Keratoconjunctivitis sicca medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Purposefully blinking more often, and resting the eyes are basic steps one can take.[1] Rubbing one's eyes can irritate them further, so it should be avoided. Persons with dry eyes caused by an eyelid disorder should undergo treatment for the underlying condition.
Rehydration
For mild and moderate cases, supplemental lubrication is the most important part of treatment.
Artificial tears
Application of artificial tears every few hours[2] can provide temporary relief.
Additional options
Lubricating tear ointments can be used during the day, but they generally are used at bedtime due to poor vision after application. They contain white petrolatum, mineral oil, and similar lubricants. They serve as a lubricant and an emollient. Application requires pulling down the eyelid and applying a small amount (0.25 in) inside. Depending on the severity of the condition, it may be applied from every hour to just at bedtime. It should not be used with contact lenses.
Medication
Inflammation occurring in response to tears film hypertonicity can be suppressed by mild topical steroids or with topical immunosuppressants such as cyclosporine.[3][4] Elevated levels of tear NGF can be decreased with 0.1% prednisolone.
Restasis
Topical cyclosporine A (tCSA) 0.05% ophthalmic emulsion, marketed in the United States by Allergan under the trade name Restasis, is the only prescription product approved for chronic dry eyes.[5] Approved by the U.S. Food and Drug Administration in 2002 for this indication[5], the drug decreases inflammation on the eye surface. Cyclosporine appears to work since the chronic inflammation of the ocular surface is mediated mainly by T-lymphocytes and cyclosporine’s proposed mechanism of action in immunosuppression is through T-lymphocyte inhibition[6] through “binding an intracellular protein that ultimately controls transcription factors required for cytokine production and T-lymphocyte maturation”.[7]
It increases healthy tear production, which may be reduced because of inflammation on the eye surface.[5] In a clinical trial involving 1,200 individuals, Restasis increased tear production in 15 percent of patients, compared with 5 percent of patients in the placebo group.[5]
Usually, 1 gutt (drop) of Restasis is instilled in each eye twice a day, 12 hours apart. It should not be used when wearing contact lenses, or by persons with eye infections[5] or hypersensitivity[5] to the ingredients. It has not been tested in people with herpes viral infections of the eye,[5] and it should not be used by anyone with a history of such an infection. The most common side effect is a burning sensation.[5] Other side effects may be eye redness, discharge, watery eyes, eye pain, foreign body sensation, itching, stinging, and blurred vision.[5]
Generic alternatives
Cheaper generic alternatives to Restasis are available in some countries. In India, it is marketed as Cyclomune by Sun Pharma.[8]
Conserving tears
There are methods that allow both natural and artificial tears to stay longer.
Blocking tear drainage
In each eye, there are two puncta[9] — little openings that drain tears into the tear ducts[5]. There are methods to partially or completely close the tear ducts. This blocks the flow of tears into the nose, and thus more tears are available to the eyes.[2]
Punctal plugs
Punctal plugs are inserted into the puncta to block tear drainage.[5] For people who have not found dry eye relief with drugs, punctal plugs may help.[5] They are reserved for people with moderate or severe dry eye when other medical treatment has not been adequate.[5]
Cauterization
If punctal plugs are effective, thermal or electric cauterization of puncti can be performed.
In thermal cauterization, a local anesthetic is used, and then a hot wire is applied. This shrinks the drainage area tissues and causes scarring, which closes the tear duct.
Customized contact lenses
Persons with severe dry eyes may benefit from the Boston Scleral Lens which is a customized contact lens. Resting on the sclera, it creates a fluid filled layer over the cornea, thus preventing it from drying.
References
- ↑ "Dry eyes". MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. 2006-10-04. Retrieved 2006-11-16.
- ↑ 2.0 2.1 "Keratoconjunctivitis Sicca". The Merck Manual, Home Edition. Merck & Co., Inc. 2003-02-01. Retrieved 2006-11-12.
- ↑ Tatlipinar S, Akpek E (2005). "Topical cyclosporine in the treatment of ocular surface disorders". Br J Ophthalmol. 89 (10): 1363–7. PMID 16170133.
- ↑ Barber L, Pflugfelder S, Tauber J, Foulks G (2005). "Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years". Ophthalmology. 112 (10): 1790–4. PMID 16102833.
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12
Meadows, Michelle (2005). "Dealing with Dry Eye". FDA Consumer Magazine. U.S. Food and Drug Administration. Retrieved 2006-11-16. Unknown parameter
|month=ignored (help); More than one of|author=and|last=specified (help); External link in|work=(help) - ↑ Micromedex® Healthcare Series, (electronic version). Thomson Micromedex, Greenwood Village, Colorado, USA. Available at: http://0-www.thomsonhc.com.library.uchsc.edu:80 (cited: 09/05/06).
- ↑ Barber LD, Pflugfelder SC, Tauber J, Foulks GN. Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years. Ophthalmology. 2005 Oct;112(10):1790-4.
- ↑
"Sun Pharma Product List". Sun Pharma. Retrieved 2006-11-27. External link in
|publisher=(help) - ↑
"Dry eye syndrome". Health encyclopaedia. NHS Direct. 2006-04-10. Retrieved 2007-02-26. External link in
|work=(help)