Dry eye symptoms improve with 0.6% povidone-iodine drops
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Treating dry eye with 0.6% povidone-iodine eye drops in patients with damaged ocular surfaces was “safe and well tolerated,” according to data published the Journal of Ocular Pharmacology and Therapeutics.
Considering emerging resistance to many commercially available antibiotics, povidone-iodine in ophthalmic solution, “presents an interesting potential as an alternative treatment to prevent infections,” Giovanni Oliverio, MD, of the University of Messina in Italy, and colleagues wrote.
In an observational, single-center study, Oliverio and colleagues assessed 20 patients who received 0.6% povidone-iodine (PVI) eye drops twice daily for 28 days to treat their dry eye disease (DED). Most patients were women (n = 18); age range was 18 to 80 years, and median age was 61 years. Investigators enrolled patients from the ocular surface disease unit of the University of Messina.
Researchers tracked patients’ symptoms by recording their answers to an Ocular Surface Disease Index (OSDI) questionnaire. They evaluated data from the questionnaire to assess the severity and frequency of symptoms such as burning, eye dryness, tearing, photophobia and other factors.
After 28 days of treatment, patients reported a reduction in symptoms such as burning (P = .0002), ocular dryness (P = .0003), foreign body sensation (P = .0001) and watery eye (P = .03). Patients also reported mild burning after eye drop instillation, researchers wrote. This sensation lasted for a few minutes and disappeared altogether after about 3 days.
Study limitations include no control group with which to compare patients and their data, according to the researchers.
They recommend that future studies examine the use of 0.6% PVI as a “complementary treatment” for DED and suggest investigating the “possible mechanisms underlying ocular surface modifications induced by 0.6% PVI treatment.”
Oliverio and colleagues concluded that 0.6% PVI is effective at reducing DED symptoms, writing, “It can be hypothesized that 0.6% PVI acting on ocular surface microbiota may rebalance the anomalous bacterial overgrowth typical of DED, thus promoting the prevalence of immune tolerance on inflammatory mechanisms.”
Perspective
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In this observational study, Oliviero and colleagues examined the impact of 0.6% PVI on mild-moderate DED patients. The effect on clinical practice is twofold: There is a potentially immediate impact on ophthalmic surgery and intravitreal injections. The effect on our daily treatment of dry eye disease is less certain.
Povidone-iodine is commonly used as a prophylactic antiseptic to reduce the bacterial load and risk for infection with intravitreal injections. The authors argue that 0.6% PVI accomplishes this goal without the ocular toxicity of higher concentrations. In fact, not only did 0.6% PVI avoid ocular toxicity in this study, it had a positive impact, improving both tear break-up time and corneal-conjunctival staining.
The authors discuss whether this preparation could provide an additional treatment option for clinical management of dry eye disease. They hypothesize that the antiseptic drop abolishes microbial overgrowth, thereby disrupting the inflammatory stimulus prevalent in DED. However, this study has significant limitations that prevent a firm conclusion regarding DED treatment. It is a small observational study with no control group, and the vehicle may have been responsible for some of the positive results. Therefore, further research is indicated to determine whether this treatment may play a role in our DED toolkit.
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