New treatment of dry eye: the eVect of calcium ointment through eyelid skin delivery

Aim—To demonstrate the eYcacy of a petrolatum based calcium ointment applied to the lower lid skin in the management of dry eye. Methods—In a controlled double masked study, the eVects of water free petrolatum ointment containing calcium carbonate (10% w/w) on tear functional factors and ocular surface vital staining in dry eye patients were observed. Petrolatum without calcium carbonate served as control. Patients were instructed to place ointment to the lower lid skin twice a day. Evaluation of subjective complaints, fluorescein and rose bengal staining patterns, blink rate, tear evaporation and tear break up time (BUT) were performed before and 3 months after treatment. In order to demonstrate the movement of petrolatum from the skin to the tear film, petrolatum containing 1% sodium fluorescein was placed on the lower lid of four healthy volunteers, and the concentration of fluorescein in the tear film was followed up to 6 hours using an anterior fluorometer. Results—Subjective symptoms significantly improved in both the calcium group (p=0.001) and control (p=0.012), while only the calcium group demonstrated a significant improvement in fluorescein (p=0.043), rose bengal (p=0.021) scores, and blink rate (p=0.004). Tear evaporation also significantly decreased in both the calcium group (p=0.0004) and control (0.043). BUT did not improve in either group. Conclusion—Petrolatum based calcium ointment significantly improved symptoms, tear dynamics, and ocular surface staining in dry eye patients. However, some of the therapeutic eVects may be due to lipids in the petrolatum vehicle. Petrolatum applied to the lower lid skin is an eVective drug delivery system for slowly releasing drugs to the ocular surface. (Br J Ophthalmol 1999;83:767–770) Recent research on the interaction between tears and the ocular surface has revealed that important tear components such as vitamin A or epidermal growth factor (EGF) are vital for the proper proliferation and diVerentiation of ocular surface epithelium. When the tear supply is diminished, these components may not be adequately supplied to the ocular surface, especially in severe dry eye. A new hypothesis for the pathogenesis of dry eye includes the concept that the lack of tear components causes abnormal proliferation and diVerentiation of ocular surface epithelium. It is the common experience of many dry eye specialists that rose bengal and fluorescein staining patterns are worse in Sjögren’s syndrome (SS) compared with non-SS dry eye, with increased lymphocyte infiltration as well as squamous metaplasia formation. 8 Such diVerences cannot be explained by simple desiccation alone, and severe dry eye such as this seen in SS patients cannot be treated satisfactorily by artificial tear replacement or protective