The role of inflammation and antiinflammation therapies in keratoconjunctivitis sicca

Abstract

Purpose: To review and integrate recent advances in identifying the role of inflammation in the pathogenesis of dry eye conditions and the biological rationale and practical clinical aspects of newer, antiinflammatory theories.

Methods: A comprehensive literature survey.

Results and conclusion: Keratoconjunctivitis Sicca (KCS) is a multifactorial and complex disorder in which ocular surface inflammations play a central role. Identification of specific CD4-T-Cell pathways and the recent recognition of targeting of alpha-fodrin suggest a case for novel new therapeutic aspects such as anti-CD4 monoclonal antibodies, systemic linoleic and gamma-linolenic acids, and omega-6 essential fatty acids. Replacement of tear volume with nonpreserved wetting agents and standard typical antiinflammatory corticosteroid and/or cyclosporine A continues to be central current conventional therapy for KCS.

Keywords: antiinflammatory therapy; dry eye; keratoconjunctivitis sicca.

Figure 1

This schematic figure reveals the association of ocular surface inflammation, lacrimal gland dysfunction, and keratoconjunctivitis sicca. Abbreviations: MMP, matrix metalloproteinase; JNK, c-Jun NH₂ terminal kinase; MAPKs, mitogen activated protein kinases; ERK, extracellular-signal regulated kinase; IL, interleukin; TNF, tumor necrosis factor; CXCL, chemokine ligand.