Surgery, environmental factors may trigger dry eye flares
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Fluctuating dry eye symptoms following surgery or exposure to environmental triggers are “highly suggestive” of flares, according to a poster presented at the Women in Ophthalmology Summer Symposium.
A rapid evidence assessment of five refractive surgery studies, five daily life studies and 12 controlled environment studies looked at data on short-term exacerbations of symptoms or signs in patients with dry eye disease after ocular surgery or environmental challenges, such as air conditioning, wind, reading, low humidity and digital device use.
“Although none of the included studies specifically used the term ‘DED flare,’ the patterns of exacerbation of signs and symptoms reported were consistent with the definition of dry eye flares,” Desiree Owen, OD, and colleagues said in the presentation.
Of three refractive surgery studies that included mean tear film breakup time preoperatively and postoperatively, one reported statistically significant differences (P < .05) between measurements at baseline and at all points at 1 day, 1 month and up to 3 months of follow-up of 18 patients. In another study of 96 patients whose ocular surface was treated preoperatively, statistically significant differences (P < .05) in tear film breakup time were seen between baseline and 1 day and 1 month, but at up to 3 months, mean tear film breakup time was improved over baseline values.
In the daily life studies, three used controlled environment chambers to elicit ocular surface response in dry eye disease signs and symptoms. In all three studies, matrix metalloproteinase-9 (MMP-9) was statistically significantly increased over the baseline value at 2 hours after the challenge.
“The rapid increase of MMP-9 expression after exposure indicates the innate immune response plays a role in DED flares, which may be a suitable biomarker for the assessment of DED flares. The presence of MMP-9 also suggests the need for broad-spectrum anti-inflammatories in the treatment of dry eye flares,” the authors said.
Reference:
- Starr CE, et al. Ocul Surf. 2021;doi:10.1016/j.jtos.2021.07.001.
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Owen D, et al. 10 year rapid evidence assessment of dry eye disease flares. Presented at: Women in Ophthalmology Summer Symposium; Aug. 26-29, 2021; Amelia Island, Florida.
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