“EFFECTS OF HYPERTONIC SALTWATER WASH ON OCULAR SURFACE SENSITIVITY”
Main Article Content
Keywords
Hypertonic saline, ocular surface sensitivity, tear film stability, corneal sensitivity, dry eye, ocular surface disease, hyperosmolarity, saline wash.
Abstract
Background: Ocular surface is very important in retaining sensory acuity and visual acuity. With ocular disruption caused by epithelial cell disruption, tear film instability, or osmotic imbalance, changes in the sensitivity of the ocular surface may result in discomfort and ocular dysfunction. The osmotic and epithelial protective effects of hypertonic saline have been well investigated, however, little has been conducted on the sensitivity of the ocular surface.
Purpose: The study aimed to assess the outcomes of hypertonic salt water wash on ocular surface sensitivity, tear film stability and patient-reported comfort.
Methods: This was a prospective interventional study that took place at Isra Postgraduate institute of ophthalmology Al Ibrahim Eye Hospital, Pakistan between March, 2024 and March, 2025. One hundred and twenty individuals whose skin encountered discomfort were enrolled. The sensitivity of the ocular surface was measured by a Cochet-Bonnet esthesiometer, tear breakup time (TBUT) was used to determine the stability of the tear film and the Ocular Surface Disease Index (OSDI) was applied to assess the symptoms. The participants were given sterile 5% hypertonic saline wash twice a day during a four-week period. The baseline, 2-week and 4-week assessments were done.
Findings: Corneal sensitivity increased significantly between 42.8 +- 6.4 mm at the beginning of the study and 54.2 +- 5.1 mm at four weeks (p < 0.001). Tear breakup time went up to 12.1 +- 1.5 seconds as compared to 7.9 +- 1.8 (p < 0.001). The scores of OSDI were lower (19.4 +- 5.9) as compared to 38.5 +- 7.2 (p < 0.001), which showed a better patient comfort score. No serious adverse effect was observed and mild transient irritation was reported in 7.5% of participants.
Conclusion: Hypertonic salt water wash has a significant effect on the ocular surface sensitivity, stability of the tear film, and comfort of the patient. It is a safe, efficient and readily available therapeutic method of enhancing the health of the ocular surface.
References
2. Štanfel D, Kalogjera L, Ryazantsev SV, Hlača K, Radtsig EY, Teimuraz R, Hrabač P. The role of seawater and saline solutions in treatment of upper respiratory conditions. Marine Drugs. 2022;20(5):330.
3. Parviz S, Duncan L, Rabago D. Soap and water to hands and face-eye rinse, nasal irrigation and gargling with saline for COVID-19 with anecdotal evidence. Rhinology. 2021;4:185–193.
4. Xia Y, Zhang Y, Du Y, Wang Z, Cheng L, Du Z. Comprehensive dry eye therapy: overcoming ocular surface barrier and combating inflammation, oxidation, and mitochondrial damage. Journal of Nanobiotechnology. 2024;22(1):233.
5. Yang M, Chen X, Chen Z, Zhao N, Zeng Z, Huang X, Li Z, Li J, Zhao G, Deng M, Zou Z. Thermoresponsive antioxidant metal-free carbon nanodot hydrogel: An effective therapeutic approach for ocular surface disease. Science Advances. 2025;11(30):eadt8775.
6. Graca M, Sarantopoulos K, Horn DB. Chemical toxic exposures and chronic ocular pain. Frontiers in Toxicology. 2023;5:1188152.
7. Chen T, Zhou N, Liang Q, Li Q, Li B, Chu Y, Zhang D, Chen Z, Tsao JR, Feng X, Hu K. Biochanin A: Disrupting the inflammatory vicious cycle for dry eye disease. European Journal of Pharmacology. 2024;977:176583.
8. Ma B, Pang L, Huang P, Bai J, Zhang Z, Wu H, Cai M, Yang J, Xu Y, Yin X, Qu C. Topical delivery of levocarnitine to the cornea and anterior eye by thermosensitive in-situ gel for dry eye disease. Drug Design, Development and Therapy. 2021;15:2357–2373.
9. Han Y, Zhang Y, Yuan K, Wu Y, Jin X, Huang X. Hyperosmolarity promotes macrophage pyroptosis by driving the glycolytic reprogramming of corneal epithelial cells in dry eye disease. Frontiers of Medicine. 2023;17(4):781–795.
10. Lin S, Cai M, Zhang L, Mao Y, Wu H, Liu X, Li Y, Liang M, Cheng X, Yu F, He H. Limbal stem cell dysfunction induced by severe dry eye via activation of the p38 MAPK signaling pathway. The American Journal of Pathology. 2023;193(11):1863–1878.
11. Quiroga-Garza ME, Ruiz-Lozano RE, Azar NS, Mousa HM, Komai S, Sevilla-Llorca JL, Perez VL. Noxious effects of riot control agents on the ocular surface: Pathogenic mechanisms and management. Frontiers in Toxicology. 2023;5:1118731.
12. González-Cela-Casamayor MA, López-Cano JJ, Bravo-Osuna I, Andrés-Guerrero V, Vicario-de-la-Torre M, Guzmán-Navarro M, Benítez-del-Castillo JM, Herrero-Vanrell R, Molina-Martínez IT. Novel osmoprotective DOPC-DMPC liposomes loaded with antihypertensive drugs as potential strategy for glaucoma treatment. Pharmaceutics. 2022;14(7):1405.
13. Chu D, Zhao M, Rong S, Jhe W, Cai X, Xiao Y, Zhang W, Geng X, Li Z, Zhang X, Li J. Dual-atom nanozyme eye drops attenuate inflammation and break the vicious cycle in dry eye disease. Nano-Micro Letters. 2024;16(1):120.
14. Hynnekleiv L, Magno M, Vernhardsdottir RR, Moschowits E, Tønseth KA, Dartt DA, Vehof J, Utheim TP. Hyaluronic acid in the treatment of dry eye disease. Acta Ophthalmologica. 2022;100(8):844–860.
15. Fakih D, Guerrero-Moreno A, Baudouin C, Réaux-Le Goazigo A, Parsadaniantz SM. Capsazepine decreases corneal pain syndrome in severe dry eye disease. Journal of Neuroinflammation. 2021;18(1):111.
16. Fakih D, Guerrero-Moreno A, Baudouin C, Réaux-Le Goazigo A, Parsadaniantz SM. Capsazepine decreases corneal pain syndrome in severe dry eye disease. Journal of Neuroinflammation. 2021;18(1):111.
17. Fan L, He T, Shi J, Ke X, Lu X. Effects of recombinant human epidermal growth factor eye drops combined with phacoemulsification on visual acuity recovery and dry eye complications. Computational and Mathematical Methods in Medicine. 2022;2022:1041558.
18. Cammalleri M, Amato R, Olivieri M, Pezzino S, Bagnoli P, Dal Monte M, Rusciano D. Effects of topical gabapentin on ocular pain and tear secretion. Frontiers in Pharmacology. 2021;12:671238.
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Abdul Qadeem Soomro
Consultant Ophthalmologist, Alibrahim EYE Hospital, Isra Postgraduate Institution of Ophthalmology Malir, Karachi
Fayaz Ahmed Soomro
Consultant Ophthalmologist, Institute Al Ibrahim EYE Hospital Isra Postgraduate Institute of Ophthalmology Karachi
Abdul Sattar
Consultant Ophthalmologist, Institute Al Ibrahim EYE Hospital Isra Postgraduate Institute of Ophthalmology Karachi
Shoaib Ahmed Shaikh
Consultant Ophthalmologist, Institute Al Ibrahim EYE Hospital Isra Postgraduate Institute of Ophthalmology Karachi
Syed Saifullah Shah
Consultant Ophthalmologist, Institute Al Ibrahim EYE Hospital Isra Postgraduate Institute of Ophthalmology Karachi
Abdullah Laghari
Optometrist, Institute Al Ibrahim EYE Hospital Isra Postgraduate Institute of Ophthalmology Karachi
Hina Khan
Professor, Deputy Director Research and Postgraduate Affairs
