A prospective, longitudinal study to assess progression of ocular surface signs, tear cytokines and protein profiles in young adults

Purpose

To compare ocular surface characteristics, tear protein profiles, and cytokines in young adults with and without evaporative dry eye disease (DED), exploring any associations with lifestyle factors, and determine any progression after one year.

Methods

Fifty participants, aged 18–25 years, were recruited. Detailed ocular surface parameters were assessed following administration of lifestyle and symptom questionnaires. Tear samples collected by microcapillary tubes were analysed using the Agilent Bioanalyzer (7 proteins between 14 and 230 kDa); tears collected with Schirmer strips were analysed for ten cytokines using Luminex Assay.

Results

56 % of participants fulfilled the TFOS DEWS II criteria for DED. 48 % had at least 25 % meibomian gland loss in either lid regardless of dry eye status, while over 90 % had at least one diagnostic sign. Progression was observed, characterised by significant increases (p < 0.05) in ocular redness, lid wiper epitheliopathy and blink rate. Albumin was upregulated (p = 0.003) in DED, while zinc-α2-glycoprotein, which showed significant correlations with several meibomian gland parameters, was downregulated. Upregulation of both pro- and anti-inflammatory cytokines was observed, with several significant clinical correlations, including IL-1β with meibomian gland parameters.

Conclusions

Evidence of inflammation and overlap of ocular signs in these young adults reinforces the need for early detection and differentiation of those likely to progress to DED. While upregulation of both pro- and anti-inflammatory cytokines has provided evidence of a mechanism to maintain homeostasis, the subtle progression of ocular surface disease observed suggests that counselling is required around the modifiable risk factors of DED identified, regardless of whether symptoms are present or not.