A stabilized ozone-based ophthalmic gel could act as a barrier against the entry of the Sars-CoV-2 virus through the eyes, thus acting a bit as an eye mask, to be worn together with the classic surgical mask that covers nose and mouth. This is the proposal that comes from a study published in the August issue of Traslational Vision Science & Technology, signed by researchers from the Catholic University of the Sacred Heart of Rome and the University of Ferrara. “Ozone ozone gels – explains Stanislao Rizzo, Full Professor of Ophthalmology at the Catholic University of the Sacred Heart, Rome campus, and UOC Director of Ophthalmology Foundation Policlinico Universitario Agostino Gemelli IRCCS – they are already used to soothe the symptoms of inflammatory eye diseases, including those of infectious origin; our study suggests they may also have a barrier effect against virus entry through the eyes or the nasolacrimal system. However, this is an in vitro study, the results of which will have to be confirmed by studies on animal models and in humans “.
The eyes: little considered route of entry for the virus
The SARS CoV-2 virus can also enter the body through the eyes, as a member of the US National Expert Panel on Pneumonia, sent to Wuhan for inspection, discovered to his expense; the man, who wore no eye protection devices, first developed conjunctivitis, then the classic Covid-19 pneumonia. Other studies have shown that the virus can remain in the eye even a few weeks after the acute phase of the disease. In short, the eyes are a target organ of SARS CoV-2, in particular in the presence of small damage, such as those that occur in dry eye syndrome. In patients with Covid-19, it is mainly the ‘goblet’ mucus cells to be affected, while those of the cornea and conjunctival cells, perhaps because they are protected by the tear film that renews every 5 minutes, seem more protected from infection, unless you are not in a condition such as dry eye syndrome.
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This observation has led to think that the tear film can also act as a protective barrier against the virus; but in reality it is a double-edged sword, because if the virus manages to penetrate the layer of tears, their drainage determines its arrival in the nasolacrimal system, from where the SARS CoV-2 can easily penetrate the organism, through its preferred approach, the nose.
Enhance the barrier effect of tears against SARS CoV-2
“From these observations – explains Professor Rizzo – the idea was born of enhancing the barrier effect of tears against SARS CoV-2, using a special ozone-based eye drops”. The antimicrobial properties of ozone have long been known, probably linked to its ability to induce temporary oxidative stress (reacting with polyunsaturated fatty acids and water present on the surface of the eyes, it induces the production of hydrogen peroxide, i.e. hydrogen peroxide); this in turn stimulates the production of Nrf2 (nuclear factor-erythroid 2-related factor 2) which activates the transcription of a series of antioxidant factors, such as superoxide dismutase and glutathione peroxidase.
Ozone has long been used in medicine to disinfect and treat infectious diseases, given its ability to inactivate bacteria, viruses, fungi, yeasts and even protozoa. Its antiviral activity in particular is expressed by damaging the viral capsid and altering viral replication through peroxidation.
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“Being a gas – explains Professor Rizzo – ozone is very unstable, but to make it suitable for topical use, it can be stabilized by making it react with a monounsaturated fatty acid such as oleic acid and thus creating the so-called ‘ozonated oils’ , which maintain the same properties of gaseous ozone and are well tolerated by the tissues. Ozonated oils in nanoformulation are already used in the form of eye drops or ophthalmic gel to soothe the symptoms associated with inflammatory ocular pathologies, even of infectious origin; however, ozone facilitates the healing of corneal damage, minimizing the risk of scarring and opacification of the cornea “.
The role of ozone
Can ozone block the entry of SARS CoV-2 into the cells of the surface of the eye?
The study, just published in Translational Vision Science & Technology, evaluated in vitro the effect of an ozonated oil-based liposomal ophthalmic gel on human corneal epithelial cells infected with SARS CoV-2.
“The aim of the study – explains Professor Rizzo – was to evaluate whether this ophthalmic gel was able to prevent SARS CoV-2 infection in the superficial tissues of the eye and to evaluate whether, in patients with dry eye syndrome, could help restore the integrity of the eye surface by repairing and regenerating conjunctival microvilli. ” Both objectives achieved because in this study, the ozone-based eye gel was shown to inhibit viral replication and the entry of the virus into the cells of the eye surface (corneal and conjunctival). Ozone eye gel has also been shown to restore cell regeneration and control inflammation in dry eye syndrome.
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“Waiting for a vaccine that can also block the spread of the virus – concludes Professor Rizzo – there are still few measures that can be implemented to reduce the risk of infection (mask, social distancing, washing hands often). And the ocular surface represents a potential route of entry for the virus, particularly in the case of tear film abnormalities, such as in dry eye syndrome. Should the results of this research also be confirmed by studies on animal models and in humans, it would therefore be conceivable to propose the topical administration of ozone eye gels to prevent the entry of SARS CoV-2 through the ocular surface; a protective measure to be recommended in the first place to healthcare personnel and possibly to be extended to the entire population. “