From the Guidelines
For severe dry eye, permanent punctal occlusion, autologous serum or plasma rich in growth factors drops, and oral medications like cevimeline are effective alternatives to luxury options. When considering treatment for red, dry eyes, it's essential to prioritize approaches that address the underlying causes of dryness and inflammation. According to the dry eye syndrome preferred practice pattern 1, permanent punctal occlusion can be an effective treatment for severe dry eye, and it's recommended to start with a trial occlusion using nonpermanent implants like silicone punctal plugs.
For patients with Sjögren’s syndrome or GVHD, autologous serum or autologous plasma rich in growth factors drops have been shown to improve ocular irritation symptoms and conjunctival and corneal dye staining 1. In cases where repeated blood sampling is not possible, allogeneic serum eye drops can be a safe and effective alternative.
Oral medications like cevimeline have been approved by the FDA to treat dry mouth in patients with Sjögren’s syndrome and have been found to improve ocular irritation symptoms and aqueous tear production 1. However, it's crucial to weigh the benefits against potential side effects, such as excessive sweating, which occurred in over 40% of patients taking oral pilocarpine 1.
Some key considerations for treating severe dry eye include:
- Using preservative-free artificial tears
- Applying warm compresses and gentle eyelid massage
- Considering antihistamine eye drops if allergies are contributing
- Taking omega-3 supplements to improve oil gland function
- Using prescription options like cyclosporine or lifitegrast
- Making environmental modifications, such as using a humidifier and taking screen breaks.
It's essential to consult with a healthcare professional to determine the best course of treatment for individual cases of severe dry eye, as the most effective approach may vary depending on the underlying causes and severity of symptoms.
From the FDA Drug Label
Lifitegrast ophthalmic solution 5% is indicated for the treatment of the signs and symptoms of dry eye disease (DED). The answer to the question of other options for red dry eye other than luxury is not directly addressed in the provided drug labels.
- Lifitegrast is indicated for the treatment of dry eye disease, but it does not specify if it is a luxury option or not.
- There is no information provided about other options for red dry eye. 2 2
From the Research
Alternative Options for Red Dry Eye
Other than luxury treatments, there are several options available for managing red dry eye. These include:
- Artificial tears: As stated in 3, tear replacement by topical artificial tears is a widely used therapy for dry eye disease.
- Punctal occlusion: This is a non-pharmacological treatment that prevents the drainage of natural or artificial tears, as mentioned in 3.
- Topical anti-inflammatory and immunomodulatory agents: Such as cyclosporin A, which is under investigation for the treatment of dry eye, as noted in 3.
- Lid hygiene: This is helpful in the treatment of hyperevaporative dry eye, as stated in 4.
- Collagen or silicon plugs: These can be used for partial occlusion of the efferent lacrimal ducts to treat severe hyposecretory dry eye, as mentioned in 4.
- Omega-3 and omega-6 fatty acids: These have been proposed as a therapy for dry eye, as noted in 5 and 6.
- Orally administered tetraycycline derivatives: These are also used in the treatment of dry eye, as stated in 4.
Specific Treatments
Some specific treatments that have been studied include:
- Omega-3 fatty acid supplementation: This has been shown to improve dry eye symptoms and signs, as noted in 5 and 6.
- Artificial tear treatments: Such as Clinitas Soothe, Hyabak, Tears Again, and TheraTears, which have been compared in a randomized crossover trial, as mentioned in 7.
- Osmolarity balanced artificial tears: These were preferred by individuals with low baseline tear volume, as noted in 7.
- Liposomal spray: This was preferred by individuals with a baseline lipid layer deficiency, as mentioned in 7.