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Neurostimulation for tear production
Ji Kwan Park1, Sandra Cremers2, Andrea Lora Kossler3
1Loma Linda Eye Institute, Loma Linda University, Loma Linda, California.
Current Opinion in Ophthalmology
|August 9, 2019
Summary
Intranasal tear neurostimulators offer a promising new treatment for dry eye disease (DED). This noninvasive approach effectively increases tear production and may improve tear composition, offering relief for millions suffering from DED.
Area of Science:
- Ophthalmology
- Neuroscience
- Biomedical Engineering
Background:
- Dry eye disease (DED) is a prevalent, chronic condition impacting millions globally, with current treatments facing limitations.
- Neurostimulation represents an emerging therapeutic avenue for enhancing tear production, leading to innovations like the intranasal tear neurostimulator (ITN).
Purpose of the Study:
- To review the neuroanatomy and pathophysiology of tear production.
- To discuss the evolution of neurostimulation techniques for DED treatment.
- To evaluate the efficacy and safety of the intranasal tear neurostimulator (ITN).
Main Methods:
- Review of existing literature on lacrimal nerve and anterior ethmoid nerve stimulation.
- Analysis of data from pilot studies and multicenter randomized controlled trials on the ITN.
- Examination of studies investigating the effects of intranasal stimulation on tear composition.
Main Results:
- The ITN, approved in 2017, demonstrated success in animal studies involving lacrimal and anterior ethmoid nerve stimulation.
- Clinical trials confirm that the ITN increases aqueous tear production, alleviates DED symptoms, and is safe for use.
- Emerging research indicates intranasal stimulation positively influences mucin and lipid secretion, potentially improving tear film quality.
Conclusions:
- Neurostimulation, particularly via the ITN, presents a promising noninvasive treatment for DED by enhancing tear volume.
- The ITN may also improve tear composition, including mucin and lipid levels.
- Further research is necessary to optimize patient selection and ascertain the long-term effectiveness of neurostimulation for DED management.
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