What are the prescription management options for dry eye syndrome?

From the Guidelines

Prescription management for dry eye syndrome should prioritize the use of cyclosporine ophthalmic emulsions, such as Restasis 0.05% or Cequa 0.09%, applied twice daily to reduce inflammation and increase tear production, as they have shown statistically significant improvements in Schirmer test results and symptom relief in patients with moderate to severe dry eye 1. The treatment of dry eye syndrome involves a stepwise approach, with the initial steps focusing on non-pharmacological interventions and the later steps incorporating pharmacological treatments. Some key points to consider in the prescription management of dry eye syndrome include:

• The use of cyclosporine ophthalmic emulsions, which have been shown to be effective in reducing inflammation and increasing tear production in patients with moderate to severe dry eye 1.
• The use of lifitegrast ophthalmic solution, which works by inhibiting T-cell inflammatory pathways and has been shown to provide symptom relief in patients with dry eye syndrome 1.
• The use of corticosteroid eye drops, such as loteprednol 0.5%, which can be used short-term to quickly reduce inflammation, but require monitoring for increased intraocular pressure and cataract formation 1.
• The use of autologous serum tears, which can be prescribed for severe cases of dry eye syndrome and have been shown to improve ocular irritation symptoms and conjunctival and corneal dye staining in patients with Sjögren’s syndrome and GVHD 1.
• The use of oral tetracyclines, such as doxycycline or azithromycin, which can help manage meibomian gland dysfunction and ocular rosacea contributing to dry eye 1. It is essential to consider the individual patient's presentation, the relative level of evidence supporting the use of each medication, and the potential side effects when selecting a treatment option. Additionally, the treatment plan may need to be adjusted based on the patient's symptom response and potential side effects. In some cases, surgical interventions, such as punctal occlusion or tarsorrhaphy, may be necessary to manage severe dry eye syndrome 1. Overall, the goal of prescription management for dry eye syndrome is to reduce inflammation, increase tear production, and improve symptoms, while minimizing potential side effects and considering the individual patient's needs.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION Instill one drop of lifitegrast ophthalmic solution twice daily (approximately 12 hours apart) into each eye using a single-dose container Discard the single-dose container immediately after using in each eye. Contact lenses should be removed prior to the administration of lifitegrast ophthalmic solution and may be reinserted 15 minutes following administration.

The prescription management options for dry eye syndrome include:

• Dosage: Instill one drop of lifitegrast ophthalmic solution twice daily (approximately 12 hours apart) into each eye.
• Administration: Use a single-dose container and discard it immediately after use.
• Contact Lenses: Remove contact lenses prior to administration and reinsert 15 minutes after administration. According to the drug label of lifitegrast ophthalmic solution 2.

From the Research

Prescription Management Options for Dry Eye Syndrome

The following are some prescription management options for dry eye syndrome:

• Punctal occlusion: This is a mechanical treatment that blocks the tear drainage system to aid in the preservation of natural tears on the ocular surface 3.
• Lifitegrast: This is a novel drug that has been approved by the US Food and Drug Administration for the treatment of dry eye disease. It has a novel mechanism of action and is safe and effective for the treatment of dry eye disease 4, 5.
• Topical cyclosporine A: This is an anti-inflammatory that has been widely used to treat inflammatory ocular surface diseases. It has been approved by the US Food and Drug Administration for managing dry eye 6.
• Artificial tears: These are usually the first line of treatment for patients with dry eye disease. They can be used in combination with other treatments such as punctal plugs or lifitegrast 3, 7.

Comparison of Prescription Management Options

The following are some comparisons of the prescription management options for dry eye syndrome:

• Punctal plugs versus no punctal plugs: There is very low-certainty evidence on symptomatic improvement, but low-certainty evidence suggests less ocular surface staining and more tear film stability in the punctal plug group 3.
• Lifitegrast versus artificial tears: Lifitegrast has been shown to cause statistically significant improvements in inferior corneal fluorescein staining scores and eye dryness scores compared to artificial tears 4.
• Topical cyclosporine A versus artificial tears: There is low-certainty evidence that topical cyclosporine A may be more effective than artificial tears in improving symptoms and ocular surface and tear film parameters, but the evidence is inconsistent and sometimes may not be different from vehicle or artificial tears 6.

Adverse Effects of Prescription Management Options

The following are some adverse effects of the prescription management options for dry eye syndrome:

• Punctal plugs: Epiphora, itching, tenderness and swelling of lids with mucous discharge, and plug displacement are common adverse effects 3.
• Lifitegrast: Eye irritation, dysgeusia, and reduced visual acuity are common adverse effects, but most are mild to moderate in severity 4.
• Topical cyclosporine A: Burning and stinging are common adverse effects, and participants treated with topical cyclosporine A may be more likely to have treatment-related adverse events than those who treated with vehicle 6.