Effects of Dry Eye Therapies on Environmentally Induced Ocular Surface Disease

Am J Ophthalmol. 2015 Jul;160(1):135-42.e1. doi: 10.1016/j.ajo.2015.04.008. Epub 2015 Apr 11.


Purpose: To evaluate the effectiveness of artificial tears and corticosteroids on mitigating the acute ocular surface response to low-humidity environments.

Design: Single-group, crossover clinical trial.

Methods: Twenty subjects with aqueous deficient dry eye were enrolled. Subjects meeting inclusion criteria at visit 1 were exposed to a baseline 90-minute low-humidity environment at visit 2. They then used artificial tears for 2 weeks prior to low-humidity exposure at visit 3, followed by 0.1% dexamethasone for 2 weeks prior to the final low-humidity exposure at visit 4. Outcome measures included corneal and conjunctival staining, blink rate, and irritation symptoms before and after each low-humidity exposure. Digital polymerase chain reaction (PCR) was performed to measure HLA-DR RNA transcripts in conjunctival cells taken by impression cytology at each visit.

Results: There was significantly less corneal and conjunctival epitheliopathy after the low-humidity exposure at visit 4 compared to after the low-humidity exposure at visit 3 (P = .003). Subjects reported significantly less eye irritation during the low-humidity exposure after using the dexamethasone (visit 4) compared to artificial tears (visit 3) (P = .01). HLA-DR transcripts significantly decreased after the stress at visit 4 (post dexamethasone) compared to visit 2.

Conclusion: Our study demonstrates that corticosteroid eye drops mitigate the acute adverse effects of an experimental low-humidity challenge, likely owing to suppression of stress-activated inflammatory pathways. While extended use of corticosteroids is not indicated, other anti-inflammatory therapies with activity against stress-activated pathways may prove as effective.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Adult
  • Blinking / physiology
  • Conjunctiva / metabolism
  • Cross-Over Studies
  • Dexamethasone / administration & dosage
  • Dexamethasone / therapeutic use*
  • Dry Eye Syndromes / drug therapy*
  • Dry Eye Syndromes / etiology
  • Dry Eye Syndromes / genetics
  • Environment, Controlled*
  • Female
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / therapeutic use*
  • HLA-DR Antigens / genetics
  • Humans
  • Humidity / adverse effects
  • Lubricant Eye Drops / administration & dosage
  • Lubricant Eye Drops / therapeutic use*
  • Male
  • Ophthalmic Solutions
  • Polymerase Chain Reaction
  • Prospective Studies
  • RNA / genetics
  • Single-Blind Method
  • Tears


  • Glucocorticoids
  • HLA-DR Antigens
  • Lubricant Eye Drops
  • Ophthalmic Solutions
  • RNA
  • Dexamethasone