Hydroxypropyl methylcellulose for the treatment of severe dry eye associated with Sjogren's syndrome

Our purpose was to evaluate the efficacy of a new formulation of methylcellulose, preservative-free 0.5% hydroxypropyl methylcellulose (HPMC), for the treatment of dry eye. In the clinical part of our study, two groups of dry-eye patients, those with Sjogren's syndrome (SS) and those without (non-SS), were treated topically with 0.5% HPMC and evaluated for symptoms, ocular surface vital staining, tear breakup time (BUT), and tear evaporation rate from the ocular surface at 40% ambient humidity (TEROS40). In the in vitro part of the study, rose bengal uptake was measured in human conjunctival epithelial cells, which were cultured and incubated with or without 0.5% HPMC. Although symptoms improved in both groups, rose bengal and fluorescein staining and BUT improved significantly only in the SS group. TEROS40 increased for 30 min after instillation of 0.5% HPMC, but not after the use of 0.1% sodium hyaluronate or saline-based artificial tears. Rose bengal uptake by cultured conjunctival epithelial cells was blocked by 0.5% HPMC. These findings suggest that 0.5% HPMC provides long coverage of and protection for the ocular surface. Patients with severe dry eye, such as in SS, are good candidates for this treatment.