The Effect of Long-Term Use of an Eyewash Solution on the Ocular Surface Mucin Layer

Hiroyuki Yazu, Naoyuki Kozuki, Murat Dogru, Ayako Shibasaki, Hiroshi Fujishima, Hiroyuki Yazu, Naoyuki Kozuki, Murat Dogru, Ayako Shibasaki, Hiroshi Fujishima

Abstract

The use of eyewash solutions in Japan, especially in patients with allergic conjunctivitis and contact lens wearers, has been increasing. Our aim was to investigate how the use of preservative-free eyewash solution in healthy eyes for one month affects corneal safety and ocular surface mucin. We analyzed 42 eyes of 21 individuals (17 males, four females; mean age: 36.1 ± 7.4 years) without ocular allergies, dry eyes, or other ocular diseases through a prospective study. Eyes were randomized to a wash group (group one) and a nonwash follow up group (group two). We evaluated the dry eye-related quality-of-life score (DEQS), tear film breakup time (TBUT), fluorescein staining score, mRNA expression of MUC5AC and MUC16, MUC16 immunohistochemistry, and MUC5AC periodic acid Schiff (PAS) staining. There was a significant decrease in DEQS scores after one month of eyewash use (p < 0.05). There were no significant differences in other evaluation items that were analyzed (all p > 0.05). Furthermore, no significant differences were observed between group one and group two in all endpoints (all p > 0.05). The results suggest that one month use of a nonpreserved eyewash solution has no detrimental effects on the tear film and the ocular surface mucins.

Keywords: MUC16; MUC5AC; eyewash; mucin.

Conflict of interest statement

H.Y., N.K., and A.S. had no conflict of interest to declare associated with this manuscript; M.D. and H.F. received an honoraria from the Kobayashi Pharmaceutical Co., Ltd. and Otsuka Pharmaceutical Co., Ltd., but not related to the consent of current study; H.F. received an honoraria from the Santen Pharmaceutical Co., Ltd., Senju Pharmaceutical Co., Ltd., White Medical Co., Ltd., Regeneron Pharmaceuticals Inc., Allergan, and Alcon Laboratories, Inc., but not related to the consent of current study.

Figures

Figure 1
Figure 1
Changes in the dry eye-related quality-of-life score (DEQS) score. Note the significant improvement between before and after 1 month of eyewash use (p = 0.001).
Figure 2
Figure 2
Changes in tear film breakup time (TBUT). Note the nonsignificant TBUT changes between before and after 1 month of eyewash use (p > 0.05).
Figure 3
Figure 3
Changes in MUC5AC and MUC16 mRNA expressions. Note the nonsignificant MUC5AC and MUC16 RNA expression level changes between before and after 1 month of eyewash use (p > 0.05): (A) MUC5AC and (B) MUC16.
Figure 4
Figure 4
Representative MUC16 immunohistochemistry staining. Note the positive MUC16 staining before and after 1 month of eyewash use (red arrows): (A) baseline in group one; (B) after 1 month in group one; (C) baseline in group two; and (D) after 1 month in group two.
Figure 5
Figure 5
Ratio of areas stained with MUC16 antibodies to overall area of cellular pick-up. Note the nonsignificant MUC16 antibody staining changes between before and after 1 month of eyewash use (p > 0.05).
Figure 6
Figure 6
Representative MUC5AC PAS staining. Note the numerous MUC5AC + goblet cells before and after 1 month of eyewash (black arrows): (A) baseline in group one; (B) after 1 month in group one; (C) baseline in group two; and (D) after 1 month in group two.
Figure 7
Figure 7
Goblet cell count in periodic acid Schiff (PAS) staining. Note the nonsignificant changes in goblet cell count between before and after 1 month of eyewash use (p > 0.05).
Figure 8
Figure 8
Areas of impression cytology: (A) superior bulbar conjunctiva for RT-PCR of MUC5AC and MUC16, (B) inferior temporal bulbar conjunctiva for MUC16 immunohistochemistry, and (C) inferior nasal bulbar conjunctiva for MUC5AC PAS stain.

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