What is the treatment for severe dry eye syndrome (keratoconjunctivitis sicca) and conjunctival hyperemia (redness)?

From the Guidelines

For severe dry eyes and redness, the most effective treatment approach is to start with preservative-free artificial tears used frequently throughout the day, combined with prescription options such as cyclosporine (Restasis) or lifitegrast (Xiidra) eye drops, as these have been shown to reduce inflammation and increase tear production 1.

Initial Treatment Steps

• Use preservative-free artificial tears like Systane Ultra or Refresh Optive every 2-4 hours
• Apply a thicker lubricating ointment like Refresh P.M. or GenTeal Gel before bed for overnight relief
• Consider oral omega-3 supplements (1000-2000mg daily) to improve tear quality

Additional Measures

• Use warm compresses for 5-10 minutes twice daily followed by gentle eyelid massage to unclog oil glands
• Utilize a humidifier in the home, especially while sleeping
• Take regular breaks from screen time using the 20-20-20 rule (every 20 minutes, look 20 feet away for 20 seconds)
• Avoid exposure to smoke, wind, and air conditioning directed at the face

Specialized Treatment Options

• If symptoms persist after 2 weeks of consistent treatment, consider consulting an eye doctor for specialized treatments such as punctal plugs, autologous serum tears, or treatment for meibomian gland dysfunction 1
• For patients with severe dry eye, options like permanent punctal occlusion, autologous serum or plasma rich in growth factors drops, and rigid gas-permeable scleral lenses may be considered 1

Medication Considerations

• Cyclosporine (Restasis) has been shown to be effective in treating dry eye syndrome, with a statistically significant increase in Schirmer test results compared to vehicle at 6 months 1
• Lifitegrast (Xiidra) has also been approved for the treatment of dry eye syndrome, with published studies showing benefit in signs and symptoms over a period of 3 months 1

From the FDA Drug Label

CLINICAL PHARMACOLOGY Mechanism of Action Cyclosporine is an immunosuppressive agent when administered systemically. In patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca, cyclosporine emulsion is thought to act as a partial immunomodulator.

Clinical Evaluations Four multicenter, randomized, adequate and well-controlled clinical studies were performed in approximately 1200 patients with moderate to severe keratoconjunctivitis sicca. RESTASIS demonstrated statistically significant increases in Schirmer wetting of 10 mm versus vehicle at six months in patients whose tear production was presumed to be suppressed due to ocular inflammation.

INDICATIONS AND USAGE RESTASIS® ophthalmic emulsion is indicated to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca.

1 INDICATIONS AND USAGE Lifitegrast ophthalmic solution 5% is indicated for the treatment of the signs and symptoms of dry eye disease (DED).

Treatment for Severe Dry Eyes and Redness:

• Cyclosporine (OPHTH): May be used to increase tear production in patients with keratoconjunctivitis sicca, which can help alleviate symptoms of dry eyes and redness 2, 2.
• Lifitegrast (OPHTH): Is indicated for the treatment of signs and symptoms of dry eye disease (DED), which can include severe dry eyes and redness 3. Key Considerations:
• Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs 2, 2.
• No increase in bacterial or fungal ocular infections was reported following administration of RESTASIS® 2.

From the Research

Severe Dry Eyes and Redness Treatment

• Severe dry eyes and redness can be treated with various methods, including topical cyclosporine, punctal occlusion, and a combination of both 4, 5.
• Topical cyclosporine has been shown to improve ocular surface health and reduce inflammation in patients with dry eye syndrome 4, 5.
• Punctal occlusion, which involves blocking the tear drainage system, can aid in the preservation of natural tears and reduce symptoms of dry eye 6, 7, 8.
• A combination of topical cyclosporine and punctal occlusion has been found to be more effective than either treatment alone in improving symptoms and reducing inflammation in patients with dry eye disease 4, 5.

Treatment Options

• Topical cyclosporine 0.05% ophthalmic emulsion (RESTASIS) twice daily 4.
• Lower-lid punctal plugs (PARASOL) 4.
• Combination of punctal plugs and topical cyclosporine 4, 5.
• Artificial tears 6, 7.

Efficacy of Treatments

• Topical cyclosporine has been shown to improve Schirmer scores, reduce ocular surface staining, and decrease artificial tear use in patients with dry eye syndrome 4.
• Punctal occlusion has been found to improve symptomatic improvement, reduce ocular surface staining, and increase tear film stability in patients with dry eye syndrome 6, 7.
• Combination therapy with topical cyclosporine and punctal occlusion has been shown to be more effective than either treatment alone in improving symptoms and reducing inflammation in patients with dry eye disease 5.