Liver Disease May Influence Pathogenesis of Dry Eye   

Liver disease may be associated with the pathogenesis of dry eye disease, according to a case-control retrospective analysis published in Ophthalmology and Therapy. Patients with dry eye secondary to primary biliary cholangitis (PBC) are more prone to aqueous-deficient dry eye, while patients with dry eye secondary to drug-induced liver injury (DILI) and hepatitis B (HBV) are more prone to meibomian gland dysfunction (MGD), according to the report.

The study included a total of 180 eyes from 60 patients: 38 eyes of 19 patients (mean age, 56 years; 15 women, 4 men) with PBC, 36 eyes of 18 patients (mean age, 51.83 years; 16 women, 2 men) with DILI, 46 eyes of 23 patients (mean age, 53.7 years; 13 women, 10 men) with HBV, and 60 eyes of 30 healthy individuals (mean age, 52.77 years, 18 women, 12 men) placed into a control group. All patients were enrolled at the Beijing Youan Hospital between March 2019 and December 2019.

Participants were assessed by the SPEED questionnaire, corneal fluorescein staining (CFS), noninvasive tear breakup time (NIBUT), Schirmer I test, tear meniscus height test (TMH), the area of meibomian glands dropout (MG dropout), partial blinking rate (PBR), lipid layer thickness (LLT), meibum expressibility, and meibum quality.

The study found that there are statistical differences in ophthalmic examination results between patients with different types of liver diseases and normal individuals (P <.05). Compared with the DILI group and the HBV group, the CFS score of the PBC group score was higher (P <.05), the PBR was higher (P <.05), and the Schirmer testing was lower (P <.01).

The TMH of PBC and DILI groups were significantly lower compared with the HBV group, and this difference was statistically significant (P <.05). Compared with the PBC group, the LLT of the DILI group was lower (P <.01).

The area of meibomian glands dropout of the 3 groups showed mild-to-moderate defects, but there was no significant statistical difference among the groups (P >.05). The meibum quality score in the DILI group was significantly higher compared with the HBV group (P <.05).

“In short, our results show that the types of dry eye disease are different in different types of liver diseases. Dry eye secondary to PBC showed aqueous tear-deficient dry eye, dry eye secondary to drug-induced liver injury and viral hepatitis B was evaporative dry eye, with the former being more prone to obstructive MGD and the latter being more prone to nonobstructive MGD,” according to the researchers. “This provides a new understanding of dry eye caused by different types of liver diseases.”

Study limitations include the limited sample size and a need for a more comprehensive and more detailed observation.