journal article·2022-04-30Open access

Dry Eye Disease and Vitamins: A Narrative Literature Review

Joon Young Hyon, Sang Beom Han

Applied Sciences· Volume 12· Issue 9

Abstract

Dry eye disease (DED) is a major public health problem worldwide that seriously impairs the quality of life, reduces work productivity, and poses significant economic burden. In DED, tear film instability or hyperosmolarity activates a self-perpetuating vicious cycle that may aggravate ocular surface inflammation and damage. Thus, treatment approaches should focus on interrupting this cycle and ameliorating inflammation. In addition to anti-inflammatory medications, such as corticosteroids, cyclosporine, and lifitegrast, nutrients with anti-inflammatory and anti-oxidative properties may also be effective for the treatment of DED. Evidence indicates that vitamin deficiencies may be associated with an increased risk of DED and that vitamin supplementation can be an effective treatment for DED. In the present review, we introduce the results of clinical and experimental studies on the association between vitamin deficiencies and DED. The potential efficacy of systemic and topical supplementation in the treatment of DED is also discussed.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Ocular Surface and Contact Lens · Olfactory and Sensory Function Studies · Skin Protection and Aging

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea

Department of Ophthalmology, Kangwon National University Medical School, Kangwon National University Hospital, Chuncheon 24289, Korea

Funding

Kangwon National University Hospital

References (100+)

