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DOI: 10.1055/a-1111-9414
Osmokinetics: Defining the Characteristics of Osmotic Challenge to the Ocular Surface
Osmokinetik: Definition der Charakteristika der osmotischen Herausforderung der AugenoberflächePublikationsverlauf
received 18. Dezember 2019
accepted 24. Januar 2020
Publikationsdatum:
20. Mai 2020 (online)
![](https://www.thieme-connect.de/media/klimo/202005/lookinside/thumbnails/10-1055-a-1111-9414_kl2126-1.jpg)
Abstract
The association of severe dry eye disease with elevated osmolarity in the tear film is a subject of ongoing discussions. As the absolute value of osmolarity in tear film is highly variable, the daily variation in osmolarity (DVO) has recently been proposed to further identify the osmotic stress at the ocular surface. However, the DVO alone does not explain the variations in the available published data or allow their use in diagnostic testing or therapy. We therefore investigated and evaluated further details of osmokinetics and their importance for ocular surface disease on the basis of the available literature. Additionally, osmolarity was measured in the tear samples of volunteers in the morning hours between 8 – 10 a. m., midday noon–2 p. m., and afternoon between 3 – 5 p. m., i.e., during normal office hours. The results were compared with available published data which suggested that within the DVO, the daily maximal amplitude of osmotic variation (M-DVO) and the frequency of osmotic cycles (defined as daily osmolarity cycles, DOC) could be the main factors that further characterize osmokinetics. In addition, a decisive role could be the level of osmolarity at which the variation does occurs (L-DVO). The possible effects of these characteristics on ocular surface pathophysiology are discussed, along with their relationship to topical therapy with hypo-osmolar solutions, and the model of the osmotic roller coaster is introduced.
Zusammenfassung
Die Assoziation einer erhöhten Tränenosmolarität mit dem Vorliegen von schweren Erkrankungen des trockenen Auges ist ein aktuelles Thema derzeitiger Diskussionen. Wegen der großen Variabilität der gemessenen absoluten Osmolaritätswerte wurde die Tagesschwankung der Osmolarität (TSO = Daily Variation of Osmolarity, DVO) als Parameter zur Beurteilung des osmotischen Stresses auf der Augenoberfläche vorgeschlagen. Doch auch mit dem TSO lassen sich nicht alle vorliegenden Ergebnisse erklären oder therapeutisch nutzen. Daher wurde die vorliegende Literatur auf weitere Erkenntnisse zu den Eigenschaften der Osmokinetik und ihre mögliche Bedeutung für die Augenoberfläche untersucht. Außerdem wurde das Tagesprofil der Tränenosmolarität an Probandenaugen erstellt (Messungen zwischen 8 und 10 Uhr, 12 und 14 Uhr sowie 15 und 17 Uhr, also während eines normalen Arbeitstags). Beim Vergleich der Resultate mit den Erkenntnissen der Literatur erscheint es möglich, dass die Bedeutung der TSO (DVO) von der maximalen Amplitude der DVO (M-DVO) und der Anzahl von osmotischen Zyklen per Zeiteinheit, nämlich Tageszyklen (DOC), abhängig sein kann. Darüber hinaus ist das Osmolaritätsniveau (Level of DVO = L-DVO), auf dem diese Veränderungen stattfinden, von potenziell entscheidender Bedeutung. Die möglichen Auswirkungen dieser Charakteristika auf die Pathophysiologie der Augenoberfläche werden diskutiert, auch unter dem Aspekt der Topikaltherapie mit hypoosmolaren Augenpräparaten, wobei das Modell der osmolaren Achterbahn vorgestellt wird.
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