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Corticosteroids may alleviate low-humidity effects in dry eye patients
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The use of corticosteroid eye drop therapy may lessen the acute adverse effects of low-humidity environment stress for dry eye disease patients, according to a study.
The single-group crossover clinical trial evaluated 20 patients with aqueous deficient dry eye to determine the effectiveness of artificial tears and corticosteroid eye drop therapy.
During three low-humidity challenges, patients wore controlled environmental goggles to maintain a relative humidity of 18% to 25% for 90 minutes while watching a video display. After enrollment and baseline visits, patients used artificial tears for 2 weeks before low-humidity exposure at visit 3, followed by the use of 0.1% dexamethasone for 2 weeks before the final low-humidity exposure at visit 4.
When patients were untreated and treated with artificial tear therapy, dry eye signs and symptoms worsened after exposure to the low-humidity environment.
After using dexamethasone, patients had fewer eye irritation symptoms with a significantly lower increase in expression of the human leukocyte antigen gene and a decrease in corneal and conjunctival staining.
“The development of anti-inflammatory therapies for the ocular surface will become increasingly important to reduce the impact of dry eye disease as the use of digital technology rises and more people work in office environments,” the study authors said. – by Kristie L. Kahl
Disclosure: Moore reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Darrell E. White, MD
Moore and colleagues examined ocular surface stress associated with acute dryness and described why it occurs. We now have more evidence that dry eye signs and symptoms are associated with an increase in inflammatory activity on the surface of the eye. By showing an up-regulation of HLA-DR in response to environmental stress, this elegant study solidifies our current understanding of the primacy of inflammation as the underlying cause of dry eye.We have long known that it is easier to prevent dry eye symptoms from occurring than it is to treat them once they have arrived. High-quality artificial tears failed to prevent symptoms when a dry eye stressor was applied. Topical steroid application, on the other hand, effectively did just that. I believe that this should make us all much less reluctant to initiate anti-inflammatory treatment early in the course of dry eye. While I agree with the authors that dexamethasone is problematic as a long-term therapeutic agent, we have at our disposal very adequate alternatives (loteprednol, cyclosporine A) with newer agents possibly on the way (lifitegrast).
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Moore QL, et al. Am J Ophthalmol. 2015;doi:10.1016/j.ajo.2015.04.008.
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