Dry Eye Disease: Eye Drop Management Options

The following is a summary of Dr. Elise Kramer's course: follow the link here to watch the course

“Dry eye is a multi-factoral disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles”

-DEWS2 STUDY

Aqueous Deficient Dry Eye

Lissamine green staining in dry eye

• Evaporation is normal. Tear flow is low

• Severe in sjogrens, less severe in non-sjogrens

• Usually caused by inflammatory conditions —> infiltration of lacrimal gland

• Diagnostic testing:

  • OSDI and SPEED questionnaires

  • Lissamine green staining highlights dead conjunctival cells

  • Schirmers test <10mm

  • Phenol red test <15mm

Evaporative Dry Eye

• Evaporation is excessive. Tear flow is normal.

• Related to meibomian gland dysfunction, incomplete blinks, CL use

• Thickened meibum/ plugging of glands present

• Diagnostic testing:

  • Meibography

  • Mechanical pressure

Treatment Options

• STEP ONE —> EDUCATION

  • Lid hygiene must be improved (baby shampoo washes, ocusoft lid wipes)

  • Omega 3s

  • Warm compresses

  • Artificial Tears

    • First line therapy

    • Lipid Based Tears

      • Contains mineral oils and phospholipids

      • Improves lipid quality

      • Good for evaporative dry eye

      • Emulsions

      • Ex: Retaine, Refresh Optive Advanced

    • Lubricating Tears

      • Increases tear volume and minimizes dessication

      • Good for aqueous deficient dry eye

      • Contains NaCl inorganic ions, hyaluronic acid, semi synthetic celllulose

      • Ex: Freshkote

      • Gels can be used at night

        • Ex: Genteal, Theratears, Systane gel

  • Blinking Exercises

    • Close eyes to touch, squeeze, open.

    • Pause for 1-2 seconds

• STEP TWO —> IN OFFICE PROCEDURES/ MED THERAPY

  • Lipiflow

  • IPL

  • Lacrimal punctal occlusion

    • Temporary and permanent plugs available

    • Best for aqueous deficient dry eye

  • Prescription drops

    • Xiidra (liftegrast)

      • Inhibits T cell activation which inhibits cytokine release

    • Restasis (cyclosporine)

      • Immunosuppressive

      • 6 months to increase goblet cells —> helps restore tear production

    • Steroids

      • Decreases HLA DR positive cells

      • Eysuvis (loteprednol 0.25%)

        • Approved for dry eye

        • Short term use - 2 weeks

    • Autologous serum tears

      • Patient’s blood is centrifuged and made into eye drops

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