Importance of estimation of inflammatory marker (MMP 9) in tear film of dry eye patients
Journal Title: Indian Journal of Clinical and Experimental Ophthalmology - Year 2016, Vol 2, Issue 4
Abstract
Abstract Aim: To evaluate the presence of inflammatory marker MMP-9 in dry eye patients and institute appropriate anti-inflammatory therapy. Materials and Methods: This is a prospective study done in 30 patients, suspected of having dry eye based on history and clinical examination inputs. All of them followed the following sequence - Meticulous History, Clinical examination, Ocular Surface disease index (OSDI) score, Tear film break up time (TBUT), Schirmer I test, Tear osmolarity level with Tearlab and MMP- 9 estimation with Inflamma Dry® Package Insert. Results: Out of 30 patients, Female (56.66%) dominated over male patients(43.33%). The most common age group in the study was between 51 and 60 years while it was nil in age group below 20 years. Ocular Surface Disease Index(OSDI) score graded the patients in Mild (23.33%), Moderate (63.33%) and Severe(13.33%) respectively. We took 315mOsms/l as a cut off value for tagging the tear as hyperosmolar and 17(56.66%) patients fell in this category. MMP-9 was found to be positive in 9 (30.00%) patients. Patients having inflammatory marker positive in tear film, were put on appropriate anti-inflammatory therapy. Discussion: Elevated tear fluid osmolarity has been recognised as a common feature of dry eye for decades 14. Tear osmolarity is one of the best single metrics to diagnose and classify dry eye disease 13. Hyperosmotic stress stimulates the expression and production of inflammatory markers including MMP- 9 by human corneal epithelial cells(HCEC)15. In the present study we evaluated the MMP- 9 level in 30 dry eye patients and found 9 cases exhibiting positive response. Osmoprotectants (L- carnitine, Erythritol, Betaine and Glycerol) differentially suppress gene expression, protein production, and enzymatic activity of inflammatory markers in primary HCECs exposed in hyperosmotic stress16. In light of above evidence we prescribed a tear substitute having the osmoprotectants as its ingredients, to our MMP- 9 positive dry eye patients. In addition we added anti-inflammatory agents e.g. topical soft steroids and topical Cyclosprine as per the DEWS treatment recommendations.
Authors and Affiliations
Dipak Bhuyan, HN Hazarika, Bonomita Neogi, Sujit Addya
Keywords
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