Clinical Study On The Role Of Combined Action Of Hydrocortisone And Artificial Tears In The Management Of Inflammatory Dry Eye Disease, Based On Mmp-9 Detection.

Dry eye disease (DED) is a highly prevalent ocular condition with a significant burden on affected patients. DED is often accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. Research shows MMP-9 is elevated in the tears of dry eye patients. We investigated the effect of combined action of hydrocortisone and artificial tears   in the management of inflammatory dry eye disease, following a protocol based on identification of MMP-9

Research &Therapeutic Institute “Ophthalmos”, Glyfada, Athens, Greece

A total of 30 patients with chronic DED were included.  InflammaDry (Rapid Pathogen Screening), a single-use, non-invasive test to detect MMP-9 was performed in all our patients, as well as Tear film assessment and corneal staining. All patients filled a Speed questionnaire for evaluation of subjective symptoms. Patients who had a positive test, were randomized to receive either preservative-free hydrocortisone 0.335% (Softacort, Laboratories Thea, France) and Thealoz Duo(Thea, France) for 28 days three times daily or Thealoz Duo 4 times daily for 28 days. Ocular redness was assessed at baseline and day 28. Measurement of intraocular pressure (IOP) and clinical tests to assess signs and symptoms of DED were performed.

Conjunctival hyperaemia and DED decreased in both treatment groups. We found an increase in tear film thickness and improvement in tear quality which was more significant in the group that had the combination treatment ( Softacort and Thealoz Duo) 4 weeks after treatment start. Subjective symptoms had greater improvement also in the same group.  IOP did not change in either of the two treatment groups (p = 0.45). Inflammadry result was positively correlated with the outcome and resolution of symptoms.

Inflammadry was useful in identifying the patients with inflammatory DED , and guided their treatment with low dose hydrocortisone, which also had a good safety profile.  Combination of hydrocortisone and artificial tears had greater impact on subjective and objective improvement of DED.