Geerling G., Laqua H.

Klinik für Augenheilkunde, Medizinische Universität zu Lübeck

The natural tear film has mechanical, optical, antimicrobial and nourishing functions. Tear film components, such as EGF and vitamin A play a vital role in proliferation and differentiation of corneal and conjunctival epithelium. In severely dry eyes the ocular surface is depleted of these nourishing factors. Replacing the aqueous component of tears alone, by using pharmaceutical tear substitutes, often has little effect on the ocular surface disease. Autologous substances such as saliva and serum were recently reported to be beneficial in this situation. In cell culture experiments they were found to maintain the morphology and function of keratinocytes better than preserved and unpreserved pharmaceutical products. In clinical studies autologous serum drops in concentrations of 20 to 100% were found to improve the signs and symptoms of severe dry eyes and to encourage healing of persistent epithelial defects. Saliva from a transplanted submandibular gland has successfully been used to achieve permanent lubrication of absolute dry eyes. Autologous serum and saliva may be advantageous because they are unpreserved and non allergenic. As they contain growth factors, vitamins and mucins, their biochemical and biomechanical properties are similar to natural tears. Autologous tear substitutes offer a new therapeutic approach for severely dry eyes. It remains to be shown that they can improve the chance for visual rehabilitation of severe dry eyes.

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