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Elisabeth M. Messmer, Victoria v. Lindenfels, Alexandra Garbe, Anselm Kampik; Matrix-Metalloproteinase-9 (MMP-9) - Testing in Dry Eye Syndrome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2001. doi: https://doi.org/.
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The pathogenesis of Dry Eye Syndrome (DES) is complex. Inflammation seems to play a pivotal role to initiate and maintain the disease process. Multiple inflammatory markers, including MMP-9, have been isolated from the tear film of patients with DES.
A cohort of 101 probands and patients was evaluated by a subjective symptom questionnaire (ocular surface disease index-OSDI), break up time (BUT), conjunctival and corneal staining, Schirmer test and meibomian gland examination. 54 healthy eyes and 47 eyes fulfilling diagnostic criteria of DES underwent MMP-9 testing of the tear film by a commercially available test (RPSInflammadry™) detecting MMP-9 levels > 40ng/ml.
The MMP-9 tear test showed a significant difference between healthy eyes and eyes with DES (p<0.001). It correlated well with subjective symptoms evaluated by OSDI (p=0.001), BUT < 5 seconds (p<0.013), Schirmer test (p<0.001), conjunctival (p<0.001) as well as corneal staining (p=0.007). Moreover, it correlated with the number of obstructed meibomian ducts (p=0.005) and a pathologic meibomian gland secretion (p=0.001). It was significantly increased in female patients (p<0.001), and patients with autoimmune disease (p=0.005), especially Sjögren-Syndrome (p=0.001, and thyroid disease (p=0.012).
MMP-9-testing in DES is a valuable new diagnostic tool. It correlates well with other dry eye tests. It is especially helpful to identify patients with ocular surface inflammation and autoimmune disease and may facilitate the decision to institute anti-inflammatory treatment in these patients.
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