Cyclosporine in ocular surface inflammation

Dry eye disease (DED) is the most frequent encountered ocular surface condition and remains one of the world’s most overlooked and treatment elusive ocular conditions. There a multitude of lubricating eye drops, agents/approaches to deal with the condition and associated external eye disease. Without gaining much in symptomatic relief

Evidence that dry eye represents a chronic overlapping pain condition

Recent data suggest that corneal somatosensory dysfunction may be the underlying cause of severe dry eye symptoms in the absence of ocular surface pathology seen in a subset of patients diagnosed with “dry eye syndrome.” This subset of patients tends to demonstrate a unique constellation of symptoms that are persistent, more severe, and generally respond poorly to current dry eye therapies targeting inadequate or dysfunctional tears. A growing body of literature suggests that symptoms in these patients may be better characterized as neuropathic ocular pain rather than dry eye. In these patients, dry eye symptoms are often associated with numerous comorbid pain conditions and evidence of central pain processing abnormalities, where eye pain is just one of multiple overlapping peripheral manifestations. In this review, we discuss the concept and potential mechanisms of chronic overlapping pain conditions as well as evidence for considering neuropathic ocular pain as one of these overlapping pain conditions

In Vivo Confocal Microscopic Evaluation of Corneal Langerhans Cells in Dry Eye Patients§

PURPOSE. To assess inflammatory involvement of cornea in dry eye by means of confocal microscopy, evaluating the presence and distribution of Langherans cells (LCs). METHODS: 98 eyes of 49 subjects were enrolled: 18 subjects affected by Sjögren Syndrome Dry Eye (SSDE), 17 with Non-Sjögren Syndrome Dry Eye (NSSDE), 14 healthy volunteeers. Dry eye symptoms, tear film, ocular surface damage and corneal confocal microscopy were analized. RESULTS: A significant increase of LCs density was observed at sub-basal nerve plexus (SSDE = 79 cells/mm(2 )andNDE = 22 cells/mm(2); p = 0,0031) and sub-epithelial nerve plexus (SSDE = 38 cells/mm(2 )and NDE = 3 cells/mm(2); p = 0,0169) in central cornea of SSDE group. An increased number of LCs from the center to the periphery of the cornea was observed, significant only in healthy volunteers group. In dry eye patients there was an increase in LCs density in both peripheral and central cornea with a significant difference between NDE (14,66 cells/mm(2)) and SSDE (56,66 cells/mm(2)) only in central cornea (p = 0,0028). In SSDE group, mean density of LCs in central cornea results also superior to NSSDE group (29,33 cells/mm(2)). There was no correlation between LCs density and dry eye symptoms, tear film deficiency and ocular surface damage. CONCLUSION: This study demonstrates the activation of an inflammatory and immunological reaction in cornea of NSSDE and SSDE patients. Confocal microscopy can be an important diagnostic tool in evaluation and follow-up of dry eye disease