Oral Vitamin A-Including Antioxidant Formula versus Topical Vitamin A Added to Lubricant Eye Drops in Treatment of Dry Eye Syndrome ; A Comparative Study

AIM: Is to explore the safety and compare the efficacy of oral (systemic) vitamin A antioxidant with topical vitamin A (eye drops) in treatment of dry eye syndrome and the lasting period of their effects after cessation of therapies. PATIENTS AND METHODS: This prospective, interventional, randomized, comparative study has been conducted on 160 eyes of 80 patients (aging from 19 to 65 years) divided randomly into two groups; group A included 40 patients; 80 eyes (24 males and 16 females) who received eye drops containing lubricant and topical vitamin A, this eye drop was given to these patients as one drop in each eye every 4 hours during the waking hours for 6 months. While ORIGINAL ARTICLE Oral Vitamin AIncluding Antioxidant Formula versus Topical Vitamin A Added to Lubricant Eye Drops in Treatment of Dry Eye Syndrome; A Comparative Study Hossam Eldin Abdelmonem Ziada 252 Int. J. Ophthalmic Res 2017 December; 3(4): 252-258 ISSN 2409-5680 Online Submissions: http://www.ghrnet. org/index. /ijor/ doi:10.17554/j.issn. 2409-5680.2017. 03.69 International Journal of Ophthalmic Research of corneal epithelial cells, preserves conjunctival goblet cells, and has been used in the treatment of eye diseases such as dry eye and superior limbic keratoconjunctivitis for some time[10]. Vitamin A is an essential nutrient present naturally in tear film of healthy eyes. Vitamin A plays an important role in production of the mucin layer, the most innermost lubricating layer of tear film that is crucial for a healthy tear film. Vitamin A deficiency leads to loss of mucin layer and goblet cell atrophy[11]. Vitamin A drops protect the eyes from free radicals, toxins, allergens, and inflammation. Topical retinoic acid therapy in conjunction with systemic administration of vitamin A has been investigated to treat xerophthalmia[12]. Effective amount of one or more retinoids alone may be dispersed in a pharmaceutically acceptable ophthalmic vehicle and topically applied for effective treatment of dry eye disorders. Tseng et al[13] demonstrated that topical all-trans retinoic acid ointment was effective in the treatment of four severe cases of the following ocular surface diseases: keratoconjunctivitis sicca, StevensJohnson syndrome, drug-induced pseu-dopemphigoid, and surgeryinduced dry eye. In addition to synthetic Vitamin A supplements, we need to know that vitamin A can be obtained from different kind of food, and it is obtained in two different forms: it can be found pre-formed in animal sources – it is also called retinol or retinal; pro-vitamin A – also called beta carotene – is derived from plant sources. Vitamin A also have been shown effective for the treatment of the following eye diseases: superior limbic keratoconjunctivitis, agerelated macular degeneration (AMD), retinitis pigmentosa (RP), loss of peripheral vision, Stargardt’s disease[14]. Deficiency of Vitamin A has been shown to contribute to dry eyes. Mild vitamin A deficiency may result in changes in the conjunctiva (corner of the eye) called Bitot’s spots. Severe or prolonged vitamin A deficiency causes a condition called xerophthalmia (dry eye), characterized by changes in the cells of the cornea The first line of treatment to insure an adequate level of Vitamin A is a healthy diet with fresh dark green leafy vegetables[15]. The present study assessed whether oral supplement of -vitamin A includingantioxidant formula could improve symptoms and clinical parameters of disease activity and of note, ultra-structural changes in patients with DES. PATIENTS AND METHODS A prospective, interventional, randomized, comparative study was conducted on a total number of 80 patients visiting my clinic, within the period of March 2015 and January 2016. The institutional (Al Azhar University) review boards and the local ethics committee approved the trial. A written informed consent was obtained from all patients based on Helsinki protocol. Inclusion criteria were age of 19 years or more with symptoms of dry eye; fluorescein tear film break-up time (TBUT) less than 10 seconds, Schirmer test less than 10 mm moisture, and, the presence of lid margin scaling, telangiectasia, and meibomian gland plugging on slit-lamp examination. Exclusion criteria were any pre-existing ocular disease other than DES, history of herpetic eye disease, patients on oral tetracycline or corticosteroids, and corneal surgeries like corneal cross linking, or laser in situ keratomileusis (LASIK). Other exclusion criteria included pregnancy, or lactating mothers. The total duration of this study was 9 months; 6 months, in which, patients recieve treatment, and 3 months more, after cessation of treatment with continued follow up to assess the lasting effect period expected after cessation Ziada H. Oral Vitamin AIncluding Antioxidant Formula versus Topical Vitamin A in Treatment of Dry eye