Inflammatory cytokine and osmolarity changes in the tears of dry eye patients treated with topical 1% methylprednisolone

Abstract

Dry eye syndrome is a common condition, affecting approximately 10-20% of the adult population, and its pathogenesis has not been clearly established. However, there is increasing evidences that ocular inflammation plays a key role in the pathogenesis of dry eye syndrome.This dissertation deals with changes in clinical outcome, inflammatory cytokine levels, and tear osmolarity in the tears of patients with dry eye syndrome both before and after the application of topical 1% methylprednisolone.Thirty-two patients (64 eyes) with moderate to severe dry eye were enrolled. Topical 1% methylprednisolone was applied four times per day for 1 month and tapered for the next month. Preservative-free 0.1% sodium hyaluronate was also applied 4-6 times per day. Corneal and conjunctival staining scores, tear film breakup time (TFBUT), and tear osmolarity were assessed at baseline, week 4, and week 8. Tear samples were collected at every visit for cytokine analysis. Corneal and conjunctival staining scores and TFBUT showed statistically significant improvement at weeks 4 and 8. Schirmer test scores were improved at weeks 4 and 8, but there were no statistically significant differences. Tear osmolarity decreased significantly at week 8. All cytokine levels decreased at weeks 4 and 8, and interleukin (IL)-1β, IL-8, IL-17, and monocyte chemoattractant protein-1 were significantly decreased at week 8 compared with baseline. No adverse events were observed during the study period.Short-term treatment with topical 1% methylprednisolone not only improved clinical outcome but also decreased tear osmolarity and inflammatory cytokine levels without significant adverse events. Measurement of inflammatory cytokine levels and tear osmolarity, in addition to widely used clinical parameters, might be used as an objective method to evaluate the efficacy of treatment in dry eye patients.