tretinoin and Keratoconjunctivitis-Sicca

In a prospective, double-masked clinical study, the authors evaluated the efficacy and safety of topically applied tretinoin ophthalmic ointment (0.01%) versus placebo in the treatment of squamous metaplasia associated with various ocular surface disorders involving dry eyes. Study parameters consisted of graded symptoms and signs, and serial impression cytologies. A total of 161 patients were enrolled in the study. Of these patients, 116 who had a minimum of 4 to 8 months of follow-up qualified for final statistical analysis. These patients were classified into two major groups: (1) keratoconjunctivitis sicca (KCS) and (2) conjunctival cicatricial diseases (Stevens-Johnson syndrome, inactive pemphigoid, radiation-induced dry eye, drug-induced pseudopemphigoid, and toxic epidermal necrolysis). An analysis of adjusted mean changes for KCS patients showed no statistically significant differences between active drug and placebo. A similar analysis of patients with conjunctival cicatricial diseases indicated a statistically significant (P less than 0.05) reversal of conjunctival keratinization in the temporal bulbar site after treatment with active drug, however, clinical symptoms and signs showed no significant improvement with active drug relative to placebo. Side effects were limited to blepharoconjunctivitis and were reversible upon tapering or stopping the drug.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Conjunctiva; Conjunctival Diseases; Double-Blind Method; Epithelium; Female; Follow-Up Studies; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Male; Metaplasia; Middle Aged; Multicenter Studies as Topic; Prospective Studies; Random Allocation; Tretinoin

To test the efficacy of topically applied tretinoin eyedrops (0.01%, twice daily, in a solution of peanut oil) in the treatment of squamous metaplasia of the conjunctival epithelium associated with dry-eye, the authors evaluated the impression cytology (IPC) of a total of 31 patients. The cytological findings were classified into four different stages with an overall range from 0 to 9 points. The average period of treatment was 12 weeks. The patients were classified into three groups: (1) Those with mucin deficiency (Mucin less than - greater than; n = 19), (2) those with Keratoconjunctivitis sicca (KSC; n = 6), and (3) a control group in whom pure peanut oil was used (n = 6). The IPC showed a considerable improvement of squamous metaplasia in the mucin less than - greater than group, by an average of 4.3 points (from 6.2 points before treatment to 1.9 points). No changes were seen in the IPC of the KCS patients or the control group. The results of this study show a good effect of tretinoin eyedrops in patients with a significant decrease in or loss of goblet cells seen in the IPC, a decreased break-up time and with no severe aqueous deficiency of tear film. These patients seem to have a "primary" mucin deficiency induced by the decrease in or loss of goblet cells. There is no indication for tretinoin treatment in patients with aqueous deficiency involving major or accessory lacrimal glands. The results of other previous and recent studies on tretinoin treatment are discussed.

Topics: Adult; Conjunctiva; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Male; Metaplasia; Ophthalmic Solutions; Tretinoin

Despite the diverse causes of dry-eye disorders, the ocular surface epithelia in these diseases all undergo squamous metaplasia, manifested by loss of goblet cells, mucin deficiency, and keratinization. These changes account for tearfilm instability, which leads to various ocular symptoms and corneal complications. This article reviews research in the use of topical tretinoin to treat severe dry-eye disorders. To classify squamous metaplasia into stages, a modified impression cytology technique was used to monitor the therapeutic effect of topical tretinoin ointment (0.01% or 0.1%, w/w) in 22 patients. This population had severe dry-eye disorders, including keratoconjunctivitis sicca, Stevens-Johnson syndrome, inactive ocular pemphigoid, drug-induced pseudopemphigoid, and surgery- or radiation-induced dry eyes. After treatment, clinical improvements were correlated with the reversal of squamous metaplasia as evidenced by the impression cytology technique. Tretinoin may also be effective in treating conjunctival keratinization without dry eyes, as illustrated by a case study. This may represent the first reported attempt to treat ocular surface disorders by reversing diseased epithelium.

Topics: Administration, Topical; Adolescent; Eye Diseases; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Pemphigoid, Benign Mucous Membrane; Postoperative Complications; Radiotherapy; Skin Diseases, Vesiculobullous; Stevens-Johnson Syndrome; Tretinoin