Main Research Findings

Allergic eye conditions, particularly seasonal allergic conjunctivitis (SAC), are common and are often accompanied by itching, swelling, and redness. 3 . Topical H1-antagonists or sodium cromoglycate can alleviate these symptoms. 3 . Nedocromil sodium, a newer mast-cell stabilizing agent, has a similar safety profile to sodium cromoglycate but is more potent and has a more convenient twice-daily dosing regimen. 3 . Several placebo-controlled studies have shown that 80% of patients reported symptom relief when using nedocromil sodium to treat SAC. 3 . In a separate study, nedocromil sodium eye drops (twice-daily dosing) had similar overall efficacy to sodium cromoglycate eye drops (four-times-daily dosing) in subjects with SAC during the birch season, but during the period of highest pollen challenge, only nedocromil sodium eye drops were significantly more effective than placebo. 3 . Another study found that nedocromil sodium had efficacy equivalent to levocabastine over 7 days but tended to have a more rapid onset of action. 3 . Clinicians and patients reported significantly better symptom control with nedocromil sodium eye drops than with placebo in patients with perennial allergic conjunctivitis (PAC) who did not respond to sodium cromoglycate. 3 . In a recent long-term study of vernal keratoconjunctivitis (VKC) treatment, nedocromil sodium 2% eye drops led to faster and more significant symptom improvement compared to sodium cromoglycate 2% eye drops, and also allowed for lower use of steroid rescue medication. 3 . Both drugs were well tolerated and without serious side effects. 3 . Non-infectious uveitis is a potentially sight-threatening disease. . Recently, therapeutic strategies have shifted towards a new methodology that includes biologic agents. . The introduction of biologic drugs has revolutionized ophthalmology, providing a revolutionary option for patients with non-responsive, sight-threatening uveitis. . These therapies have improved uveitis outcomes. . This review highlights the most relevant medical literature on biologic agents in ophthalmology, including tumor necrosis factor blockers, anti-interleukins, and other related biologics. . Several papers have reported the efficacy of biologic agents in a large number of refractory uveitides, suggesting a promising role of biologic drugs for selected cases. . However, the medical literature lacks consistent numbers to validate the promising preliminary results. . While biologic agents are promising drugs for the treatment of non-responder uveitis, they also exhibit a seemingly favorable safety profile. . Several unanswered questions remain: it is still unclear when to commence treatment, which agent to choose, and the duration of biologic therapy. . Furthermore, the high costs and unclear safety profile have often limited their use to severe, non-responder uveitis in highly specialized uveitis centers. . Dry eye, characterized by insufficient wetting of the ocular surface, is very common. 4 . Artificial tears are commonly used for treatment. 4 . The influence of a product formulated with polyvidon and electrolytes resembling natural tears on symptoms and tolerability was investigated. 4 . The eye and the kidney share structural and developmental similarities at the cellular and clinical levels, and they are often affected by the same disease processes. . Eye exams to look for signs of conditions like hypertension and diabetes can provide a window into the health of the kidney. . Patients with kidney transplants (KT) are a unique population requiring close monitoring. . These patients are maintained on various immunosuppressive medications and may experience complications such as medication side effects, infections, and graft rejection. . KT patients are at a higher risk for both infectious and non-infectious eye conditions related to underlying systemic disease or the use of immunosuppressive medications. . Screening for eye conditions is important because preserving visual function is essential for quality of life, and eye exams can aid in the early detection and treatment of systemic conditions. . This paper describes some of the common eye findings and conditions in KT patients. . It recommends that KT patients receive annual eye exams and hopes that the information provided can help nephrologists become more familiar with eye findings and identify situations where a referral to ophthalmology is warranted. . Cromolyn sodium's effectiveness has continued to expand across various clinical situations. 2 . Ocular cromolyn has been used in allergic eye conditions, as well as vernal conjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis. 2 . Nasal cromolyn has been successfully used in treating allergic rhinitis, both seasonal and perennial types. 2 . Oral cromolyn has been used for individuals with multiple food allergies in unusual conditions such as systemic mastocytosis. 2 . This agent's versatility has been rediscovered due to its effective blocking of both early and late-phase allergic reactions and its anti-inflammatory potential. 2 . Cromolyn sodium is a valuable agent, not only for its therapeutic efficacy but also for its virtual lack of side effects. 2 . Allergic eye diseases encompass a spectrum of diseases, each characterized by complex immunopathology. . More severe and chronic conditions, like vernal keratoconjunctivitis and atopic keratoconjunctivitis, primarily involve mast cells and eosinophils, and are also associated with a predominance of T cells. . Treatment with topical antihistamines or mast cell stabilizers is often unsatisfactory, and therapy depends on topical corticosteroids. . Corticosteroids have significant side effects with long-term use, making them more suitable for short-term pulse therapy. . Immunomodulatory agents can also be used to inhibit T-cell activation and show promising results in patients with severe allergic eye conditions. . This review attempts to present a comprehensive picture of recent investigations into topical immunomodulatory agents' therapy in severe allergic eye diseases, especially cyclosporine A and tacrolimus, and their mechanisms of action. . Visual impairment (VI) due to adverse drug reactions (ADR) is rare in adults and children, leading to an incomplete evidence base for informing guidance on screening and counseling patients on the potential risks of medications. . This report details suspected drugs and eye conditions found in a national study of the incidence of visual impairment diagnoses due to suspected ADR. . Case ascertainment was through the British Ophthalmological Surveillance Unit (BOSU) between March 2010 and February 2012, with follow-up after 6 months. . Oral administration of cholesterol-lowering statins, HMG-CoA reductase inhibitors, has been associated with beneficial effects on eye conditions. 