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Figure 2: “Conjugation of naphthalene-1,2-oxide with glutathione and formation of naphthalene mercapturic acid” [Figure source: Timbrell (2009) Biochemical Mechanisms of Toxicity.4 th Ed

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DED pathophysiology includes an excess of inflammatory cytokines that increase reactive oxygen species (ROS) production, leading to a disruption of the balance between the antioxidant and the prooxidant systems, damaging the healthy tear film (Dogru et al., 2018)