What are the prescription treatment options for dry eyes?

From the Guidelines

Prescription treatment options for dry eyes include cyclosporine (Restasis, Cequa), lifitegrast (Xiidra), and corticosteroid eye drops, with cyclosporine being a preferred option due to its disease-modifying potential 1. When considering treatment options, it's essential to evaluate the severity of dry eye syndrome.

• For moderate dry eye, cyclosporine 0.05% has been shown to be effective in increasing tear production and reducing inflammation, with a statistically significant 10-mm increase in Schirmer test results compared with vehicle at 6 months 1.
• Lifitegrast 5% has also been approved by the FDA for the treatment of dry eye syndrome, with published studies showing benefit in signs and symptoms over a period of 3 months 1.
• Corticosteroid eye drops, such as loteprednol etabonate 0.25%, can be used for quick relief of inflammation, but are generally limited to 2-4 weeks due to potential side effects like increased eye pressure and cataract formation 1. Some key points to consider when prescribing these medications include:
• Cyclosporine may cause ocular burning in some patients, but can be decreased to once a day in a portion of patients after 1 full year of twice-daily therapy without a decrease in beneficial effects 1.
• Lifitegrast seems to be safe over 12 months, but long-term effects are unknown 1.
• Autologous serum eye drops may be prescribed for severe cases, and have been shown to improve ocular irritation symptoms and conjunctival and corneal dye staining in patients with Sjögren’s syndrome and GVHD 1. Regular follow-up appointments are crucial to monitor treatment effectiveness and adjust therapy as needed, as dry eye syndrome is a chronic condition that requires long-term management 1.

From the FDA Drug Label

Lifitegrast ophthalmic solution 5% is indicated for the treatment of the signs and symptoms of dry eye disease (DED). Instill one drop of lifitegrast ophthalmic solution twice daily (approximately 12 hours apart) into each eye using a single-dose container

The prescription treatment option for dry eyes is Lifitegrast ophthalmic solution 5%. The recommended dosage is one drop twice daily, approximately 12 hours apart, into each eye. Key points to consider:

• Administration: Use a single-dose container and discard immediately after use.
• Contact lenses: Remove prior to administration and may be reinserted 15 minutes after.
• Contraindications: Patients with known hypersensitivity to lifitegrast or any ingredient in the formulation 2.

From the Research

Prescription Treatment Options for Dry Eyes

• Topical cyclosporine ophthalmic emulsion, such as Restasis, is a commonly prescribed treatment for dry eyes 3, 4, 5
• Punctal occlusion, which involves inserting a plug into the tear duct to block drainage, can also be effective in treating dry eyes 3, 6
• Combination therapy, which involves using both topical cyclosporine and punctal occlusion, may produce the greatest overall improvements in dry eye symptoms 3
• Other treatment options, such as artificial tears, topical corticosteroids, and oral tetracyclines, may also be prescribed to help manage dry eye symptoms 7, 4

Mechanisms of Action

• Topical cyclosporine works by reducing inflammation on the ocular surface and promoting tear production 3, 5
• Punctal occlusion works by blocking the drainage of tears, allowing them to stay on the eye surface for longer and providing more moisture 3, 6
• Combination therapy may have additive effects, with cyclosporine promoting long-term ocular surface health and punctal occlusion increasing wetness initially 3

Efficacy and Safety

• Studies have shown that topical cyclosporine can improve dry eye symptoms, including ocular surface staining and tear volume 3, 5
• Punctal occlusion has also been shown to be effective in reducing dry eye symptoms, particularly in combination with topical cyclosporine 3, 6
• However, the evidence for the efficacy of topical cyclosporine is not consistent across all studies, and more research is needed to fully understand its effects 5
• Common adverse events associated with topical cyclosporine include burning and stinging, but these are typically mild and temporary 5