Ocular Surface Inflammatory Disorders (OSID): A Collective of Systemic Etiologies Which Cause or Amplify Dry Eye Syndrome

Abstract

The ocular surface inflammatory disorders (OSID) are caused by systemic disorders that conduct a persistent inflammatory reaction in the ocular adnexal connective tissues, such as the conjunctiva, lacrimal gland (LG) and meibomian glands (MGs), which cause an inflammatory dry eye. The etiologies of OSID are a subset of systemic pathologies such as graft versus host disease, Sjögren's syndrome, allergies, cicatrizing conjunctivitis, and more. These cause a purely inflammatory dry eye syndrome as a consequence of the persistent surrounding inflammation in the adnexal tissues, which is distinct from the age-related dry eye disease. A limitation toward management of these conditions is the lack of available biomarkers that can detect presence of inflammation and quantify damage on the conjunctiva and LG, even though these are considered to be drivers of the inflammatory milieu. The OSID and dry eye syndrome are caused by different immune cells which are not exclusively limited to T cell lymphocytes, but rather derive from an orchestrated multicellular immunologic response. Recognition of this syndrome is crucial to direct research in a direction that clarifies the potential role of inflammation and its associated immune phenotype on the conjunctiva and adnexal ocular tissues in OSID and dry eye syndrome. On this paper, we review the basic and clinical research evidence for the existence of OSID with focus on the different immune cells involved, the target tissues and potential consequences and OSIDs diagnostic and therapeutic implications.

Keywords: conjunctiva; dry eye; inflammation; inflammatory dry eye; lacrimal gland; meibomian gland; ocular surface inflammation.

FIGURE 1

Ocular Surface Inflammatory Disorders (OSID) target organs. Note that the Diverse OSID impact in different degrees all the adnexal connective tissue structures. OSID, ocular surface inflammatory disorders; GVHD, graft versus host disease; SJS, Stevens Johnsons syndrome.

FIGURE 2

Potential conjunctival changes in OSID that lead to ocular dryness and increased inflammation. Note that the OSID impact the conjunctiva in many ways that are not fully appreciated.