Show source-provided references
1. TFOS DEWS II Definition and Classification Report10.1016/j.jtos.2017.05.008 ↗
2. Association of dry eye disease with psychiatric or neurological disorders in elderly patients10.2147/CIA.S137580 ↗
3. Prevalence of dry eye disease in an elderly Korean population10.1001/archophthalmol.2011.78 ↗
4. Clinical impact of inflammation in dry eye disease: Proceedings of the ODISSEY group meeting10.1111/aos.13436 ↗
5. TFOS DEWS II Epidemiology Report10.1016/j.jtos.2017.05.003 ↗
6. Prevalence of dry eye among an elderly Chinese population in Taiwan: The Shihpai Eye Study10.1016/S0161-6420(03)00262-8 ↗
7. Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women10.1093/ajcn/82.4.887 ↗
8. Economic and Humanistic Burden of Dry Eye Disease in Europe, North America, and Asia: A Systematic Literature Review10.1016/j.jtos.2015.11.002 ↗
9. The Pathophysiology of Dry Eye Disease: What We Know and Future Directions for Research10.1016/j.ophtha.2017.07.010 ↗
10. Tear cytokine profiles in dysfunctional tear syndrome10.1016/j.ajo.2008.08.032 ↗
11. A multicentre, double-masked, randomized, controlled trial assessing the effect of oral supplementation of omega-3 and omega-6 fatty acids on a conjunctival inflammatory marker in dry eye patients10.1111/j.1755-3768.2011.02196.x ↗
12. Pellegrini, M., Senni, C., Bernabei, F., Cicero, A.F.G., Vagge, A., Maestri, A., Scorcia, V., and Giannaccare, G. (2020). The Role of Nutrition and Nutritional Supplements in Ocular Surface Diseases. Nutrients, 12.10.3390/nu12040952 ↗
13. Fogagnolo, P., De Cilla, S., Alkabes, M., Sabella, P., and Rossetti, L. (2021). A Review of Topical and Systemic Vitamin Supplementation in Ocular Surface Diseases. Nutrients, 13.10.3390/nu13061998 ↗
14. The eye and nutrition10.1016/S0021-5155(00)00161-1 ↗
15. Vitamin A deficiency alters the expression of mucin genes by the rat ocular surface epithelium
16. The Role of Neurotropic B Vitamins in Nerve Regeneration10.1155/2021/9968228 ↗
17. Doseděl, M., Jirkovský, E., Macáková, K., Krčmová, L.K., Javorská, L., Pourová, J., Mercolini, L., Remião, F., Nováková, L., and Mladěnka, P. (2021). Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination. Nutrients, 13.10.3390/nu13020615 ↗
18. Vitamin D Activation and Function in Human Corneal Epithelial Cells During TLR-Induced Inflammation10.1167/iovs.15-17768 ↗
20. Topical vitamin C, vitamin E, and acetylcysteine as corneal wound healing agents: A comparative study10.4103/ijo.IJO_1463_20 ↗
21. Vitamin A deficiency and the eye10.1097/00004397-200010000-00007 ↗
22. Vitamin A deficiency and xerophthalmia in children of a developed country10.1111/jpc.13243 ↗
23. Vitamin B12 deficiency evaluation and treatment in severe dry eye disease with neuropathic ocular pain10.1007/s00417-017-3632-y ↗
24. Sjögren’s syndrome associated with vitamin B12 deficiency10.3109/rhe1.1970.16.issue-1-4.22 ↗
25. Yoon, S.Y., Bae, S.H., Shin, Y.J., Park, S.G., Hwang, S.H., Hyon, J.Y., and Wee, W.R. (2016). Low Serum 25-Hydroxyvitamin D Levels Are Associated with Dry Eye Syndrome. PLoS ONE, 11.10.1371/journal.pone.0147847 ↗
26. Dry eye in vitamin D deficiency: More than an incidental association10.1111/1756-185X.12727 ↗
27. Vitamin D Deficiency Is Associated with Severity of Dry Eye Symptoms and Primary Sjögren’s Syndrome: A Systematic Review and Meta-Analysis10.3177/jnsv.66.386 ↗
28. Lower Serum Vitamin D Level Was Associated with Risk of Dry Eye Syndrome
29. Lower Vitamin D Level and Distinct Tear Cytokine Profile Were Observed in Patients with Mild Dry Eye Signs but Exaggerated Symptoms10.1167/tvst.5.6.16 ↗
30. Association between vitamin D and dry eye disease: A systematic review and meta-analysis of observational studies10.1016/j.clae.2020.03.001 ↗
31. The association of vitamin D deficiency with tear break-up time and Schirmer testing in non-Sjögren dry eye10.1038/eye.2015.96 ↗
32. The Association of Serum Vitamin D Level With the Severity of Dry Eye Parameters in Primary Sjögren Syndrome10.1097/ICO.0000000000002234 ↗
33. Oral versus intramuscular vitamin A in the treatment of xerophthalmia10.1016/S0140-6736(80)91053-3 ↗
34. Effects of short-term oral vitamin A supplementation on the ocular tear film in patients with dry eye10.2147/OPTH.S198349 ↗
35. Management of Ocular Neuropathic Pain With Vitamin B12 Supplements: A Case Report10.1097/ICO.0000000000000572 ↗
36. Vitamin D Replacement Improves Tear Osmolarity in Patients with Vitamin D Deficiency10.1080/08820538.2017.1358752 ↗
