From the Guidelines
Modern management of dry eye involves a stepwise approach starting with lifestyle modifications and artificial tears, with the most recent evidence from 2024 supporting the use of preservative-free artificial tears, anti-inflammatory treatments, and oral omega-3 supplements. Patients should avoid environmental triggers like dry air, wind, and smoke, and take regular screen breaks using the 20-20-20 rule (looking 20 feet away every 20 minutes for 20 seconds) 1. Preservative-free artificial tears should be used 4-6 times daily, with options including Systane Ultra, Refresh Optive, or TheraTears. For moderate cases, anti-inflammatory treatments are added, including cyclosporine 0.05% (Restasis) twice daily, lifitegrast 5% (Xiidra) twice daily, or loteprednol 0.5% for short-term use 1. Oral omega-3 supplements (1000-2000mg daily) may help reduce inflammation.
Some key points to consider in the management of dry eye include:
- The use of autologous serum tears, scleral contact lenses, or punctal plugs may be necessary in severe cases 1
- Oral doxycycline (50-100mg daily for 1-3 months) can help with meibomian gland dysfunction 1
- Patients with dry eye syndrome considering keratorefractive and lens-based surgery should be cautioned that the dry eye symptoms could become worse after surgery 1
- Dry eye symptoms that continue beyond the normal postoperative period of 3 months are seen in about one third of individuals, and baseline ocular surface and tear film parameters predict the patients at risk 1
The most recent evidence from 2024 supports the use of a stepwise approach to managing dry eye, with a focus on lifestyle modifications, artificial tears, and anti-inflammatory treatments 1. The use of preservative-free artificial tears, cyclosporine, and lifitegrast are supported by the most recent evidence, and should be considered in the management of dry eye.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Mechanism of Action Cyclosporine is an immunosuppressive agent when administered systemically. In patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca, cyclosporine emulsion is thought to act as a partial immunomodulator. Clinical Evaluations Four multicenter, randomized, adequate and well-controlled clinical studies were performed in approximately 1200 patients with moderate to severe keratoconjunctivitis sicca. RESTASIS demonstrated statistically significant increases in Schirmer wetting of 10 mm versus vehicle at six months in patients whose tear production was presumed to be suppressed due to ocular inflammation.
The modern management strategy for dry eye syndrome (Keratoconjunctivitis Sicca) that can be directly inferred from the provided information is the use of cyclosporine emulsion to increase tear production.
- Key points:
- Cyclosporine emulsion is thought to act as a partial immunomodulator in patients with keratoconjunctivitis sicca.
- RESTASIS (cyclosporine ophthalmic emulsion) has been shown to demonstrate statistically significant increases in Schirmer wetting in patients with moderate to severe keratoconjunctivitis sicca.
- This effect was seen in approximately 15% of RESTASIS treated patients versus approximately 5% of vehicle treated patients. 2
From the Research
Modern Management Strategies for Dry Eye Syndrome
The management of dry eye syndrome, also known as Keratoconjunctivitis Sicca, involves a multifaceted approach that goes beyond the use of artificial tears. According to 3, personalized treatment is crucial for successful management, as it takes into account the underlying causes of the disease, including inflammation and external contributing factors.
Artificial Tears and Beyond
Artificial tears are a common first-line therapy for dry eye disease, but their effectiveness may depend on patient compliance and the type of product used 3. Studies have shown that sodium hyaluronate-based artificial tears can be effective in reducing symptoms and improving tear film parameters 4, 5. Additionally, novel formulations such as ABBV-444, which contains trehalose and sodium hyaluronate, have shown promise in providing rapid symptom relief and improving patient experience 6.
Currently Approved and Upcoming Treatments
Currently approved treatments for dry eye disease include cyclosporine formulations, lifitegrast, loteprednol etabonate, and perfluorohexyloctane 7. Medical devices such as intense pulsed light devices and thermal pulsation systems are also approved for treating meibomian gland dysfunction. Several new treatments are being evaluated, including cyclosporine nanoemulsions, IC 265, and OXERVATE (cenegermin-bkbj ophthalmic solution) 7.
Key Considerations
When managing dry eye syndrome, it is essential to consider the individual patient's needs and characteristics, including the subtype of dry eye disease, the presence of inflammation, and coexisting conditions 3. A personalized approach to treatment can help improve patient outcomes and quality of life.
- Artificial tears can provide symptom relief, but their effectiveness may vary depending on the product and patient compliance
- Sodium hyaluronate-based artificial tears have shown promise in improving tear film parameters and reducing symptoms
- Novel formulations such as ABBV-444 may provide rapid symptom relief and improve patient experience
- Currently approved treatments include cyclosporine formulations, lifitegrast, and loteprednol etabonate
- Several new treatments are being evaluated, including cyclosporine nanoemulsions and OXERVATE (cenegermin-bkbj ophthalmic solution) 6, 4, 7, 5