June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Dry Eye Disease Flares: A Ten-Year Literature Review
Author Affiliations & Notes
  • Christopher Starr
    Weill Cornell Medicine, New York, New York, United States
  • Desiree V Owen
    Kala Pharmaceuticals, Massachusetts, United States
  • Sara Lucas
    Envision Pharma Group Limited, Horsham, West Sussex , United Kingdom
  • Stephen C Pflugfelder
    Baylor College of Medicine, Houston, Texas, United States
  • Reza Dana
    Harvard Medical School, Boston, Massachusetts, United States
  • Edward Holland
    Cincinnati Eye Institute, Cincinnati, Ohio, United States
  • Kim Brazzell
    Kala Pharmaceuticals, Massachusetts, United States
  • Steven Zhang
    Kala Pharmaceuticals, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Christopher Starr, Kala Pharmaceuticals (C); Desiree Owen, Kala Pharmaceuticals (E); Sara Lucas, Kala Pharmaceuticals (F); Stephen Pflugfelder, Kala Pharmaceuticals (C); Reza Dana, Kala Pharmaceuticals (C); Edward Holland, Kala Pharmaceuticals (C); Kim Brazzell, Kala Pharmaceuticals (E); Steven Zhang, Kala Pharmaceuticals (E)
  • Footnotes
    Support  Kala Pharmaceuticals
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1257. doi:
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    • Get Citation

      Christopher Starr, Desiree V Owen, Sara Lucas, Stephen C Pflugfelder, Reza Dana, Edward Holland, Kim Brazzell, Steven Zhang; Dry Eye Disease Flares: A Ten-Year Literature Review. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1257.

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

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Purpose : To evaluate the existing literature on dry eye disease (DED) and to report the features of DED flares including triggers, characteristics (signs and symptoms), and biomarkers.

Methods : A 10-year literature review was conducted of 2093 publications identified from MEDLINE, Embase, and PubMed databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol (PRISMA-P) guidelines. The literature review was performed on English language publications only of clinical trials or observational studies in adults with DED from 2009-2019 using an array of keywords associated with dry eye flares. The searches were designed to identify any observational studies or clinical trials published in the 10-year period that reported dry eye flares or short-term exacerbations of the signs and symptoms of DED.

Results : Screening using PICOS criteria identified 22 studies that met the inclusion criteria. To meet the study objectives, evidence was drawn from studies reporting exacerbations of signs and symptoms following exposure to environmental triggers encountered during daily life, following cataract and refractive surgery, and following exposure to controlled adverse environments. These studies suggest that exacerbations, or flares, of the signs and/or symptoms of DED occur in response to environmental triggers and/or ocular surgeries. Studies evaluating tear biomarkers following controlled adverse environment exposure found significant increase in inflammatory biomarkers matrix metalloproteinase 9 (MMP-9) and interleukin 6 (IL-6), and significant decrease in homeostatic biomarker epidermal growth factor (EGF). Other chronic inflammatory conditions such as chronic asthma, Sjogren syndrome, and rheumatoid arthritis have similar immune-mediated pathways as DED and feature subgroups of patients who experience episodes of flare and remission similar to those in DED.

Conclusions : DED flares are exacerbations of a patient’s signs and/or symptoms and can be caused by a variety of triggers. Episodic exacerbation is a common feature of chronic inflammatory diseases.

This is a 2021 ARVO Annual Meeting abstract.


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