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Ophthalmic drug delivery faces major limitations due to poor absorption across the corneal membrane. This process is primarily driven by diffusion and is influenced by two main factors: the physicochemical properties of the drug and tear drainage. Most ophthalmic drugs, such as pilocarpine, epinephrine, atropine, and local anesthetics, are weak bases. They are typically formulated at an acidic pH to enhance chemical stability. However, this leads to high ionization, reducing their ability to...
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Clinical Application of Intense Pulsed Light Therapy and Radio Frequency for Treatment of Ocular Surface Diseases
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Rethinking dry eye disease: a perspective on clinical implications.

Anthony J Bron1, Alan Tomlinson2, Gary N Foulks3

  • 1Professor emeritus - University of Oxford, Nuffield Laboratory of Ophthalmology, Nuffield Dept of Clinical Neurosciences, UK.

The Ocular Surface
|April 15, 2014
PubMed
Summary
This summary is machine-generated.

Rethinking dry eye disease (DED) is necessary due to new evidence. Elevated tear osmolarity is a key diagnostic marker, improving patient outcomes and management strategies for this heterogeneous condition.

Keywords:
aqueous-deficient dry eye diseasedry eye diseaseinflammationmeibomian gland dysfunctionosmolaritypoint-of-care testing

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Area of Science:

  • Ophthalmology
  • Dry Eye Disease Research

Background:

  • The 2007 DEWS report defined dry eye disease (DED) science.
  • Recent evidence necessitates a re-evaluation of traditional DED concepts, epidemiology, and diagnostic strategies.
  • DED is a heterogeneous condition with significant presentation variability.

Purpose of the Study:

  • To summarize recent advances in DED understanding, diagnosis, and clinical care.
  • To highlight the limitations of current diagnostic signs and symptoms.
  • To discuss the implications of new findings for managing DED.

Main Methods:

  • Review of current scientific evidence on DED epidemiology and diagnosis.
  • Analysis of the correlation between DED signs, symptoms, and objective measures.
  • Evaluation of tear osmolarity as a diagnostic marker.
  • Discussion of emerging markers and future research directions.

Main Results:

  • Traditional DED signs show poor correlation with each other and symptoms.
  • Less than 60% of subjects with objective DED evidence are symptomatic, indicating potential underdiagnosis.
  • Elevated tear osmolarity is a reliable global marker for DED diagnosis and severity.
  • Tear film instability is a key identifier of DED and emphasizes its bilateral nature.
  • Tear osmolarity normalizes with effective treatment, reducing inter-eye variability.

Conclusions:

  • Accurate DED recognition is now achievable, improving patient management.
  • Elevated tear osmolarity is the most effective single metric for DED diagnosis.
  • New diagnostic tests and technologies promise improved clinical trial endpoints and therapeutics.
  • Addressing DED heterogeneity and diagnostic challenges is crucial for optimal patient outcomes.