Effect of Ethanol Administration on Tear film and ocular surface Young Joo Shin1,Joo Hyun Kim1, Jung Ha Kim2, Woo Ho Nam1, Kayoung Yi1, Joon Young Hyon3, 1Department of Ophthalmology, Hallym University College of Medicine, Seoul, Korea 2Department of Family Medicine, Chung-ang University College of Medicine, Seoul, Korea 3Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea The authors have no finantial interest in the subject matter of this poster
Introduction • The mechanisms of ethanol absorption, distribution, metabolism, and elimination are well known.1 The majority of ingested alcohol (90%–98%) is metabolized in the liver. Alcohol is reportedly excreted in the breath, sweat, and urine.1 Alcohol has been associated with many systemic diseases, including gout2 and fatty liver,3 as well as with an increased prevalence of cataracts4 and age-related macular degeneration.5 • However, there has been no study about the effect of alcohol consumption on dry eye syndrome.
Purpose • In the present study, we investigated whether oral alcohol consumption disturbs the tear film and ocular surface in humans.
Methods • Subjects • Our experiments were carried out with 10 healthy male volunteers between 20 and 25 years of age. The decisive criterion for inclusion in the study was a normal body mass index (BMI) of 20 to 25. • The medical history interview and physical examination revealed no indication of liver disease, history of ophthalmic surgery, or dry eye symptoms within the previous 6 months. The subjects were neither on medication nor on eye drops. • The protocol was approved by the Institutional Review Board of the Hallym University Medical Center. All subjects signed an informed consent form before starting the study. • Testing protocols • The experiments began at 6 pm. • Each subject received a drink (Soju, 19.5% ethanol; a popular Korean drink) with a meal at 8 pm. The drinks were offered in a measured quantity (0.75 g/kg) to prevent uncontrolled alcohol consumption. • The drinking time was set at 2 h. The subjects went to bed at midnight. They were not allowed to wash up nor apply eye drops. The subjects woke at 6 am and underwent the same examinations immediately and 2 h after waking. • First, the subjects were evaluated for signs and symptoms of dry eye by tear osmolarity, visual analog pain scale (VAS), Schirmer’s tear test with anesthesia, tear film break-up time (TBUT), ocular surface staining, Ocular Surface Disease Index (OSDI), and corneal sensation at baseline. Tear and blood sampling, Schirmer’s test, TBUT, corneal sensitivity measurement, and fluorescein staining were performed by the same investigator (JHK) within 1 h from the preset time.
Tear osmolarity measurement • A microcapillary glass tube (Marienfeld, Lauda-Königshofen, Germany). • Tear and serum ethanol concentration measurements • tears : using an ethanol assay kit (BioVision, Mountain View, CA, USA). • serum : using the Cobas Integra 800 (Roche, Berlin, Germany) for the diagnostic reagent (EtOH2, Roche, Berlin, Germany). • Schirmer’s tear test • VAS • The scale range was 0 (absence of pain) to 10 (maximal pain). • TBUT • Fluorescein staining • The corneal surface was divided into 5 areas (1 center zone and 4 peripheral zones). Fluorescein staining was performed as previously described. After staining, corneal erosion staining was recorded using a standardized grading system of 0 to 3 for each of the 5 areas.8 • Measurement of corneal sensitivity • using a Cochet-Bonnet esthesiometer (Luneau, Chartres, France). • Statistical analysis • Analyses were performed with SPSS software, version 12.0K (SPSS Inc., Chicago, IL, USA). • The Wilcoxon signed rank test was used to compare tear film and ocular surface changes. A p value of <0.05 was considered to be statistically significant.
Results Characteristics of the subjects at baseline
VAS Schirmer test and corneal sensitivity
Conclusions • Oral alcohol administration induced a transient dry eye syndrome in healthy individuals. • This suggests that alcohol aggravates symptoms and signs of dry eye syndrome, and can serve as a tear lipid-layer–deficient dry eye model. • This study is preliminary. Further study about cytokine alteration, as well as prevention and treatment of dry eye syndrome induced by alcohol administration, is necessary.