Urban Syndrome and ocular surface

Pubblicato il

Wednesday, 24 January 2024

Argomento

Ocular Inflammations

What is 'Urban Syndrome' and what is its impact on eye and ocular surface health?

Urban syndrome is a new concept that has emerged in recent years, defining a set of ocular and systemic symptoms that have as common causal factors exposure to environmental pollutants, prolonged use of digital devices and visual stress associated with the work environment.

In our urban communities the air quality has been steadily deteriorating in recent decades due to the growing volume of traffic and the increase in the number of cars and other motor vehicles on the road, resulting in growing emissions of particulate matter and other residues from the combustion of fossil fuels. This situation is further aggravated by the global warmingwhich in 2023 reached unprecedented peaks.

From an aetiological point of view, it has been shown that environmental pollutants can directly trigger, through a number of specific mechanisms, a condition of inflammation of the ocular mucous membranes that manifests itself as a non-specific vasomotor conjunctivitis with signs and symptoms similar to those of ocular allergy, but without a detectable allergic process or family history of allergy.

Symptoms commonly associated with Urban syndrome include ocular hyperemia, mucus secretion, itching, burning, dryness, photophobia, foreign body sensation and blurred vision.

Underlying Urban syndrome is an inability of the ocular surface to maintain its homeostatic balance in response to non-specific insults.

It must be premised at this point that in the ocular surface system, all tissues cooperate to maintain a critical homeostasis that ensures comfort and good visual function. This balance is endangered daily by repeated stimuli and insults, but the physiological homeostatic status is continuously preserved through a tightly regulated innate immune response called 'para-inflammation'. This form of innate inflammation is self-limiting and directly proportional to the intensity of the insult. Aggressive insults, such as infection or tissue damage, activate para-inflammatory mechanisms, which help the tissue to restore its physiological function and homeostasis. A protracted or disproportionate para-inflammatory response may, on the other hand, induce a shift from homeostatic balance to a pathological inflammatory condition.

In Urban syndrome there is a very acute inflammatory response disproportionate to the stimulus of environmental pollutants, which leads to a systemic deficit and causes ocular symptoms such as redness and ocular discomfort. A further aggravating factor is certainly the prolonged use of digital devices, in less than optimal lighting conditions, which is particularly frequent in young adults of both sexes of working age.

This implies that Urban syndrome has a major impact on the productivity of these workers.

Treatment

As far as behavioural aspects are concerned, it is recommended not to exaggerate with the use of digital devices, laptops, PCs and smartphones, and to 'impose' regular breaks to give your eyes a rest.

Daily ocular hygiene measures are also recommended to keep the eyes clean and free of contaminants at all times.

Pharmacologically, one can resort to the prophylactic, continuous and constant administration of tear substitutes containing, first and foremost, hyaluronic acid for its well-known re-epithelialising properties.

Another substance that seems to produce beneficial effects is Glycerophosphoinositol, which has a rebalancing function in epithelia and reduces symptoms related to irritative phenomena.