Title: Study of Role of Vitamin D3 Supplementation in Patients Suffering from Dry Eye Syndrome (DES) Attending in Tertiary Care Hospital, at S.K.M.C.H. Muzaffarpur, Bihar
Authors: Dr Ramakant Thakur, Dr Rajiv Kumar Singh
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.13
Abstract
Objective: Present study was conducted to evaluate the role and effect of Vitamin D supplementation on tear film and in ameliorating the symptoms of Dry Eye Syndrome (DES).
Materials and Methods: A total of 56 patients aged between 38 to 75 years presenting with symptoms related to dry eye Syndrome attending in eye OPD were included in the study. Vitamin D estimation was done before starting treatment, at 2 weeks, 4 weeks and 8 weeks intervals after Vitamin D supplementation. Quantitative determination of Vitamin D estimation was done by fully automated Architect machine supplied by Roche pharma by CMIA (Chemiluminiscent Microparticle Immunoassay) methods. Schirmer's test and Tear break up time (TBUT) were done to assessment of the tear film. Eye discomfort was assessed by Ocular surface disease index (OSDI).
Results: Out of 56 patients mean age of the patients were 47.5 ± 22.5 years. Mean serum 25 OH-D level was found to be l1.4 ± 3.6ng /ml. Mean Tear break up time (TBUT) was 2.6 ± 2.2 s at pretreatment. It increased to 4.2 ± 1.4 s after 2 weeks and to 5.2 ± 1.6 s after 4 weeks and to 5.9 ± 1.4 s after 8 weeks. Schirmer's test at pretreatment level was 5.7 ± 2.2mm, 7.8 ± 4.3mm after 2 weeks, 8.3 ± 5.6mm after 4 weeks and 9.9 ± 6.3 mm after 8 weeks. Ocular surface disease index (OSDI) was 29.56 ± 21.2 at pretreatment, 24.9 ± 20.5 after 2 weeks, 21.9 ± 19.13 after 4 weeks and 19.52 ± 17.3 after 8 weeks.
Conclusion: Tear secretion is a major factor in the development of DES. Reduced tear production results in tear instability and ocular surface damage. Vitamin D supplementation was shown to promote tear secretion, reduce tear instability, and reduce inflammation of the ocular surface and eyelid margin
Keywords: Dry Eye Syndrome (DES), vitamin D supplementation, Tear break up time (TBUT), Ocular surface disease index (OSDI).
References
- Stevenson, W. Chauhan, S.K. & Dana, R. Dry eye disease: An immune related ocular surface disorder. Arch Opothalmol 130, 90-100 (2012)
- Tan, X. et al. Analysis of Th 17 associated cytokines in tears of patients with Dry Eye Syndrome. Eye (Land) 28, 608-13, 2014.
- Galor, A et al. Effect of a Mediterranean dietary pattern and Vit. D levels on Dry Eye Syndrome. Cornea 33, 437- 441 (2014)
- Albert DM Jakobiec FA Water and electrolyte secretion and fluid modification. Principles and Practice of Ophthalmology Basic Sciences (Vol 1.1A.)Philadelphia, Pa WB Saunders Co1995;sect 1B, chap 29B.Google Scholar
- Miljanovic B., Dana R., Sullivan D. A. & Schaumberg D. A. Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol 143, 409–415 (2007).
- The definition and classification of dry eye disease: report of the definition and classification subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 5, 75–92 (2007).
- Zheng X. et al. Desiccating stress promotion of Th17 differentiation by ocular surface tissues through a dendritic cell-mediated pathway. Invest Ophthalmol Vis Sci 51, 3083–3091 (2010).
- Pflugfelder S. C., de Paiva C. S., Li D. Q. & Stern M. E. Epithelial-immune cell interaction in dry eye. Cornea 27 Suppl 1, S9–S11 (2008).
- Lan W. et al. Nuclear Factor-κB: central regulator in ocular surface inflammation and diseases. Ocul Surf 10, 137–148 (2012).
- Lawrence T. The nuclear factor NF-κB pathway in inflammation. Cold Spring HarbPerspectBiol 1, a001651 (2009).
- Abu-Amer Y. et al. Tumor necrosis factor-alpha activation of nuclear transcription factor-kappaB in marrow macrophages is mediated by c-Src tyrosine phosphorylation of Ikappa Balpha. J BiolChem 273, 29417–29423 (1998).
- Luo L. et al. Experimental dry eye stimulates production of inflammatory cytokines and MMP-9 and activates MAPK signaling pathways on the ocular surface. Invest Ophthalmol Vis Sci 45, 4293–4301 (2004).