37. Vitamin D Supplementation for Patients with Dry Eye Syndrome Refractory to Conventional Treatment10.1038/srep33083 ↗
38. Impact of oral vitamin D supplementation on the ocular surface in people with dry eye and/or low serum vitamin D10.1016/j.clae.2017.09.007 ↗
39. Carazo, A., Macáková, K., Matoušová, K., Krčmová, L.K., Protti, M., and Mladěnka, P. (2021). Vitamin A Update: Forms, Sources, Kinetics, Detection, Function, Deficiency, Therapeutic Use and Toxicity. Nutrients, 13.10.3390/nu13051703 ↗
40. Retinoic acid induces corneal epithelial CYP4B1 gene expression and stimulates the synthesis of inflammatory 12-hydroxyeicosanoids10.1089/108076804772745473 ↗
41. Effect of retinoic acid on gene expression in human conjunctival epithelium: Secretory phospholipase A2 mediates retinoic acid induction of MUC1610.1167/iovs.05-0627 ↗
42. Treatment of corneal xerophthalmia in rabbits with micromolar doses of topical retinoic acid10.3109/02713688709034838 ↗
43. The efficacy of retinoic acid ointment for treatment of xerophthalmia and corneal epithelial wounds10.3109/02713688509003350 ↗
44. Beneficial effects of a retinoic acid analog, CBS-211 A, on an experimental model of keratoconjunctivitis sicca
45. Effects of Vitamin A on Expressions of Apoptosis Genes Bax and Bcl-2 in Epithelial Cells of Corneal Tissues Induced by Benzalkonium Chloride in Mice with Dry Eye
46. Ocular instillation of vitamin A-coupled liposomes containing HSP47 siRNA ameliorates dry eye syndrome in chronic GVHD10.1182/bloodadvances.2018028431 ↗
47. The effect of additional topical cyclosporine or vitamin A on the ocular surface during antiglaucoma medication administration10.1159/000334248 ↗
48. Xerophthalmia and vitamin A status10.1016/S1350-9462(97)00001-3 ↗
49. Detection of early xerophthalmia by impression cytology10.1001/archopht.1986.01050140091027 ↗
50. Ocular complications of hypovitaminosis a after bariatric surgery10.1016/j.ophtha.2004.12.045 ↗
51. Sterile Corneal Perforation Occurring Several Years After Biliopancreatic Diversion10.1007/s11695-020-04523-2 ↗
52. Goblet cell response to vitamin A treatment for corneal xerophthalmia10.1016/0002-9394(82)90077-0 ↗
53. Vitamin A-responsive punctate keratopathy in xerophthalmia10.1016/0002-9394(79)90072-2 ↗
54. Evaluation of Plasma Vitamin A and E Levels and Tear Film Changes in Patients with Psoriasis Vulgaris10.3341/kjo.2013.27.3.158 ↗
55. Open-label crossover study of vitamin A ointment as a treatment for keratoconjunctivitis sicca10.1016/S0161-6420(89)32909-5 ↗
56. Vitamin A Palmitate and Carbomer Gel Protects the Conjunctiva of Patients With Long-term Prostaglandin Analogs Application10.1097/IJG.0000000000000316 ↗
57. Evaluation of retinoic acid ophthalmic emulsion in dry eye10.1177/112067210001000205 ↗
58. Topical retinoid therapy for squamous metaplasia of various ocular surface disorders. A multicenter, placebo-controlled double-masked study10.1016/S0161-6420(88)33009-5 ↗
59. Topical retinoid treatment for various dry-eye disorders10.1016/S0161-6420(85)33968-4 ↗
60. A comparison of vitamin a and cyclosporine a 0.05% eye drops for treatment of dry eye syndrome10.1016/j.ajo.2008.08.015 ↗
61. Comparing Vitamin A and Moist Chamber in Preventing Ocular Surface Disorders10.1177/1054773817695618 ↗
62. Application of vitamin A palmitate eye gel and nurse value of Watson’s theory of caring in children with dry eye after strabismus surgery: A randomized trial10.21037/tp-21-385 ↗
63. Primary Sjögren’s syndrome and vitamin B12 deficiency: Preliminary results in 80 patients10.1016/j.amjmed.2005.09.015 ↗
64. Effects of Oral Vitamin B1 and Mecobalamin on Dry Eye Disease10.1155/2020/9539674 ↗
65. Use of vitamin supplements and cataract: The Blue Mountains Eye Study10.1016/S0002-9394(01)00922-9 ↗
66. Burning Eye Syndrome: Do Neuropathic Pain Mechanisms Underlie Chronic Dry Eye?
67. The potential role of neuropathic mechanisms in dry eye syndromes10.1016/j.optom.2016.06.002 ↗
68. Neuropathic ocular pain: An important yet underevaluated feature of dry eye10.1038/eye.2014.263 ↗
69. Predictors of Discordance between Symptoms and Signs in Dry Eye Disease10.1016/j.ophtha.2016.11.008 ↗
70. Understanding Neuropathic Corneal Pain--Gaps and Current Therapeutic Approaches10.3109/08820538.2015.1114853 ↗
71. Urbanski, G., Chabrun, F., Schaepelynck, B., May, M., Loiseau, M., Schlumberger, E., Delattre, E., Lavigne, C., and Lacombe, V. (2020). Association of Primary Sjögren’s Syndrome and Vitamin B12 Deficiency: A Cross-Sectional Case-Control Study. J. Clin. Med., 9.10.3390/jcm9124063 ↗