1 . This work aimed to design contact lenses (CLs) that could sustain the delivery of pravastatin, thereby improving ocular efficacy while avoiding systemic side effects of statins. 1 . Bioinspired hydrogels were prepared using monomers that resemble hydrophobic (ethylene glycol phenyl ether methacrylate) and amino (2-aminoethyl methacrylamide hydrochloride) functionalities of the active site of HMG-CoA. 1 . The best-performing CLs loaded >6 mg/g, fulfilled the in vitro release demands for daily wear, and showed anti-inflammatory activity (lowering TNF-α). 1 . High hydrostatic pressure sterilization preserved the stability of both the drug and the hydrogel network. 1 . Ex vivo tests revealed pravastatin's ability to accumulate in the cornea and sclera and penetrate through the transscleral route. 1 . In vivo tests (rabbits) confirmed that, compared to eye drops and for the same dose, CLs provided significantly higher pravastatin levels in tear fluid within 1 to 7 hours of wearing. 1 . Furthermore, after 8 hours of wear, pravastatin was present in the cornea, sclera, aqueous humor, and vitreous humor. 1 . Strong correlations were found between percentages of drug released in vitro and in vivo. 1 . Effects of volume and proteins on release rate and Levy plots were identified. 1 . Laser treatment for diabetic retinopathy is often associated with visual field reduction and other ocular side effects. . Our aim was to assess whether long-term lipid-lowering therapy with fenofibrate could reduce the progression of retinopathy and the need for laser treatment in patients with type 2 diabetes mellitus. . Age-related eye disorders are chronic diseases that affect millions of people worldwide, causing visual impairment and, in some cases, irreversible blindness. . Drug targeting to the retina is still a challenge due to the difficulties with drug distribution, crossing eye barriers, and reaching intraocular tissues at an effective therapeutic concentration. . While intravitreal injections can directly deliver drugs to the posterior segment of the eye, it remains an invasive technique and leads to several side effects. . Conventional formulations, such as emulsions, suspensions, or ointments, have been associated with frequent instillation and an inability to reach intraocular tissues. . New drug delivery systems and medical devices have been designed. . However, these treatments are not always effective and sometimes require a specialist to administer the dose. . Therefore, treatments for age-related ocular diseases remain one of the major unmet clinical needs to manage these widespread eye conditions. . Nanotechnology may become the appropriate tool for developing effective and non-invasive therapies suitable for self-administration. . This review discusses emerging therapeutic options based on nanoengineering of cyclodextrin nanocarriers for the treatment of age-related eye disorders, including their pathophysiology, pharmacological options, and feasibility of clinical translation. . Both experimental and clinical research has been conducted to establish the value of combining soft contact lenses with certain types of eye drops. . The use of soft contact lenses with eye drops may be beneficial in some specific cases: a) more prolonged and sustained effect compared to the usual eye drop administration (especially antiglaucomatous substances, antimetabolites, and mydriatics). . b) The ability to reduce concentration to avoid local discomfort or systemic side effects without compromising effectiveness on the eye conditions being treated. . Combining soft lenses (12.5-15 mm in diameter) with eye drops can be achieved by presoaking the lens in the liquid or by regularly instilling eye drops after lens insertion. . This research initially examined the advantages of using hydrophilic lenses with osmotically active substances in vitro and in vivo to achieve better and more prolonged corneal dehydration. . The following substances were tested: 10% propylene glycol, 10% glycerol, 10% glucose, and 5% sodium chloride. . The clearing effect of different treatment types was evaluated in 45 patients with edematous bullous keratopathy using an instrument that measured infrared light emitted by an optic fiber and reflected by the cornea. . The effects were more pronounced for epithelial than for stromal edema. . Another group of investigations was conducted with two high-molecular-weight polypeptides: Eledoisin, extracted from a Mediterranean octopus, Eledone moschata, and Physalaemin, extracted from the skin of a South American batrachian, Physalaemus fuscomaculatus. Both stimulate lacrimal secretion and have been previously used topically by the authors to treat keratoconjunctivitis sicca. . However, the increase in fluid amount was short-lived. . Eledoisin, at a concentration of 200 mug/ml, was examined for its effects both in vitro and in vivo, whereas Physalaemin, at a concentration of 20 mug/ml, was only tested in vitro due to a current shortage of the product. . Clinical tests in 23 eyes of 14 patients with keratoconjunctivitis sicca proved satisfactory, as combining the instillation of Eledoisin with a presoaked soft lens resulted in a lacrimal stimulating effect that was not only greater but lasted three times longer. . Finally, some antiglaucomatous products (propranolol, clonidine, prostigmine) were used in conjunction with a soft lens to reduce the concentration of eye drops for better tolerance locally (propranolol: a beta-adrenergic blocking agent) or generally (clonidine: an alpha-adrenergic agent), also with the advantage of protracted release. . With propranolol, the concentration could be reduced to 0.01-0,10% (instead of 0.125 to 0.25%) and to 1.5% (instead of 3%) with prostigmine when lenses were presoaked, or instillations took place at regular intervals after lens insertion. .

