Therapies

Dry Eye Therapies Part I: Drops

An introduction to some of the many available dry eye treatments.

By Bill Kekevian, Senior Associate Editor

Dry eye refers to a host of tear layer abnormalities, ocular surface diseases, and keratoconjunctivitis. For patients, dry eye can be painful and life altering.

Patients experiencing dry eye may report a foreign-object sensation or a sensitivity to wind. Problems with blinking are common, too. Some may experience vision fluctuation after blinking or experience a reduced blink rate.

Once ocular surface dryness is identified, the first step is to determine if it’s a case of aqueous-deficient or evaporative dry eye. For aqueous deficiency, topical cyclosporine and also punctal plugs can help. Evaporative dry eye, on the other hand, typically is treated with topical azithromycin, warm compresses, topical steroids or antibiotic/steroid combinations, intraductal meibomian gland probing or a thermal pulsation system.

Lifestyle changes can help soothe the symptoms. For instance, incorporating a sleep mask and eliminating ceiling fan use can help. Patients may also consider wraparound eyewear.

However, most patients will be interested in what kind of “eye drops” — artificial tears and medications — can help alleviate their pain. All over-the-counter dry eye drops carry similar warnings: To avoid contamination, do not touch tip of container to any surface. Replace cap after using. Do not use if this product changes color or becomes cloudy. Store at room temperature. Also, some products are not meant to be used with contact lenses.

The following is a sampling of the eye drop options available to dry eye patients.

Akorn TheraTears Eye Lubricant

Active Ingredient (AI): Sodium carbomethyl cellulose (0.25% in drops, 1.0% in liquid gel)

Useage and dosage (U&D): Instill 1 or 2 drops in the affected eye(s) as needed.

Warnings: Do not use this medication while wearing contact lenses. Wait at least 15 minutes before putting contact lenses in.

Other attributes: Contains the preservative sodium perborate in bottle version. Unit doses are preservative free.

Alcon GenTeal

AI: Hypromellose 0.3%

U&D: Instill 1 or 2 drops in affected eyes as needed. Temporarily relieves discomfort due to minor irritations of the eye from exposure to wind, sun, or other irritants and protects against further irritation.

Other attributes: GenTeal PF is a hypotonic and preservative-free solution, specially formulated to be a soothing lubricant. Gen-Teal PF is available in a pack of 36 single-use containers 0.105 fl. oz. in each container.

Alcon Systane

AI: Polyethylene Glycol 400 0.4%, Propylene Glycol 0.3%

U&D: Instill 1 or 2 drops in affected eyes as needed for the temporary relief of burning and irritation due to dryness of the eye.

Other attributes: Available in 15 and 30 mL bottles and convenient 5 mL Pocket Packs.

Alcon Systane Balance

AI: Propylene Glycol 0.6%

U&D: 1 or 2 drops in affected eyes as needed for the temporary relief of burning and irritation due to dryness of the eye.

Other attributes: This formula helps restore a crucial component of tears that locks in moisture to relieve dry eye symptoms associated with meibomian gland dysfunction.

Alcon Systane Ultra

AI: Polyethylene Glycol 400 0.4%, Propylene Glycol 0.3%

U&D: For temporary relief of burning and irritation due to dryness of the eye.

Other attributes: Alcon also offers a preservative-free Systane Ultra option for those with sensitive or for those who use drops regularly.

Allergan Refresh Optive

AI: Carboxymethylcellulose Sodium (0.5%), Glycerin (0.9%)

U&D: Instill 1 or 2 drops in the affected eyes as needed and discard container.

Other attributes: Allergan also offers Refresh Optive Advanced with triple-action formulation that works on three tear film layers to provide reduced evaporation, hydration and advanced lubrication. A third option, Refresh Optive Sensitive, is a preservative-free formula.

Allergan Restasis

AI: Cyclosporine 0.05%

U&D: Invert the unit dose vial a few times to obtain a uniform, white, opaque emulsion before using. Instill one drop twice a day in each eye approximately 12 hours apart. Can be used concomitantly with artificial tears, allowing a 15-minute interval between products.

Warnings: Restasis is contraindicated in patients with active ocular infections and in patients with known or suspected hypersensitivity to any of the ingredients in the formulation. It has not been studied in patients with a history of herpes keratitis.

Other attributes: Restasis is only available with a prescription.

AMO Blink Tears

AI: Polyethylene Glycol 400 0.25%

U&D: For the temporary relief of burning, irritation, and discomfort due to dryness of the eye or exposure to wind or sun. May be used as a protectant against further irritation.

Other attributes: Abbot Medical Optics also offers a preservative-free Blink Tears option for those with sensitive or for those who use drops regularly. The company also offers Blink Gel Tears, a more viscous formula specially designed for enhanced comfort in moderate-severe dry eye patients.

Bausch + Lomb Advanced Relief Dry Eye Rejuvenation Lubricant Eye Drops

AI: Glycerin (.03%), Propylene glycol (1.0%)

U&D: Prevents further irritation of dry eye. 1 or 2 drops in affected eye.

Other attributes: This product is for adults 40 and over, but a sister product, the Advanced Eye Relief Dry Eye Environmental Lubricant Eye Drops (with an active ingredient of 1.0% Glycerin) is designed for teenagers and people in their 20s and 30s.

Oasis Tears

AI: Glycerin (0.2%)

U&D: Prevents irritation from dry eye. 1 or 2 drops in affected eye.

Warnings: Do not use if solution changes color or becomes cloudy.

Other attributes: Oasis Tears is a preservative-free, lubricating eye drop with a special substance that combines with glycerin to keep tears on the eye surface for a long time. This unique combination lubricates and moisturizes the surface of the eye for instant comfort. With each blink of the eye, it re-lubricates to provide long-lasting relief. Oasis Tears Plus is offered for moderate to severe symptoms.

Ocusoft Retaine MGD

AI: light mineral oil 0.5%; mineral oil 0.5%

U&D: Emollient for relieving eye dryness. Apply 1 or 2 drops in affected eye.

Warnings: Do not touch tip of container to any surface to avoid contamination. Do not use if solution changes color or becomes cloudy. Do not reuse once opened.

Other attributes: A preservative-free ophthalmic emulsion that moisturizes, lubricates and protects moderate to severe dry eyes.

Similasan Dry Eye Relief

AI: Belladonna (containing 0.000002% alkaloids calculated as hyoscyamine) 6X: dryness, redness/Euphrasia 6X: redness/Mercurius sublimatus 6X: dryness

U&D: According to homeopathic principles, the active ingredients in this homeopathic medicine temporarily relieve minor symptoms such as dry eye, redness of eyes and lids, reflex watering secondary to dry eye, sensation of grittiness, sensitivity to light.

Other attributes: Similasan’s product is designed to stimulate the body’s natural ability to relieve symptoms of dry eyes. OP