First, as water evaporates from the tear film, salt concentration increases dramatically, resulting in hyperosmolarity
There is increasing evidence that the hyperosmolarity
triggered by hypertonic solutions like mannitol or HS has an influence on the shape and aggregation properties of platelets (26).
Solutions which are used for preparation of lorazepam may lead to hyperosmolarity
, lactic acidosis and renal tubular acidosis, if administered alongside the drug in extended or higher dose.
 Tear hyperosmolarity
and ocular surface inflammation are important factors involved in dry eye pathogenesis.
According to the 2017 International Dry Eye Workshop II (DEWS II) report, dry eye is "a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity
, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles." (1) Typical clinically severe dry eye disease manifests with symptoms such as restriction of daily activities, pain, decreased wellness, and impairment in general health.
In the 2007 DEWS report, the definition of dry eye started to become more specific regarding the pathophysiologic basis of the disease, including tear hyperosmolarity
and ocular inflammation, alongside the influence on visual function.
The serum osmolality test showed hyperosmolarity
with inappropriate low urine osmolality.
cerevisiae, glycerol is metabolized in response to hyperosmolarity
, which is regulated by the chymase-activated high-osmolarity glycerol (HOG) pathway .
Additionally, tear hyperosmolarity
, hormonal changes, and mechanical irritation can also contribute to the onset of DED pathology [11-14].
Lee, "A rare diabetes ketoacidosis in combined severe hypernatremic hyperosmolarity
in a new-onset Asian adolescent with type I diabetes," BMJ Case Reports, vol.
McMonnies, "Conjunctival tear layer temperature, evaporation, hyperosmolarity
, inflammation, hyperemia, tissue damage, and symptoms: a review of an amplifying cascade," Current Eye Research, vol.
Recent in vitro and in vivo studies on animals suggest that water-based lubricants are not safe and induce mucosal irritation due to product hyperosmolarity
(12) that can lead to toxic effects and eventually lead to increase in the acquisition and transmission of sexually transmitted pathogens such as HIV (12).