Perfluorohexyloctane (Miebo) for Dry Eye Disease: Usage Guidelines
Miebo (perfluorohexyloctane ophthalmic solution) should be administered as one drop in each eye four times daily for optimal management of dry eye disease associated with meibomian gland dysfunction, and can be used long-term (up to 52 weeks) with sustained efficacy and safety. 1, 2, 3
Mechanism of Action and Benefits
Perfluorohexyloctane (Miebo) is a first-in-class semifluorinated alkane that:
- Forms a monolayer at the air-liquid interface of the tear film
- Stabilizes the lipid layer of the tear film
- Inhibits tear evaporation
- Contains no water, steroids, or preservatives 1
- Directly addresses the pathophysiology of excessive tear evaporation in dry eye disease 1
Dosage and Administration
- Recommended dosage: One drop in each eye four times daily 2
- Administration technique: Apply directly to the affected eye(s)
- Duration of therapy: Can be used continuously for extended periods (up to 52 weeks based on clinical studies) 3
Efficacy
Miebo has demonstrated significant improvements in:
- Total corneal fluorescein staining (objective sign of dry eye disease)
- Eye dryness scores on visual analog scale (subjective symptom)
- Improvements begin as early as 2 weeks after starting treatment 2
- Effects are maintained with long-term use (up to 52 weeks) 3
Long-Term Use
The KALAHARI study demonstrated that:
- Miebo maintains its efficacy over 52 weeks of continuous use
- Patients who switched from saline to Miebo showed improvements by week 4 that were maintained throughout the study
- Long-term use is safe and well-tolerated 3
Safety Profile
- Generally well tolerated in clinical trials
- Most common ocular adverse events (during 52-week study) were:
- Vitreous detachment (1.9%)
- Allergic conjunctivitis (1.4%)
- Blurred vision (1.4%)
- Increased lacrimation (1.4%)
- Most adverse events were mild to moderate in severity
- No serious adverse events were reported in clinical trials
- No adverse events led to treatment discontinuation in the MOJAVE study 2, 3
Unique Properties Compared to Other Dry Eye Treatments
Miebo has distinctive properties compared to other treatments like water-free cyclosporine:
- Contains 100% active ingredient (perfluorohexyloctane)
- Longer chain length results in slower evaporation rate
- Forms a stable monolayer on the ocular surface
- Demonstrates longer ocular surface residence time compared to other semifluorinated alkanes 4
Clinical Pearls
- Miebo is the first and only prescription treatment approved in the USA that directly addresses excessive tear evaporation
- It provides both symptomatic relief and improvement in objective signs of dry eye disease
- The water-free formulation may be beneficial for patients sensitive to preservatives
- Consistent use (four times daily) is important for maintaining efficacy
By targeting the underlying mechanism of tear film instability in dry eye disease, Miebo represents an important treatment option that can be used safely and effectively for extended periods.