The alteration of galectin-3 has been studied predominantly in patients with cancer and inflammatory disease but is commonly observed in pathological states of dry eye syndrome 56, and it has been speculated that galectin-3 can spread in the tears of patients with eye dry as a consequence of vascular and conjunctival permeability 32; Incomplete structures of galectin-3 in pathological cases inhibit a variety of processes such as tumor growth and wound healing 57.
Regarding interleukins, they present an important role in the adaptive immune response, since they are essential for the spread of inflammation 58, it has been especially shown that IL-1β is exacerbated in eyes with aqueous deficiency 59 and is increased in the pro-inflammatory production and activation 60. For its part, IL-17 increases its concentration in patients with dry eye, probably playing an important role in the processes of inflammation of the ocular surface 36; Additionally, the corneal 61 and conjunctival 62 fluorescein staining score has been correlated with high serum IL-17 concentrations in patients with dry eye due to systemic inflammatory disease. The presence of IL-17 stimulates the production of MMP-9 and causes damage to the corneal epithelium 38, an association between the presence of IL-6, and the production of MMP-9 23 has also been shown. That in patients with Sjögren’s dry eye syndrome, IL-17 is compromised due to local systemic immune reaction A, whereas non-Sjögren’s dry eyes can occur due to stressful situations, such as surface desiccation, which can lead to increases in IL-6 cytokines 36, which leads in the resolution of acute innate immunity and leads to an acquired immune response; likewise, there is an increase in IL-33 63) in patients with dry eyes. Consequently, the differentiation of the dry eye subtypes is crucial since some therapeutic options focus on supplementing the missing component of the tear film, while some more recent options are oriented towards the use of anti-inflammatory type molecules 64.
Against tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), they are cytokines present in the acute response that enhance cellular immune responses. 65; However, the main drawback to using tear cytokines as markers is that there are no longitudinal clinical studies 66, limiting their use confidence. On the other hand, it has been indicated that TNF-α increases in pro-inflammatory production and activation 60, while IFN-γ has an important role in the pathogenesis of dry eye 67, since this causes apoptosis and loss of cells of Conjunctival Goblet 38, thus, in the face of increased IFN-γ levels, the required treatment will be immunomodulators of T cells, such as cyclosporin A 67.
On the other hand, MMP-9 is a predictor of the clinical severity of the disease and is considered a clinical marker to monitor patients 68; in the same way, it has been indicated that patients with dry eye secondary to other diseases have a high activity of MMP-9 70, additionally increases in hyperosmolar conditions and contributes to the interruption of the corneal barrier, increasing its levels as the severity of dry eye increases 13. One of the more specific alternatives to measure MMP-9 is the InflammaDry test that, with the help of a buffer solution and in a very short period, can detect abnormally high levels of MMP-9 (40ng / ml or higher) in patients with dry eye 70.
The differentiation between each subtype of the disease facilitates the diagnosis and treatment. Thus the measurement of the mucin MUC5AC, which is secreted by the conjunctival goblet cells, is decreased in dry eye, impairing the wettability of the epithelium, given the hydrophilic nature of the mucins. Resulting from heavy glycosylation that helps keep the surface fluid 71, because MUC5AC has rheological properties that help contain fluids and lubricate the epithelial surface 71, there are even reports 73), (7 that indicate the relationship between the use of video terminals with the development of dry eye syndrome, due to the decrease in the concentration of MUC5AC in the absence of hyperemia or epithelial disorders. Likewise, it has been indicated that mucins are affected in patients with aqueous deficiency 74), (59. For their part, Shirai et al. 44 conclude that some mucins such as MUC16 play an important role in homeostasis s conjunctival and corneal; as it is, the loss of MUC16 can lead to a subclinical inflammatory reaction in the absence of additional external stimuli.
What can I do to manage my symptoms?
Use artificial tears, gel, or ointment. You give lubricants as directed. They are available without a prescription. They can replace tears and help moisturize your eyes. Ask your doctor how often to use these products. Also, ask where to buy them. Apply a warm compress to your eyelids as directed. Soak a soft washcloth in warm water. Leave the compress on your eyelids for 5 minutes. Gently massage your eyelids after removing the compress. This could help open your tear glands. The tear glands can produce an oil that will help keep tears and moisture on the eyes' surface. Wear glasses or sunglasses that cover the sides of your eyes and fit close to your face. This will protect your eyes from dry air. They could also help keep moisture in your eyes. Use a humidifier in your home. A humidifier may help keep moisture in the air and prevent dry eyes. Take vitamins and supplements as directed. Some vitamins and supplements may help reduce dry eyes. Ask your doctor what supplements you need and how often you should take them. Eat foods rich in omega 3 fatty acids. Examples are salmon, tuna, walnuts, and flax seeds. Omega 3 fatty acids can relieve dry eyes. Ask your doctor for a list of foods that contain fatty acids and how much to eat each day.
Do not smoke. Nicotine and other chemicals in cigarettes and cigars can damage the lungs. Cigarette and cigar smoke can make dry eyes worse. Ask your doctor for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Check with your doctor before using these products.
When should I contact my doctor?
Your dry eyes do not improve or get worse with treatment. One or both eyes ooze a thick, yellow fluid. Your eyelids or the skin around your eyes turn red and inflamed. You have changes in your vision. You have questions or concerns about your condition or care.
AGREEMENTS ABOUT YOUR CARE:
You have the right to help plan your care. Learn all you can about your condition and how to treat it. Discuss your treatment options with your doctors to decide the care you want to receive. You always have the right to refuse treatment. This information is for educational use only. It is not intended to give you medical advice about disease or treatment. Check with your doctor, nurse, or pharmacist before following any medical regimen to see if it is safe and effective for you.