What compounds are used to treat dry eyes?

Compounds Used to Treat Dry Eyes

The first-line treatment for dry eye disease is artificial tears containing methylcellulose or hyaluronate, which should be used at least twice daily and increased as needed based on symptom severity. 1

First-Line Treatments

Artificial Tears

• Polymeric-based lubricants are the mainstay of dry eye treatment, with key ingredients including:

  • Methylcellulose-based tears 1
  • Hyaluronic acid/hyaluronate-based tears 1
  • Carboxymethylcellulose (0.5-1%) 1
  • Carmellose sodium 1
  • Polyvinyl alcohol (though less effective than polyacrylic acid-based tears) 2
  • Polyacrylic acid-based tears (0.2%, shown to be more effective than polyvinyl alcohol) 2

• Preservative considerations:

  • Preserved artificial tears are suitable for mild dry eye with infrequent use 1
  • Preservative-free formulations are recommended when using tears more than four times daily 1

• Viscosity options:

  • Liquid drops for daytime use 1
  • Gels for longer-lasting effect 1
  • Ointments for overnight use (petrolatum-based) 1

Specialized Tear Components

• Lipid-containing eye drops are particularly beneficial for patients with meibomian gland dysfunction 1
• Osmo-protectants help maintain cellular function during hyperosmolar stress 3
• Antioxidants may help reduce oxidative stress on the ocular surface 3

Second-Line Treatments

Anti-inflammatory Agents

• Topical cyclosporine (0.05%) is effective for moderate dry eye when artificial tears are insufficient 1
• Short-term topical glucocorticoids (2-4 weeks maximum) for refractory/severe cases 1

Other Prescription Options

• Lifitegrast ophthalmic solution 5% is FDA-approved for treatment of signs and symptoms of dry eye disease 4

Advanced Treatments for Severe Dry Eye

Biological Fluids

• Autologous serum eye drops improve ocular irritation and corneal staining in Sjögren's syndrome and GVHD 1
• Autologous plasma rich in growth factors can be beneficial in severe cases 1

Muscarinic Agonists

• Oral pilocarpine (5mg four times daily) can improve visual function during reading and reduce blurred vision in Sjögren's syndrome patients 1
• Oral cevimeline improves ocular irritation symptoms and aqueous tear production with potentially fewer side effects than pilocarpine 1

Mechanical Interventions

• Punctal plugs for tear retention when other treatments are insufficient 1
• Punctal cautery for permanent occlusion in severe cases 1
• Scleral contact lenses can be used successfully in severe dry eye 1

Special Considerations

• Frequency of application should be adjusted based on symptom severity, ranging from twice daily to hourly 1
• Overnight protection is important, with ointments recommended before bedtime for nocturnal symptoms 1
• Morning lid hygiene should follow overnight ointment use to prevent blepharitis 1

Common Pitfalls to Avoid

• Overuse of preserved artificial tears can cause toxicity to the ocular surface 1
• Extended use of topical corticosteroids can lead to complications including infections and increased intraocular pressure 1
• Neglecting underlying conditions such as blepharitis or meibomian gland dysfunction that contribute to dry eye 1
• Inadequate treatment of severe dry eye can lead to corneal ulceration and vision loss 1