What is the treatment for a patient presenting with epiphora, pruritus, and burning sensation of the left eye?

From the Guidelines

For a patient presenting with excessive tearing, itching, and burning of the left eye, I recommend starting with warm compresses and eyelid cleansing, which may provide symptomatic relief for both anterior and posterior blepharitis, as suggested by the most recent study on blepharitis preferred practice pattern 1. The patient's symptoms are likely indicative of blepharitis, and the treatment should focus on improving symptoms and preventing further complications.

• Warm compresses can be applied to the eyelids for several minutes to soften adherent scurf and scales or discharge and/or warm the meibomian secretions, as recommended by 1.
• Eyelid cleansing can be accomplished by brief, gentle massage of the eyelids, and eye cleaners with hypochlorous acid at 0.01% have a strong antimicrobial effect, which has been used for the treatment of both anterior and posterior blepharitis 1.
• Artificial tears may also be helpful in providing lubrication to the ocular surface and relieving symptoms of dryness and irritation, as mentioned in the study on dry eye syndrome preferred practice pattern 1. However, the primary focus should be on treating the underlying cause of the symptoms, which in this case is likely blepharitis.
• The patient should be instructed to avoid using compresses that are too hot, as this can burn the skin, and to gently rub the base of the eyelashes using either diluted baby shampoo or commercially available eyelid cleaner on a pad, cotton ball, cotton swab, or clean fingertip, as recommended by 1.
• Topical antibiotics, antiparasitic medication, or anti-inflammatory agents may be considered if the symptoms persist or worsen, but the initial treatment should focus on warm compresses and eyelid cleansing, as suggested by 1. It is essential to note that the treatment of blepharitis often requires persistence and a trial-and-error approach, and the optimal treatment regimen may need to be tailored to the individual patient's needs, as mentioned in the study 1.

From the FDA Drug Label

Loteprednol etabonate ophthalmic suspension is indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, selected infective conjunctivitides, when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation Apply one to two drops of loteprednol etabonate suspension into the conjunctival sac of the affected eye four times daily.

The treatment for a patient presenting with excessive tearing, itching, and burning of the left eye may be loteprednol etabonate ophthalmic suspension, if the symptoms are due to a steroid-responsive inflammatory condition such as allergic conjunctivitis. The recommended dosage is one to two drops into the conjunctival sac of the affected eye four times daily 2 2.

From the Research

Treatment Options for Dry Eye Disease

The patient presenting with excessive tearing, itching, and burning of the left eye may be experiencing symptoms of dry eye disease. The treatment options for dry eye disease include:

• Cyclosporine formulations (RESTASIS® [cyclosporine 0.05% ophthalmic emulsion], VEVYE® [cyclosporine 0.1% ophthalmic solution], and CEQUA™ [cyclosporine 0.09% ophthalmic solution]) 3
• XIIDRA® (lifitegrast), a leukocyte function-associated antigen-1 (LFA-1)/intracellular adhesion molecule-1(ICAM-1) inhibitor 3
• EYSUVIS™ (loteprednol etabonate ophthalmic suspension 0.25%), a corticosteroid 3
• MIEBO™ (perfluorohexyloctane ophthalmic solution), a semifluorinated alkane 3
• TYRVAYA™ (varenicline solution nasal spray), a cholinergic agonist 3
• Punctal plugs 3
• Intense pulsed light (IPL) devices, such as Lumenis OptiLight™ 3
• Thermal pulsation systems, such as TearCare® system and TearScience™ LipiFlow™ 3

Anti-Inflammatory Therapies

Inflammation is a key component of dry eye disease, and anti-inflammatory therapies may be effective in treating the condition. These therapies include:

• Topical steroid therapy 4
• Calcineurin inhibitors 4
• T cell integrin antagonists 4
• Antibiotics 4
• Autologous serum/plasma therapy 4
• Omega-3 fatty acid dietary supplements 4

Individualized Treatment Approach

The treatment of dry eye disease must be individualized, dynamic, and optimized for each stage of the disease 5. It is essential to identify the etiological trigger and restore homeostasis to break the vicious circle of dry eye disease 5. A comprehensive diagnostic approach, including the assessment of tear film instability, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities, is necessary to develop an effective treatment plan 5.