II) in the 0.4% HHA group and from 100% pathological to 78% physiological in the 0.3% HPMC group (p < 0.01 between groups). Tear osmolarity shifted from 353 ± 23 to 305 ± 6 mosmolA in the 0-4% HHA group and from 346 ± 15 to 336 ± 8 mosmol/l in the 0.3% HPMC group (p < 0.001 between groups). On day 90, the impression cytology score improved from 1.2 to 1.9 in the 0.4% HHA group while it did not change in the 0.3% HPMC group (p < 0.05 between groups).
Conclusion In KCS appropriate treatment with a hypotonic 0.4% HHA tear substitute can change the tear environment and results in improvement of the epithelial conditions of the ocular surface.
Similar content being viewed by others
Article PDF
References
Lemp MA . Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J 1995;21:221–32.
Rolando M, Baldi F, Calabria GA . Tear mucus ferning test in keratoconjunctivitis sicca. In: Holly FJ, editor. The preocular tear film in health, disease and contact lens wear. Lubbock, TX: Dry Eye Institute Inc., 1986:203–10.
Rolando M, Terragna F, Giordano G, Calabria G . Conjunctival surface damage distribution in keratoconjunctivitis sicca: an impression cytology study. Ophthalmologica 1990;200:170–6.
Gilbard JP, Carter JB, Sang DN, Refojo MF, Hanninen LA, Kenyon KR . Morphologic effect of hyperosmolarity on rabbit corneal epithelium. Ophthalmology 1984;91:1205–12.
Van Bijsterveld OP . Diagnostic tests in the sicca syndrome. Ophthalmology 1969;82:10–4.
Pensyl CD, Dillehay SM . The repeatability of tear mucus ferning grading. Optom Vis Sci 1998;75:600–4.
Gilbard JP, Farris RL, Santamaria J . Osmolarity of tear microvolumes in keratoconjunctivitis sicca. Arch Ophthalmol 1978;96:677–81.
Tseng SCG . Staining of conjunctival squamous metaplasia by impression cytology. Ophthalmology 1985;92:728–33.
Rolando M, Refojo MF, Kenyon KR . Increased evaporation in eyes with keratoconjunctivitis sicca. Arch Ophthalmol 1983;101:557–8.
Gilbard JP, Farris RL . Tear osmolarity and ocular surface disease in keratoconjunctivitis sicca. Arch Ophthalmol 1979;97:1642–6.
Bron AJ . Non-Sjogren dry eye: pathogenesis and diagnosis and animal models. In: Holly FJ, editor. The preocular tear film in health, disease and contact lens wear. Lubbock, TX: Dry Eye Institute Inc., 1994;471–88.
Rolando M, Refojo MF, Kenyon KR . Tear water evaporation and eye surface diseases. Ophthalmologica 1985;190:147–9.
Gipson IK, Yankauckas M, Spurr-Michaud SJ, Tisdale AS, Rinehart W . Characteristics of a glycoprotein in the ocular surface glycocalyx. Invest Ophthalmol Vis Sci 1992;33:218–27.
Rolando M, lester M, Macri A, Calabria G . Low spatial-contrast sensitivity in dry eyes. Cornea 1998;17:376–9.
Gilbard JP, Kenyon KR . Tear diluents in the treatment of keratoconjunctivitis sicca. Ophthalmology 1985;92:646–50.
Bernal DL, Ubels JL . Artificial tear composition and promotion of recovery of the damaged corneal epithelium. Cornea 1993;12:115–20.
Willis RM, Folberg R, Krachmer JH, Holland EJ . The treatment of aqueous deficient dry eye with removable punctal plugs: a clinical and impression-cytologic study. Ophthalmology 1987;94:514–8.
Rolando M, Baldi F, Zingirian M . The effect of hyperosmolarity on tear mucus ferning. Fortschr Ophthalmol 1986;83:644–6.
Author information
Authors and Affiliations
Corresponding author
Additional information
M.I., G.J.O., G.G., P.M. and M.R. have no proprietary interest in development or marketing of any product mentioned in this article. M.T, and S.G. are employees of FIDIA Oftal.
Rights and permissions
About this article
Cite this article
Iester, M., Orsoni, G., Gamba, G. et al. Improvement of the ocular surface using hypotonic 0.4% hyaluronic acid drops in keratoconjunctivitis sicca. Eye 14, 892–898 (2000). https://doi.org/10.1038/eye.2000.244
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1038/eye.2000.244
Keywords
This article is cited by
-
Short-term changes in tear osmolarity after instillation of different osmolarity eye drops in patients with dry eye
Scientific Reports (2023)
-
Atorvastatin-loaded solid lipid nanoparticles as eye drops: proposed treatment option for age-related macular degeneration (AMD)
Drug Delivery and Translational Research (2020)
-
Sodium Hyaluronate in the Treatment of Dry Eye Syndrome: A Systematic Review and Meta-Analysis
Scientific Reports (2017)
-
Progress in tear microdesiccate analysis by combining various transmitted-light microscope techniques
Biological Research (2016)
-
Graft failure: II. Ocular surface complications
International Ophthalmology (2008)