What treatment is recommended for a patient with a history of stroke (cerebrovascular accident) presenting with dry eyes (xerophthalmia)?

From the Guidelines

For a patient with a history of stroke presenting with dry eyes, the recommended treatment includes artificial tears as first-line therapy, typically used 4-6 times daily, as suggested by the 2024 dry eye syndrome preferred practice pattern 1. The treatment approach should prioritize addressing potentially exacerbating exogenous factors such as environmental factors like air drafts and low-humidity environments.

• Humidifying ambient air and avoiding air drafts by using side shields on spectacles and by changing the characteristics of airflow at work, at home, and in the car may be helpful, as noted in the 2024 study 1.
• Measures such as lowering the computer screen to below eye level to decrease eyelid aperture, scheduling regular breaks, and increasing efforts to consciously blink fully and wearing moisture chamber goggles may decrease the discomfort associated with computer and reading activities. In terms of medication,
• Preservative-free formulations are preferred to minimize irritation, and
• Tear substitutes with preservatives may be sufficient for patients with mild dry eye and an otherwise healthy ocular surface, as indicated in the 2024 dry eye syndrome preferred practice pattern 1. For moderate to severe cases,
• Prescription options may be considered, but the most recent and highest quality study 1 emphasizes the importance of addressing environmental factors and using artificial tears as the primary treatment. It is also essential to consider the patient's ability to self-administer eye drops, given potential motor impairments following a stroke, and preservative-free single-use vials or assistance from caregivers may be necessary. Regular follow-up with both a neurologist and ophthalmologist is recommended to monitor both conditions and adjust the treatment plan as needed, prioritizing the patient's morbidity, mortality, and quality of life.

From the FDA Drug Label

Systane LUBRICANT EYE DROPS ULTRA HIGH PERFORMING DRY EYE RELIEF Fast-acting hydration and lasting reliefMoisture rich formula Directions To open, TWIST AND PULL TAB TO REMOVE. Instill 1 or 2 drops in the affected eye(s) as needed and discard container.

For a patient with a history of stroke presenting with dry eyes, Systane Ultra or Refresh Plus eye drops can be considered for relief.

• Systane Ultra is a high performing dry eye relief option with fast-acting hydration and lasting relief.
• Refresh Plus can be used by instilling 1 or 2 drops in the affected eye(s) as needed. It is recommended to follow the eye doctor's instructions for use, especially if the patient has had eye surgery. 2 3

From the Research

Treatment Options for Dry Eyes

The patient is complaining of dry eyes and is requesting eye drops for dry eyes. Based on the provided evidence, the following treatment options can be considered:

• Artificial tear drops, which can be used for tear replacement or preservation 4
• Cyclosporin A (CsA), which has an anti-inflammatory effect and is frequently used for the treatment of severe dry eye disease 4
• Autologous serum eye drops, which may provide some improvement in participant-reported symptoms compared with artificial tears 5
• Anti-oxidative artificial tear preparations, which may be beneficial in the treatment of dry eyes caused by environmental factors 6

Recommended Treatment

The recommended treatment for the patient with a history of stroke presenting with dry eyes is to use artificial tear drops, such as Systane or Refresh Tears, which have been shown to be effective and cost-effective interventions 7. The patient's symptoms and response to treatment should be monitored, and the treatment plan can be adjusted as needed.

Key Considerations

When selecting a treatment option, the following key considerations should be taken into account:

• The severity of the patient's dry eye symptoms
• The patient's medical history, including their history of stroke
• The potential benefits and risks of each treatment option
• The cost-effectiveness of each treatment option 7
• The patient's preference for a particular treatment option

Potential Benefits and Risks

The potential benefits and risks of each treatment option should be carefully considered, including:

• The risk of ocular infection with untreated dry eye syndrome 4
• The potential for artificial tear drops to provide symptomatic relief 8
• The potential for autologous serum eye drops to provide some improvement in participant-reported symptoms 5
• The potential for anti-oxidative artificial tear preparations to provide protection against oxidative stress factors 6