Saudi Journal of Ophthalmology (2014) 28, 163

Editorial

Dry eye and ocular surface disease

Peer review under responsibilityof Saudi Ophthalmological Society,King Saud University Production and hosting by Elsevier

Access this article onlinwww.saudiophthaljournwww.sciencedirect.com

Sight, surgical outcomes and, ultimately, patient satisfac-tion critically depend on the health of the ocular surface.The extraordinary complexity of the ocular surface is main-tained by intricate homeostasis; destabilization of this equi-librium may result in devastating consequences. Eyeliddisorders can instigate a deleterious cascade of events, effac-ing the integrity and functions of the ocular surface epithelia.In many disease processes (e.g., Stevens-Johnson syndrome,cicatricial pemphigoid, collagen vascular diseases, burns, oreven chronic blepharitis), the fundamental pathophysiologyproduces dysfunctional tear film, anomalous ocular surfaceepithelia, and disfigured lids. Disruption of the tear film pro-gresses to keratoconjunctivitis sicca. Potentially devastatingconsequences, such as corneal scarring, infection and blind-ness, may ensue. Similarly, a healthy ocular surface is animportant prognostic factor for surgical outcome. Accord-ingly, in this special edition on dry eye and ocular surface dis-ease (OSD), we endeavor to provide the anterior segmentsurgeons with information to manage OSD and ensure opti-mal eyesight, surgical outcome, and patient satisfaction.

Current literature indicates that the outcome of cataractsurgeries, especially premium IOL implantation, is governedby OSD. Preexisting OSD is associated with suboptimal visualoutcomes and higher risks of postoperative complications. Inthis issue, Movahedan and colleagues1 reviewed the salientobservation between OSD and cataract surgeries. Theauthors presented strategies to diagnose and manage theseconditions pre- and post-operatively to ensure optimal out-come. Amniotic membrane is a versatile tool for ocular sur-face reconstruction. Katzman and Jeng2 discussed differentmanagement modalities for persistent epithelial defects.Nguyen et al.3 investigated the role of amniotic membraneas an adjuvant therapy in high-risk penetrating keratoplasty.The authors aimed to leverage the anti-inflammatory proper-ties of amniotic membrane to rehabilitate the ocular surfaceand reduce graft rejection; however, no correlation wasdetermined in this retrospective series.

In severe ocular surface disorders, the loss of limbal epi-thelial stem cells, or limbal stem cell deficiency (LSCD), hasmany deleterious complications, e.g. LSCD is a leading causeof corneal blindness. The diminished regenerative capacityseen in LSCD is characterized by persistent epithelial defects,erosion and ulceration, conjunctivalization and neovasculari-zation, and chronic inflammation. Lin and Yiu4 provided anexcellent review diagnostic approaches and treatment fordry eye disease. Tu5 performed a comprehensive review of

toxicity of current ophthalmic eye drops. He and Yiu6

reviewed various stem cell based approaches for treatingLSCD as well as discussing future direction and challenges.

A recent innovation, the prosthetic replacement of theocular surface ecosystem (PROSE) scleral lens has beeninstrumental in restoring vision and improving patient satis-faction for a wide range of OSD, e.g. severe dry eye, graftversus host disease, exposure keratopathy, limbal stem celldeficiency, as well as corneal ectasia. In this issue, Chiu et al.7

presented that PROSE can improve vision in patients withSalzmann’s nodular degeneration.

OSD is a challenging adversity for the ophthalmologists.Successful outcome and patient satisfaction require thoroughevaluation utilizing appropriate clinical tools and comprehen-sive medical management. Surgical patients necessitateattentive pre- and post-operative management. Evolution inthe field will continue to arm the surgeons with tools to man-age this chronic devastating condition.

References

1. Afsharkhamseh N, Movahedan A, Motahari H, Djalilian AR. Cataractsurgery in patients with ocular surface disease: an update in clinicaldiagnosis and treatment. Saudi J Ophthalmol 2014;28(3):164–7.

2. Katzman LR, Jeng BH. Management strategies for persistent epithelialdefects of the cornea. Saudi J Ophthalmol 2014;28(3):168–72.

3. Nguyen P, Rue K, Heur M, Yiu SC. Ocular surface rehabilitation:application of human amniotic membrane in high-risk penetratingkeratoplasties. Saudi J Ophthalmol 2014;28(3):198–202.

4. Lin H, Yiu SC. Dry eye disease: a review of diagnostic approaches andtreatments. Saudi J Ophthalmol 2014;28(3):173–81.

5. Tu EY. Balancing antimicrobial efficacy and toxicity of currentlyavailable topical ophthalmic preservatives. Saudi J Ophthalmol2014;28(3):182–7.

6. He H, Yiu SC. Stem cell-based therapy for treating limbal stem cellsdeficiency: a review of different strategies. Saudi J Ophthalmol2014;28(3):188–94.

7. Chiu GB, Bach D, Theophanous C, Heur M. Prosthetic replacement ofthe ocular surface ecosystem (PROSE) scleral lens for Salzmann’snodular degeneration. Saudi J Ophthalmol 2014;28(3):203–6.

Samuel C. Yiu, MD, PhDDepartment of Ophthalmology, The Wilmer Eye Institute,

The Johns Hopkins University, 400 N Broadway/Smith Bldg. 6041,Baltimore, MD 21231, United States

Tel./fax: +1 443 2874890.E-mail address: syiu2@jhmi.edu

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