Reasons for Side Effects

Side effects from ophthalmic medications can occur when the medication directly affects eye tissues or is absorbed systemically and affects other tissues. . Medications like immunosuppressants can suppress the immune system, increasing the risk of infections and graft rejection. . Dry eye, where the ocular surface is not adequately moistened, can lead to side effects due to dryness and irritation of eye tissues. 4 .

Common Side Effects

Itching

Patients with allergic eye conditions may experience side effects like itching when using medications like antihistamines or mast-cell stabilizers. 3 .

Redness

Patients with allergic eye conditions may experience side effects like redness when using medications like antihistamines or mast-cell stabilizers. 3 .

Swelling

Patients with allergic eye conditions may experience side effects like swelling when using medications like antihistamines or mast-cell stabilizers. 3 .

Visual Impairment

While rare, visual impairment due to adverse drug reactions can occur in adults and children. .

Infections

Medications like immunosuppressants can suppress the immune system, increasing the risk of infections. .

Graft Rejection

Medications like immunosuppressants can suppress the immune system, increasing the risk of graft rejection. .

Side Effect Management

Itching

If itching occurs, cold compresses or over-the-counter medications like antihistamines can help alleviate the discomfort. 3 .

Redness

Eye drops can be used to reduce redness if it is a concern. 3 .

Swelling

Cold compresses can be used to reduce swelling if it is a concern. 3 .

Visual Impairment

If visual impairment occurs, consult a doctor immediately. .

Infections

Maintaining good hygiene practices, such as handwashing and gargling, is crucial in preventing infections. .

Graft Rejection

Taking immunosuppressants as prescribed by a doctor is essential for preventing graft rejection. .

Research Comparisons

Research Similarities

Multiple studies have demonstrated the effectiveness and safety of medications for treating eye conditions like allergic eye diseases and uveitis. 3 . These studies also indicate that treating eye conditions necessitates both traditional and novel approaches. .

Research Differences

Research varies in the medications used and the specific eye conditions being targeted. 3 . Furthermore, studies may differ in their methodologies and the number of patients included. .

Real-Life Application Considerations

Always follow a doctor's instructions when using ophthalmic medications. . Side effects from ophthalmic medications can vary depending on the medication and individual factors, requiring caution. . If any symptoms like visual impairment arise while using ophthalmic medications, seek medical attention immediately. .

Current Research Limitations

Research on eye condition treatments is still in its early stages. . Research on drug side effects is particularly lacking. .

Future Research Directions

To further advance research on eye condition treatments, strengthening research on drug side effects is crucial. . Focus on developing new treatment approaches is also essential. .

Conclusion

Research on eye condition treatments has made progress in recent years but remains insufficient. . By strengthening research on drug side effects and developing new treatment approaches, we can improve the quality of life for patients. .