72. A new approach of ocular nebulization with vitamin B12 versus oxytocin for the treatment of dry eye disease: An in vivo confocal microscopy study10.2147/DDDT.S203464 ↗
73. Fogagnolo, P., Melardi, E., Tranchina, L., and Rossetti, L. (2020). Topical citicoline and vitamin B12 versus placebo in the treatment of diabetes-related corneal nerve damage: A randomized double-blind controlled trial. BMC Ophthalmol., 20.10.1186/s12886-020-01584-w ↗
74. Evaluation of oxidative stress levels in the conjunctival epithelium of patients with or without dry eye, and dry eye patients treated with preservative-free hyaluronic acid 0.15% and vitamin B12 eye drops10.1007/s00417-014-2853-6 ↗
75. Sjogren’s syndrome and the sicca syndrome: The role of prostaglandin E1 deficiency. Treatment with essential fatty acids and vitamin C10.1016/0306-9877(80)90120-6 ↗
76. Treatment of glaucomatous patients by means of food supplement to reduce the ocular discomfort: A double blind randomized trial
77. Vitamin C: One compound, several uses. Advances for delivery, efficiency and stability10.1016/j.nano.2019.102117 ↗
78. Vitamin C levels in human tears10.1001/archopht.1987.01060030096034 ↗
79. Ascorbic acid phosphate ester and wound healing in rabbit corneal alkali burns: Epithelial basement membrane and stroma10.1007/BF00918845 ↗
80. Protective Effect of Vitamin C against Infancy Rat Corneal Injury Caused by Acute UVB Irradiation
81. Topical Vitamin C Promotes the Recovery of Corneal Alkali Burns in Mice10.1155/2021/2406646 ↗
82. Niki, E., and Abe, K. (2019). Vitamin E: Structure, Properties and Functions. Vitamin E: Chemistry and Nutritional Benefits, Royal Society of Chemistry.10.1039/9781788016216 ↗
83. Protective role of oral antioxidant supplementation in ocular surface of diabetic patients10.1136/bjo.86.12.1369 ↗
84. Conjunctival and tear film changes after vitamin C and E administration in non-insulin dependent diabetes mellitus
85. A randomized, double-blind, placebo-controlled study of oral antioxidant supplement therapy in patients with dry eye syndrome
86. The effects of topical coenzyme Q10 and vitamin E D-α-tocopheryl polyethylene glycol 1000 succinate after cataract surgery: A clinical and in vivo confocal study10.1159/000342196 ↗
87. Efficacy of 0.1% crosslinked hyaluronic acid, coenzyme Q10 and vitamin E in the management of dry eye disease in menopause patients receiving antidepressants10.1177/1120672120972026 ↗
88. Vitamin A- and E-based liposomal tear replacement in pediatric patients10.23736/S0026-4946.17.05092-7 ↗
89. Efficacy of eye drops containing crosslinked hyaluronic acid and CoQ10 in restoring ocular health exposed to chlorinated water10.1177/1120672120907311 ↗
90. Effects of eye drops containing a mixture of 3% diquafosol sodium and tocopherol acetate (vitamin E) on the ocular surface of murine dry eye10.1080/15569527.2021.1973022 ↗
91. Retinoid X receptor alpha and retinoic acid receptor gamma mediate expression of genes encoding tight-junction proteins and barrier function in F9 cells during visceral endodermal differentiation10.1006/excr.2000.5113 ↗
92. Vitamin D enhances corneal epithelial barrier function10.1167/iovs.11-7605 ↗
93. Calcitriol inhibits ROS-NLRP3-IL-1β signaling axis via activation of Nrf2-antioxidant signaling in hyperosmotic stress stimulated human corneal epithelial cells10.1016/j.redox.2018.101093 ↗
94. Calcitriol, the Active Metabolite of Vitamin D(3), Inhibits Dry Eye Related Corneal Inflammation In Vivo and In Vitro10.1080/09273948.2017.1372486 ↗
95. Correlation between tear fluid and serum vitamin D levels10.1186/s40662-016-0053-7 ↗
96. Correlation of vitamin D levels with tear film stability and secretion in patients with dry eye syndrome10.1111/aos.13241 ↗
97. Association Between Single Nucleotide Polymorphisms in the Vitamin D Receptor and Incidence of Dry Eye Disease in Chinese Han Population
98. Resveratrol Rescues Human Corneal Epithelial Cells Cultured in Hyperosmolar Conditions: Potential for Dry Eye Disease Treatment10.1097/ICO.0000000000002495 ↗
99. Jin, K., Kawashima, M., Ito, M., Arita, R., Sano, K., and Tsubota, K. (2020). A New Modified Experimental Meibomian Gland Injury Model: Partial Loss of Gland Due to Orifice Cauterization and the Alleviating Potential of 22-Oxacalcitriol. J. Clin. Med., 10.10.3390/jcm10010006 ↗
100. Effects of 1alpha,25-dihydroxyvitamin D3 on Langerhans cell migration and corneal neovascularization in mice