TREATING DRY EYE

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Allergan’s Restasis prescription eye drops inhibit activation of inflammatory T-cells, which disrupt normal production of tears.

Intervention with pharmaceuticals, topical solutions, and supplements can be the appropriate path when treating dry eye symptoms.

As most eyecare professionals know, it can take months to get dry eye disease under proper control. With that in mind, it’s best to investigate different treatment options in order to treat early and often when it comes to managing dry eye. Here are some situations where the combination of patient education and proper medical treatment of dry eye improved the patient’s symptoms.

MEDICATION AND ENVIRONMENTAL FACTORS
A patient aged 64 came to our office complaining of gritty, irritated eyes. He has been taking Wellbutrin, an anti-depressant, for two years. His eyes have been more irritated since the winter and seem to be worse at his job, where he works on a computer for many hours in a dry air environment.

His vision was 20/20 OU in his current glasses and J1 at near. Slit lamp evaluation revealed mild meibomitis OU, but no blepharitis. After instilling sodium fluorescein dye, a thin tear prism was evident. Tear breakup time (TBUT) was six seconds per eye. There was also 1+ superficial punctate keratitis OU.

We discussed these exam findings, the side effects of his medication, and an explanation of how dry air in the office and staring at a computer affected his eyes. The patient was instructed to use Alcon Laboratories, Inc.’s Systane® Ultra Lubricant Eye Drops TID OU and begin omega-3 supplements.

Systane Ultra is an HP (hydroxypropyl) guar-based artificial tear. HP guar is gel-forming and when it interacts with the tear film, it spreads rapidly across the surface of the eye, adhering to it for prolonged periods of time. By increasing retention time of the artificial tears on the eye, HP guar-based artificial tears are helpful in patients with symptomatic dry eye as well as patients demonstrating ocular surface staining.

Bausch + Lomb’s Soothe® XP Emollient eye drops, artificial tears that are metastable oil-in-water emulsion, is another good choice for this patient. Soothe XP has been shown to increase the thickness of the lipid layer of the tear film. It is therefore beneficial for those patients with evaporative causes of dry eye or a poor quality of the lipid layer.

Supplements, such as omega-3 essential fatty acids, offer an effective, safe, and natural way to address dry eye symptoms orally rather than topically. Omega-3 essential fatty acids in the diet have been shown to be helpful in suppressing the inflammation of blepharitis and the tear glands that cause decreased tear production.

Dry Eye Omega Benefits® (PRN Physician Recommended Nutriceuticals) is custom formulated with a high concentration of the omega-3, EPA (eicosapentaenoic acid) in its natural TG form.

HydroEye® from ScienceBased Health provides continuous relief from dry eye discomfort due to: age, tear deficiency, contact lens wear, computer use, frequent flying, LASIK surgery, and other causes.

Advanced Vision Research offers TheraTears Nutrition, SteriLid Eyelid Cleanser, and Lubricant Eye Drops to treat dry eye symptoms.

Capsules include a proprietary blend of omega fatty acids and nutrient cofactors that help reduce inflammation and support all three layers of the tear film.

Another choice is Advanced Vision Research’s TheraTears® Nutrition, which contains two types of omega-3s (from flaxseed oil and fish oil). This supplement has organically grown, lignan-free flaxseed oil, pharmaceutical-grade, molecularly distilled, mercury-free fish oil, and vitamin E.

AN EYELID CONDITION
A patient aged 50 with a history of rheumatoid arthritis complained of irritated eyes and occasional redness. Since it was her first visit to our office, she brought four different over-the-counter eye drops that she used the past few months with little improvement of her symptoms. While she had taken hydroxychloroquine (Plaquenil) in the past for rheumatoid arthritis, her doctor took her off about one year ago and she was now taking Mobic, a different drug for this condition, daily. This patient’s vision was 20/20 at distance OD, OS without correction. Examination of the ocular surface showed 1+ blepharitis OU, capped meibomian glands, a thin tear prism OU, and a rapid TBUT of five seconds.

The patient was educated about her eyelid condition, the meibomian gland disease, and the systemic

Bausch + Lomb’s Soothe XP Emollient eye drops have been shown to increase the thickness of the lipid layer of the tear film.

connection between her rheumatoid arthritis and her dry eye symptoms. We explained we would treat her symptoms in two stages: first, clearing the lid margin disease; and second, addressing the inflammatory causes of her dry eye disease.

The patient was prescribed warm compresses with lid massage twice daily and Advanced Vision Research’s TheraTears SteriLid Eyelid Cleanser twice daily for two weeks. Additionally, Optive™ artificial tears from Allergan were recommended to restore moisture to the corneal surface. A follow-up in two weeks was scheduled.

According to the company, SteriLid Eyelid Cleanser is the first antibacterial lid foam for lid hygiene and is designed for all conditions where bacterial overgrowth creates problems: blepharitis, dry eye, and patients preparing for eye surgery.

One off-label use of medication to treat blepharitis is Inspire Pharmaceuticals, Inc.’s AzaSite® (topical azithromycin). Many doctors are prescribing this eye drop to be used along the lid margins twice daily for 30 days.

To help restore the tear film, the patient was instructed to use Refresh Optive Lubricant Eye Drops, which contains: CMC (carboxymethylcellulose), which stabilizes the tear film and allows for long-lasting relief; glycerin, which protects corneal cells and offers long-lasting moisture without blurring vision; and purite, a gentle preservative that provides safe and effective protection without leading to the irritation or allergic reactions.

Another CMC-based artificial tear is Advanced Vision’s TheraTears Lubricant Eye Drops. These drops are hypotonic to lower elevated tear film osmolarity. They also restore conjunctival goblet cells in dry eye by providing the specific electrolyte balance of the tear film that is necessary for the maintenance of normal goblet cell density.

At the follow-up evaluation, the patient’s blepharitis had cleared and she no longer had capped meibomian glands. We discussed long-term treatment of her dry eye again and she was prescribed Restasis® (cy-closporine ophthalmic emulsion) 0.05% from Allergan and continued use of Optive artificial tears.

When administered twice a day, Restasis prescription eye drops inhibit activation of inflammatory T-lymphocytes (T-cells), which cause inflammation and disrupt normal production of tears in the lacrimal glands. Patients with chronic dry eye will need to maintain therapy on an ongoing basis.

Evaluation of the lid margins and tear film, and review of medications symptoms are important when determining the best course of treatment for dry eye disease.

Eric L. Bran, Professional Editor for Vision Care Product News, is in a private group practice at Ridgefield Family Eye Care and The Institute for Sports Vision in Ridgefield, CT.

WHERE TO FIND IT
Advanced Vision Research
781-932-8327 • theratears.com

Alcon Laboratories, Inc.
800-451-3937 • optifree.com

Allergan
800-347-4500 • allergan.com

Bausch + Lomb
800-828-9030 • bausch.com

Inspire Pharmaceuticals
919-941-9777 • inspirepharm.com

PRN
Physician Recommended Nutriceuticals
800-900-2303 • prnomegahealth.com

ScienceBased Health
888-433-4726 • sciencebasedhealth.com

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