Investigational drugs in dry eye disease

ABSTRACT

Introduction: The dry eye disease (DED) is a chronic multifactorial disorder of the tears that also involves the ocular surface, the lacrimal glands, and meibomian dysfunction. Furthermore, DED is often associated with Sjögren’s syndrome (SS) and other autoimmune disorders. Sometimes, this chronic or subclinical condition is difficult to diagnose and treat, due to its heterogeneity.

Areas covered: A literature search of relevant publications about treatment of DED was performed. All relevant articles published between 2011 and 2016 were identified through a computerized search for reviews and clinical trials using the Pub Med database. In particular, investigational treatments have been reported in this peer-reviewed publication. Relevant articles identified were manually searched and reviewed, then data concerning with novel treatment for DED were included into the manuscript.

Expert opinion: The treatment of dry eye patients evolves continuously because DED seriously impacts the quality of life of older adults. Indeed, as a chronic disease, DED prevalence is expected to worsen with the aging population. For this reason, current efforts focus on combined pharmacological strategies targeted towards multiple systems. Probably this is the correct way to reach a long lasting symptoms relief treatment that may allow an actual improvement of patients’ quality of life.

KEYWORDS:

• Biologic drugs
• cyclosporine A
• dry eye disease (DED)
• keratoconjunctivitis sicca
• Sjögren’s syndrome
• tear film

Article highlights

• A metabolic deficiency of ω3 tear film lipids can cause an impact inflammatory on the ocular surface. Oral supplements of ω3 promote tear film stabilization.

• Biologic agents targeting B cells, such as rituximab, belimumab and epratuzumab are, at present, the most promising biologic therapies for Sjögren’s syndrome.

• Newer ocular lubricants are used in various combinations for the treatment of dry eye: polymers, carmellose sodium, hyaluronic acid (HA), trehalose, polyethylene glycol, propylene glycol, hydroxypropyl guar, salts, lubricin, and osmoprotectants.

• The topical non-steroidal anti-inflammatory drugs reduce inflammation and eye pain but at the same time they could reduce eye sensitivity.

• Cyclosporine A (0.05-0.1-1-2%) is the first immunomodulator in ophthalmic emulsion approved as prescription medicine for increasing tear production.

• Topical nerve growth factor (NGF) increases both aqueous and mucous secretion. NGF trophic function is related to tyrosine kinase receptor and p75 neurotrophin receptor stimulation.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.