Dysregulated Tear Fluid Nociception-Associated Factors, Corneal Dendritic Cell Density, and Vitamin D Levels in Evaporative Dry Eye

Pooja Khamar, Archana Padmanabhan Nair, Rohit Shetty, Tanuja Vaidya, Murali Subramani, Murugeswari Ponnalagu, Kamesh Dhamodaran, Sharon D'souza, Anuprita Ghosh, Natasha Pahuja, Rashmi Deshmukh, Prerna Ahuja, Kanchan Sainani, Rudy M. M. A. Nuijts, Debashish Das, Arkasubhra Ghosh*, Swaminathan Sethu*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


PURPOSE. The purpose of this study was to study the status and association among tear-soluble factors, corneal dendritic cell density, vitamin D, and signs and symptoms in dry eye disease (DED).

METHODS. A total of 33 control subjects and 47 evaporative dry eye patients were included in the study. DED diagnosis and classification was based on the 2017 Report of the Tear Film & Ocular Surface Society International Dry Eye Workshop (TFOS DEWS II). DED workup, including tear film break-up time (TBUT), Schirmer's test I (STI), corneal and conjunctival staining, ocular surface disease index (OSDI) scoring, and in vivo confocal microscopy (to assess corneal dendritic cell density [cDCD] and subbasal nerve plexus [SBNP] features) was performed in the study subjects. Tear fluid using Schirmer's strip and serum were collected from the subjects. Multiplex ELISA or single analyte ELISA was performed to measure 34 tear-soluble factors levels including vitamin D.

RESULTS. Significantly higher OSDI discomfort score, lower TBUT, and lower STI were observed in DED patients. cDCD was significantly higher in DED patients. No significant difference was observed in SBNP features. Tear fluid IL-1 beta, IL-17A, MMP9, MMP10, MMP9/TIMP ratio, and VEGF-B were significantly higher in DED patients. Significantly lower tear fluid IL-2, IP-10, NPY, VEGF-A, and vitamin D was observed in DED patients. These dysregulated tear factors showed significant associations with DED signs and symptoms.

CONCLUSIONS. Altered tear fluid soluble factors with potential to modulate nociception exhibited a distinct association with ocular surface discomfort status, TBUT, STI, and cDCD. This implies a functional relationship between the various tear-soluble factors and dry eye pathogenesis, indicating new molecular targets for designing targeted therapies.

Original languageEnglish
Pages (from-to)2532-2542
Number of pages11
JournalInvestigative Ophthalmology & Visual Science
Issue number7
Publication statusPublished - Jun 2019


  • dry eye disease
  • corneal dendritic cells
  • nociception
  • inflammation
  • vitamin D
  • PAIN

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