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    Substance P: Dry eye and allergy’s mixed signal or missing link?

    In 2009, a seismic shift in the world of paleoanthropology occurred when a new entry into the fossil record occurred with the advent of “Ardi” (Ardipithecus ramidus).1

    Now, you may remember “Lucy” (Australopithecus afarensis) from your biology class back in the day as the oldest known human relative approximately 3.2 million years ago that was considered the missing link. By all accounts, Lucy and her brethren walked upright and had increased brain capacity in the woodland savannas of Africa.

    Everyone thought this was case closed in 1974—until Ardi came into the picture about 4.4 million years ago.1

    Ardi is a hodgepodge of sorts in that she had mixed bone structure revealing she was a quadruped in the trees and lived a biped lifestyle on the ground. Although her brain was smaller than Lucy’s, she had the potential vocal ability to socialize with others due to craniofacial modification.2

     

     

     

    It’s not a tangent

    You are likely asking yourself, how does the early human fossil record remotely connect to dry eye and allergic disease? The simple answer is everything.

    There is growing evidence in the literature over the past 20 years with synthesized compounds such as cyclosporine (Restasis, Allergan) and lifitegrast (Xiidra, Shire) that there might be more than the straightforward inflammatory response story we all accept as stalwart vernacular.

    Müller et al described the rich plexus of corneal nerves that provide innervation which is the richest in the human body. Furthermore, this leads into a concept where potential hierarchal complex neurological and inflammatory microsystems feed back and forth.3

    Optometry Times Editorial Advisory Board Member Milton Hom, OD, FAAO, in a passing conversation categorized inflammation the best when stating that we need it for healing purposes to essentially draw in the immune system but not when the reaction is allowed to sustain itself for longer periods of time.

    With this in mind, neurogenic inflammation comes to the forefront as the result from the release of substances from primary sensory nerve terminals.4 In fact, these neuromediators act on target cells and exert their biological activity on both mast cells and immune cells to prolong inflammation.

    Michael S. Cooper, OD
    Michael S. Cooper, OD, is in private practice in Willimantic, CT. He is a consultant to Allergan, BioTissue, Johnson & Johnson Vision ...

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