Nasolacrimal Lavage as a Treatment for Ocular Surface Toxic Soup Syndrome
April 25th, 2025
OSTSS leads to pooled inflammatory mediators in the tear film, causing symptoms like epiphora and discomfort. Here, we present a case where therapeutic nasolacrimal lavage every 2 months resolved epiphora and itchiness, suggesting its efficacy as a therapeutic intervention for OSTSS. Additionally, we report subjective improvements in symptoms in 3 additional patients.
We are investigating whether dilation and irrigation, a standard diagnostic procedure, can actually be used therapeutically in cases of ocular surface toxic soup syndrome, a condition that we coined. nasolacrimal lavage offers a safe, cost-effective, and efficacious procedure to alleviate symptoms of ocular discomfort, such as itchiness, burning, and foreign body sensation. Our research questions why nasolacrimal lavage and punctal occlusion, despite being opposite procedures, both reduce symptoms of discomfort.
We hypothesize that both procedures reduce backflow of noxious inflammatory mediators from the lacrimal sac onto the ocular surface. To begin, wash hands thoroughly and don clean gloves. Verify that all required instruments are available in the sterile field.
Then have the patient sit back and relax, ensuring the back of their head is supported by the headrest. Attach a three-milliliter syringe filled with saline to the lacrimal cannula. Instill one drop of topical anesthetic, such as proparacaine, into the intended eye or eyes.
Wait for 30 to 60 seconds to allow the anesthetic to take effect while monitoring the patient for comfort. After instilling the drop of topical anesthetic, select the smallest punctal dilator, if the punctum is too small to proceed with cannulation, and gently insert it vertically, one to two millimeters into the lower punctum. Rotate the dilator 90 degrees so that the tip points toward the nose.
Gradually increase the size of the dilator until it comfortably accommodates the lacrimal cannula, ensuring the punctum is dilated without causing trauma. Now, gently insert the lacrimal cannula into the lower punctum and advance it into the vertical canaliculus. Rotate the cannula horizontally with the blunt tip facing toward the nose.
Gently advance the cannula three to six millimeters into the canaliculus, ensuring smooth, resistance-free movement. Slowly inject two to three milliliters of saline solution through the cannula into the lacrimal duct system, applying gentle pressure to avoid discomfort or trauma. Then remove the cannula from the punctum.
After irrigation, observe for displaced mucus or improvement in ocular discomfort symptoms. If the patient detects irrigated fluid in the back of the throat with the head tilted back or in the nose with the head tilted forward, confirm lacrimal system patency. Finally, remove the excess discharge or mucus from the eye using a clean tissue.
Monitor the patient for signs of discomfort, redness, or significant discharge. Provide post-procedure instructions, including the use of cold compresses and preservative free artificial tears, if needed. For patients underwent nasolacrimal lavage without confounding treatment changes, all the patients reported good improvement in itchiness post-treatment, and duration of symptom relief ranged between three weeks to seven months.
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Overview
This study investigates the therapeutic use of nasolacrimal lavage in alleviating symptoms associated with ocular surface toxic soup syndrome (OSTSS). The findings suggest that this procedure can effectively reduce symptoms such as itchiness and discomfort in patients.
Key Study Components
Area of Science
- Ophthalmology
- Therapeutic interventions
- Inflammatory conditions
Background
- OSTSS leads to pooled inflammatory mediators in the tear film.
- Common symptoms include epiphora and discomfort.
- Standard diagnostic procedures may have therapeutic applications.
- Understanding the mechanisms behind symptom relief is crucial.
Purpose of Study
- To evaluate the efficacy of nasolacrimal lavage as a treatment for OSTSS.
- To explore the relationship between nasolacrimal lavage and symptom relief.
- To investigate the impact of inflammatory mediators on ocular discomfort.
Methods Used
- Therapeutic nasolacrimal lavage performed every 2 months.
- Assessment of symptom improvement in patients.
- Comparison of therapeutic and diagnostic applications of dilation and irrigation.
- Monitoring of subjective symptom changes post-treatment.
Main Results
- Therapeutic nasolacrimal lavage resolved epiphora and itchiness in the case presented.
- Subjective improvements were reported in three additional patients.
- Both nasolacrimal lavage and punctal occlusion reduced discomfort symptoms.
- Hypothesis suggests both procedures limit backflow of inflammatory mediators.
Conclusions
- Nasolacrimal lavage is a safe and effective treatment for OSTSS.
- Further research is needed to understand the mechanisms of symptom relief.
- Potential for broader applications in managing ocular discomfort.
Frequently Asked Questions
Executive Industry Relevance
Nasolacrimal lavage, traditionally a diagnostic tool, demonstrates therapeutic potential for ocular surface toxic soup syndrome (OSTSS) by reducing inflammatory mediator accumulation. This approach addresses a mechanistic gap in managing ocular surface inflammation, offering a pathway for de-risking early intervention strategies. Its integration could inform translational research and portfolio decisions in ocular surface disease pipelines.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables interrogation of inflammatory mediator dynamics in ocular surface disorders.
- Supports mechanistic de-risking by clarifying the impact of tear drainage on symptom resolution.
- Facilitates functional validation of therapeutic hypotheses targeting tear film homeostasis.
Screening & Assay Development
- Provides a reproducible procedure for evaluating interventions that modulate tear film composition.
- Standardizes assessment of symptom improvement and mediator clearance in preclinical models.
- Enables quantitative tracking of patient-reported outcomes post-intervention.
Translational & Preclinical Research
- Aligns with disease-relevant models of ocular surface inflammation for translational continuity.
- Supports risk-adjusted advancement of candidate interventions targeting tear drainage pathways.
- Offers predictive value for symptom relief in patient populations with similar pathophysiology.
Pipeline & Workflow Integration
Nasolacrimal lavage fits within the continuum from early discovery of inflammatory mechanisms to preclinical validation of ocular surface therapies.
- Discovery Biology: Clarifies the role of tear drainage in modulating inflammatory mediator backflow.
- Screening: Establishes a platform for reproducible assessment of intervention efficacy.
- Analytics: Enables quantitative measurement of symptom changes and mediator displacement.
- Translational Research: Bridges mechanistic findings to patient-reported outcomes in clinical settings.
- Enterprise Reuse: Provides a standardized protocol adaptable across ocular surface disease models.
Operational & Enterprise Impact
- Scientific Value: Enhances predictive confidence in targeting tear film and drainage pathways.
- Operational Value: Offers a safe, scalable, and reproducible intervention for ocular surface studies.
- Strategic Value: Informs go/no-go decisions for early-stage ocular surface therapeutics.
- Portfolio Impact: Supports risk-adjusted prioritization of inflammation-modulating candidates.
Implementation Considerations
- Requires expertise in ocular surface anatomy and procedural technique.
- Needs access to sterile instrumentation and patient monitoring infrastructure.
- Demands cross-team standardization for reproducible outcome measurement.
- Adaptable to various preclinical and clinical ocular surface models.
- Limited by subjective symptom reporting and need for further mechanistic validation.
