What treatment options are available for dry eyes in a hospital setting?

From the Guidelines

Treatment options for dry eyes in a hospital setting include both conservative and advanced interventions, with artificial tears like carboxymethylcellulose (Refresh) or polyvinyl alcohol (Systane) administered every 2-4 hours as needed, as recommended by the most recent study 1. For moderate cases, preservative-free formulations are preferred to reduce irritation. Prescription medications include cyclosporine 0.05% (Restasis) applied twice daily, lifitegrast 5% (Xiidra) twice daily, or corticosteroid drops like loteprednol 0.5% for short-term use (1-2 weeks) to reduce inflammation, as supported by recent studies 1. Autologous serum tears (prepared from the patient's blood at 20-50% concentration) may be used 4-8 times daily for severe cases. Punctal plugs can be inserted to block tear drainage and retain moisture on the ocular surface. In-office procedures available include intense pulsed light therapy, thermal pulsation (LipiFlow), or meibomian gland probing to address meibomian gland dysfunction. These treatments work by addressing different aspects of dry eye pathophysiology, including aqueous deficiency, increased tear evaporation, and ocular surface inflammation. Some key points to consider:

• Patients should be advised to maintain good eyelid hygiene, use humidifiers, take regular screen breaks, and consider omega-3 supplements (1000-2000mg daily) to complement medical treatment, as suggested by 1.
• The use of artificial tears may be increased, but the practicality of frequent tear instillation depends on the lifestyle and manual dexterity of the patient, as noted in 1.
• Nonpreserved tear substitutes are generally preferable; however, tears with preservatives may be sufficient for patients with mild dry eye and an otherwise healthy ocular surface, as stated in 1.
• Topical cyclosporine may be a disease-modifying agent for dry eye syndrome, as reported in 1.
• The exact mechanism of action of lifitegrast in the treatment of dry eye is unknown, but it is theorized to involve blocking the interaction between lymphocyte function-associated antigen 1 (LFA-1) and its ligand intracellular adhesion molecule 1 (ICAM-1), as explained in 1.
• Corticosteroids have been reported to decrease ocular irritation symptoms, decrease corneal fluorescein staining, and improve filamentary keratitis, as demonstrated in 1.
• Low-dose topical corticosteroid therapy can be used at infrequent intervals for short periods of time (i.e., several weeks) to suppress ocular surface inflammation, as recommended in 1.
• Patients who have been prescribed corticosteroids for dry eye should be monitored for adverse effects such as increased intraocular pressure and cataract formation, as cautioned in 1.
• The use of essential fatty acid supplements for dry eye treatment has been reported to be potentially beneficial, but a recent, large-scale, masked, prospective trial did not demonstrate benefit of oral fatty acids over 12 months compared with placebo, as noted in 1.
• For patients with aqueous tear deficiency, punctal occlusion is considered when the medical means of aqueous enhancement are ineffective or impractical, as stated in 1.
• Permanent punctal occlusion can be accomplished by means of thermal or laser cautery, but the main disadvantage of punctal cautery is that it is not readily reversible, as explained in 1.
• Autologous serum and autologous plasma rich in growth factors drops have been reported to improve ocular irritation symptoms as well as conjunctival and corneal dye staining in patients with Sjögren’s syndrome and GVHD, as demonstrated in 1.
• Filamentary keratitis may be present in patients with severe dry eye syndrome and can be treated by debriding the filaments with a moistened cotton-tip applicator, dry cellulose sponge, or forceps, as recommended in 1.
• Rigid gas-permeable scleral lenses have been used successfully in the treatment of severe dry eye for years, but widespread use of scleral lenses may be limited by fitting difficulties, patient willingness and ability to wear the lenses, and high costs, as noted in 1.
• Soft contact lenses may provide symptomatic relief in selected cases, particularly in the setting of filamentary keratitis, but the use of contact lenses must be tempered by the risk of corneal infection, as cautioned in 1.

From the FDA Drug Label

RESTASIS® can be used concomitantly with artificial tears, allowing a 15 minute interval between products.

Treatment options for dry eyes in a hospital setting include:

• Artificial tears: can be used concomitantly with RESTASIS®, allowing a 15 minute interval between products 2
• RESTASIS® ophthalmic emulsion: can be instilled one drop twice a day in each eye approximately 12 hours apart 2

From the Research

Treatment Options for Dry Eyes in a Hospital Setting

• Artificial tears (ATs) are a common treatment option for dry eyes, and they can be used to alleviate symptoms of mild to moderate dry eye 3.
• Preservative-free cationic emulsions, such as Cationorm, have been shown to be effective in managing signs and symptoms of dry eye 3.
• A study comparing the efficacy of different ATs found that Cationorm increased goblet cell count by almost 40% and decreased IL6- and IL8-stimulated secretion by 59% and 74%, respectively 3.
• Another study evaluated the efficacy of a cyclosporine-based dry eye therapy when used with marketed artificial tears as supportive therapy in dry eye, and found that the choice of concomitant therapy used with Restasis has significant effects on outcome measures 4.
• Over-the-counter (OTC) artificial tears have been found to be safe and effective means for treating dry eye syndrome, although the literature indicates that the majority of OTC artificial tears may have similar efficacies 5.
• A new artificial tear formulation, Rohto Dry-Aid, has been found to be effective in relieving the signs and symptoms of dry eye, and may provide a longer duration of symptomatic relief over the course of the day 6.
• Artificial tears have also been found to improve visual acuity in patients with dry eye, with a mean duration of improvement of 2.93 minutes in symptomatic patients and 3.70 minutes in asymptomatic patients 7.

Available Artificial Tear Options

• Cationorm: a preservative-free cationic emulsion that has been shown to be effective in managing signs and symptoms of dry eye 3.
• Systane: a marketed artificial tear that has been used as a supportive therapy in dry eye 4.
• Restasis: a cyclosporine-based dry eye therapy that can be used with marketed artificial tears as supportive therapy in dry eye 4.
• Rohto Dry-Aid: a new artificial tear formulation that has been found to be effective in relieving the signs and symptoms of dry eye 6.
• Refresh Plus: a preservative-free artificial tear that has been found to improve visual acuity in patients with dry eye 7.