The Efficacy of an Irrigating Eyelid Retractor-Facilitated Ocular Rinse on MMP-9 Expression and Dry Eye Disease

This study aimed to 1) investigate the effect of an irrigating eyelid retractor vs standard eye rinse on MMP-9 levels in the tear film, 2) evaluate clinical symptoms of dry eye disease (DED) post-irrigation, and 3) assess the long-term benefits of device-assisted ocular irrigation. Patients ≥18 years old with DED and a positive point-of-care MMP-9 test were enrolled and randomized into a control (standard irrigation) or experimental (device-assisted ocular irrigation) arm. MMP-9 was measured pre-irrigation and 3 hours post-irrigation. Clinical symptoms were investigated using the Change in Dry Eye Severity Questionnaire (CDES-Q). Exploratory endpoints in the experimental arm were percent of subjects who had a negative MMP-9 level at 7 and 30-91 days. Of the 88 eyes, 46 (52.27%) underwent device-facilitated irrigation and 42 (46.73%) underwent standard irrigation. The baseline MMP-9 expression was similar between the groups (p>0.05). At 3 hours post-irrigation, both groups exhibited MMP-9 reduction (control: p=0.0334; device: p<0.0001); two-way ANOVA indicated a significant reduction in MMP-9 levels compared to control in the device arm. At one week, the average value in the CDES-Q was 4.33 ±2.93 for the device arm vs 1.32 +1.21 for the standard arm. Forty-two percent of the eyes were negative for MMP-9 expression at 7 days, and 33% of the eyes were negative for MMP-9 at 30-91 days. The irrigating eyelid retractor offers a novel mechanism for reducing MMP-9 expression in patients with DED and improving patient symptoms. This reduction in MMP-9 can last up to 91 days.