title: Tear function changes during interferon and ribavirin treatment in patients with chronic hepatitis C.
abstract: OBJECTIVE
  To evaluate symptoms and changes in tear function and the ocular surface with interferon and ribavirin therapy for chronic hepatitis C.
  
  
  METHODS
  Nineteen patients with chronic hepatitis C undergoing a course of interferon alfa-2b/ribavirin therapy and 19 age- and sex-matched controls participated in this prospective study. Patients were evaluated for dry eye subjectively (15-symptom assessment questionnaire) and objectively, including ophthalmologic examination, Schirmer test, tear clearance rate (TCR), tear function index (TFI), and nucleus/cytoplasm (N/C) ratio of conjunctival epithelial cell by impression cytology. All tests were performed before antiviral therapy (baseline); at 1, 3, and 6 months after initiation of therapy; and at 3 and 6 months after completing the 6-month course of treatment. All the tear functional tests and impression cytology results in controls were compared with pretreatment baseline of study group, using the Student t test. A paired t test was used to compare mean patient follow-up values with mean patient baseline values.
  
  
  RESULTS
  Patients' mean score on the dry eye symptom assessment questionnaire was significantly (P < 0.05) higher than baseline after 1 and 3 months of therapy, peaked after 6 months of therapy, remained significantly elevated at 3 months after completion of therapy, but had decreased to almost baseline by 6 months after cessation of therapy. Compared with baseline, mean Schirmer test values showed a significant change only at 1 month after the start of treatment. In contrast, mean TCR, mean TFI, and mean N/C ratio were significantly different from baseline at every examination, including 6 months after discontinuation of therapy. After 6 months of therapy, 4 patients (21%) had advanced squamous metaplasia (stage 3 or 4), but 2 patients still had mild squamous metaplasia (stage 2) even 6 months after the completion of therapy.
  
  
  CONCLUSIONS
  Impairment of tear dynamics and squamous metaplastic changes in the ocular surface occurred in patients with chronic hepatitis C treated with interferon alfa-2b and ribavirin. Symptoms of dry eye were mild and reversible; however, abnormalities in tear dynamics and the ocular surface persisted even 6 months after discontinuation of treatment.
authors.affiliation: Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
authors.forename: Fu-Chin
authors.initials: FC
authors.lastname: Huang
authors.forename: Min-Hsiu
authors.initials: MH
authors.lastname: Shih
authors.forename: Sung-Huei
authors.initials: SH
authors.lastname: Tseng
authors.forename: Shih-Chin
authors.initials: SC
authors.lastname: Lin
authors.forename: Ting-Tsung
authors.initials: TT
authors.lastname: Chang
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003228:Conjunctiva / Q000473:pathology; D004359:Drug Therapy, Combination; D015352:Dry Eye Syndromes / Q000503:physiopathology; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D007765:Lacrimal Apparatus / Q000503:physiopathology*; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013666:Tears / Q000502:physiology*
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin