5/4/18 1 Advances in Ophthalmology Ramy Bassily Consultant Ophthalmic Surgeon Dry Eyes ". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.” DEWS II definition of dry eyes 7-16% of all adults over 48 1 1. Ophthalmic Epidemiol, 13 (2006), pp. 263-274 2. Arch Ophthalmol. 2000 Sep; 118(9):1264-8 3. Oc Surf. 2016; 14(2):144-167 £820,930 per year for every 1000 dry eye patients 2 Makes people miserable 3 Dry Eyes ". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.” DEWS II definition of dry eyes Measurable markers for diagnosis and treatment - Osmolarity - MMPs Investigative Ophthalmology & Visual Science May 2008, Vol.49, 5851 The Dry Eye Questionnaire 5 (DEQ-5): Use of a 5-Item Habitual Symptom Score to Discriminate Between Groups With Varying Self-Assessed Severity Improved diagnosis Dry Eyes ". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.” DEWS II definition of dry eyes Inflammation Breaking the Vicious cycle Omega 3 Reduce inflammation Increase tear production (up to 30%) Improve epithelial regeneration All studies used EPA +1500mg DHA +500mg Med Sci Mont 2014; 20: 1583–1589 Immunomodulating Drugs • TRPV1 receptor antagonist (SYL1001) • Cyclosporine A • Tacrolimus • Tumor necrosis factor α-stimulated gene/protein-6 (TSG-6) • Interleukin-1 receptor antagonist (IL-1Ra) • Anti tumor necrosis factor-α therapy (TNF- α) • Anti Interleukin-17 (IL-17) therapy • Neuropeptides • Lymphocyte function-associated antigen 1 (LFA-1) antagonist • Lifitegrast 5%