March 2013
Volume 54, Issue 3
Letters to the Editor  |   March 2013
Tear Osmolality and Whole-Body Hydration
Author Notes
  • School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia. E-mail:  
Investigative Ophthalmology & Visual Science March 2013, Vol.54, 1712. doi:
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      Charles W. McMonnies; Tear Osmolality and Whole-Body Hydration. Invest. Ophthalmol. Vis. Sci. 2013;54(3):1712. doi:

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      © ARVO (1962-2015); The Authors (2016-present)

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I have read the report of the study of whole-body hydration in relation to dry eye conditions 1 with interest and congratulate the authors, as these findings appear to indicate a new approach to the management of dry eye. Reducing tear osmolality and associated inflammation is a key area of dry eye management. 2 However, it is possible that in some cases a reduction in salt intake, either alone or in conjunction with increased whole-body hydration, might be a more appropriate recommendation than only increasing water consumption. 3 Given the importance of achieving the correct balance between hydration and osmolality in the management of other conditions, such as high blood pressure, 3 and the susceptibility of older age groups to imbalances in dietary sodium, for example, 4 unsupervised attempts to manage dry eye by changing water and salt intake may be harmful. In addition, increases to water intake may lead to dilution of other dietary components. As described by Walsh and his colleagues, 1 a trial with subjects hospitalized for the duration of the initial management period may be required if appropriate monitoring of patient responses is to be achieved. 
Walsh NP Fortes MB Raymond-Barker P Is whole-body hydration an important consideration in dry eye? Invest Ophthalmol Vis Sci . 2012; 53: 6622–6627. [CrossRef] [PubMed]
Pflugfelder SC Geerling G Kinoshita S DEWS report: management and therapy of dry eye disease. Ocul Surf . 2007; 5: 163–178. [CrossRef] [PubMed]
He FJ Markandu ND Sagnella GA MacGregor GA. Effect of salt intake on renal excretion of water in humans. Hypertension . 2001; 38: 317–320. [CrossRef] [PubMed]
Sacks FM Svetkay LP Vollmer WM Effects on blood pressure of reduced dietary approaches to stop hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. New Engl J Med . 2001; 344: 3–10. [CrossRef] [PubMed]

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