Studies have demonstrated an infiltration of the conjunctival epithelia with inflammatory cells, particularly lymphocytes [41], [42] and [43]. Furthermore, changes in the expression of immune system stimulation markers, including the intracellular adhesion molecule I antigen and the human leukocyte antigen D receptor (HLA-DR), which induce T-cell homing and antigen presentation, were observed in the context of dry eye [44]. Several studies reported alterations in the protein expression profiles of cytokines in the tears of patients with DES. This suggests that dry eye is the result of inflammatory reactions, which are caused by cytokines, resulting in an autoimmune response [45].

Moreover, recent studies have shown the positive effect

of oral omega-3 and -6 essential fatty acid supplementation in DES with an inflammatory component [46], [47] and [48]. GW786034 cost Reduced dry eye symptoms were reported as well as an improvement in objective signs, including corneal staining and decreased conjunctival HLA-DR expression. Oral omega-6 supplementation also increased tear production and reduce dry eye symptoms after photorefractive keratectomy [49]. Ginsenosides, unique saponins contained in the Panax species, are believed to be responsible for most of Antidiabetic Compound Library purchase the pharmacological actions of ginseng, which include anti-inflammatory, -stress, and -oxidant activities [50], [51], [52] and [53]. Many studies have reported the anti-inflammatory effects of ginseng extracts and ginsenosides on cellular responses triggered by various inducers, including endotoxin, tumor necrosis factor-α, and interferon-γ [54], [55] and [56]. Ginseng extracts and ginsenosides, including Rb1, Rb2, Rc, Rd, Re, Rf, Rg1, and Rg2 have been reported to have

anti-inflammatory properties in different forms of inflammation [57]. Ginsenosides inhibit various inducer-activated signaling protein kinases and nuclear factor kappa-light-chain-enhancer of activated B cells transcription factor, resulting Florfenicol in decreased production of cytokines and inflammation mediators [58] and [59]. Based on these studies, we hypothesized that the anti-inflammatory property of KRG may have a positive effect on the ocular surface. This KRG anti-inflammatory effect improved tear film instability, and consequently the TBUT was increased. Additionally, there were significant improvements in conjunctival hyperemia and MGD quantity after KRG supplementation, although these were not significantly different from the placebo group. These results strongly support our hypothesis regarding the anti-inflammatory effects of KRG on dry eye. This hypothesis should be confirmed by additional in vitro and in vivo studies. In the current study, we also found an improvement in subjective dry eye symptoms determined using the OSDI questionnaire in the KRG group, as compared to the placebo group.