1. Oral Alcohol Administration Disturbs Tear Film and Ocular Surface
초독회
Oral Alcohol Administration Disturbs Tear Film and Ocular Surface
Ophthalmology 2012;119:965–971
R4 이민규/Pf.정성근

2. Introduction
Dry eye syndrome is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance,
and tear film instability with potential damage to the ocular surface
Osmolarity reflect the balance of the input and output of tear dynamics. the most effective single measure of dry eye syndrome
Alcohol is reportedly excreted through breath, sweat, and urine
Whether oral alcohol consumption disturbs the tear film and ocular surface in humans and whether this model can serve as a tear lipid layer-deficient dry eye model.
삼투질농도 단위 용매에 녹아있는 용질의 입자수

3. Patients and Methods 20 healthy male volunteers 20~25 years of age.
normal BMI : 20~25 kg/m2.
neither medication nor eye drops.
Exclusion Criteria
: Hx. of liver disease or ophthalmic surgery,
Dry eye Sx. within the previous 6 months
-> randomly divided into 2 groups
: the alcohol group(10) and the control group(10)

4. TBUT : Tear film break-up time
Soju, 19.5% ethanol
(0.75 g/kg)
Sleep s wash up
s eye drop
PM 6
AM 12
AM 6
AM 8
PM 8
Tear osmolarity
Subjective symptoms
Schirmer’s test
TBUT
fluorescein staining
Corneal sensitivity
Tear osmolarity
Subjective symptoms
Schirmer’s test
TBUT
fluorescein staining
Corneal sensitivity
Tear osmolarity
Subjective symptoms
Schirmer’s test
TBUT
fluorescein staining
Corneal sensitivity
Tear & serum ethanol
Tear osmolarity
Subjective symptoms
Schirmer’s test
TBUT
fluorescein staining
Corneal sensitivity
Tear & serum ethanol
TBUT : Tear film break-up time

5. Tear Osmolarity Measurement
A microcapillary glass tube (Marienfeld, Germany)
- on the lower outer conjunctival sac
- To avoid reflex tearing, asked to gaze supranasally.
A total of 30㎕ of tear samples
- centrifugation at 3000 rpm for 3 min, supernatants were obtained.
- stored at -80°C
- a Multi-OSMETTE 2430 (Precision Systems, Inc., Natick, MA)

6. Tear and Serum Ethanol Concentration
- Ethanol assay kit (BioVision, Mountain View, CA)
Serum
- isolated after centrifugation at 3000rpm for 5 minutes.
- COBAS Integra 800 (Roche, Berlin, Germany) for the diagnostic reagent (EtOH2; Roche, Berlin, Germany)

7. Subjective Symptoms Visual Analog Pain Scale (VAS)
- The scale range : 0 (absence of pain) ~ 10 (maximal pain).

8. Schirmer’s Tear Secretion Test
Represents the basal tear secretion of subjects
Topical anesthesia using 0.5% proparacaine hydrochloride
(Alcaine; Alcon, Fort Worth, TX) was instilled into the conjunctival sac
residual tears were removed using a cotton swab.
Filter papers (Color Bar; EagleVision, Memphis, TN)
- in the lateral canthus for 5 minutes

9. Fluorescein Staining corneal punctuate erosion staining
- recorded using a standardized grading system
- 0 to 3 for each of the 5 areas

10. Measurement of Corneal Sensitivity
Whether alcohol drinking can induce corneal hypesthesia
a Cochet-Bonnet esthesiometer (Luneau, France)
- Apply the tip of the nylon filament perpendicularly
to the surface of the central cornea
- The length of the fiber was decreased gradually
until a blink reflex was observed. The length was recorded.
촉각계

11. Statistical Analyses Wilcoxon signed-rank test & Mann–Whitney U test
: compare tear film & ocular surface changes
Repeated-measures analysis of variance (ANOVA)
: assess the impact of orally administrated alcohol on tear film & ocular surface over time

12. Results

14. Tear and Serum Ethanol Concentration
concentration of ethanol in tears seemed to be approximately half that in serum

15. Tear Osmolarity

16. Tear Film Break-up Time

18. Fluorescence Staining
Visual Analog Pain Scale
Fluorescence Staining

19. No significant change was shown in either corneal sensitivity or Schirmer’s test results in either group

20. Discussion
Hyperosmolarity has been suggested to be the primary causative mechanism in dry eye syndrome
Mechanisms for ethanol in tears causing a dry tear film & ocular surface
1. act as a hyperosmolar agent
2. act as an organic solvent for the lipid layer
3. disturb cytokine production through various pathways,
such as the thromboxane pathway
ocular surface is in contact with open air, whereas the blood
circuit is a closed loop. Alcohol in tears may evaporate because alcohol is volatile
serum alcohol concentrations
were measured using an automatic machine, and
ethanol concentrations in tears were determined using an ethanol assay kit.
-> Although the alcohol concentrations in tears were low, they could induce cellular toxicity

21. Orally administered alcohol was found in tears.
Ethanol concentrations in tears were half those in serum
Tear film was unstable to the next morning,
when alcohol in the blood was not detected in this study
: Alcohol drinking reduces dopamine levels in the CNS
-> alter the blinking pattern that can contribute to tear film unstability
-> Reduced blinking rate may aggravate the evaporation of tear film
Corneal erosion can be caused by tear depletion -> inflammation.
Ocular inflammation aggravates dry eye symptoms and increases tear osmolarity,
which creates a vicious cycle
Schirmer’s tear test and corneal sensitivity showed no significant changes
in either group.
-> no effect of alcohol administration on tear secretion

22. Limitation
- small sample size
- fixed dose of ethanol (0.75 g/kg)
: dose–response relationship was not evaluated
Oral alcohol administration induced transient dry eye syndrome in healthy individuals.
-> Alcohol consumption may aggravate symptoms and signs of
dry eye syndrome
Can serve as a tear lipid layer-deficient dry eye model