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Dry Eye Treatment:

How Current Methods Are Driving Away The Dry Eye Blues

 

One of the most frustrating diseases to treat in eye care is dry eye. Dry eye symptoms are the most common complaints eye care doctors receive from patients, and until recently, there were few effective ways to treat them. Thanks to current therapies, this disease is becoming more treatable than it has in the past, and it's changing the way practices approach dry eye management.

 

 

Understanding what causes dry eye

While researchers found an association with inflammation from cytokines and leukotrines as a component of dry eye, others believe that the glycocalyx may play an important role.

 

In a healthy eye, the epithelial surface cells protect themselves by producing glycocalyx to trap mucins to the microvilli on the ocular surface. When glycocalyx is damaged, mucins and microvilli are lost and the epithelial cells become exposed.

 

This damage inherently exposes the corneal surface and destabilizes the tear film. Deficiency in any of these areas leads to a compromised tear film and can lead to cellular damage if not treated properly.

 

A vital goal in treating dry eye is to maintain a protected ocular surface.

 

 

Current therapies for dry eye

Current therapies for dry eye have given doctors a variety of methods to effectively treat their patients. The following are most commonly used:

 

  • Artificial tears. While artificial tears continues to be used in treating patients with mild symptoms of dry eye, manufacturers have improved their products by introducing preservative-free tears. The problem with this therapy is that it may not be enough for some patients and can become costly.
  • Ointments. Comparably efficient to artificial tears, and is a perfect alternative for patients who have problems using artificial tears. However, these can contribute to blurring and decreased visual acuity.
  • Punctual occlusion. Plug-like devices or cautery to plug the puncta. While this treatment helps patients preserve tears, exacerbated problems may occur if the tears contain inflammatory mediators.
  • Cyclosporine ophthalmic emulsion. Also known as Restasis, this drug reduces the production of cell mediators causing inflammation of the lacrimal gland. This drug can take up to six months before it takes full effect and will require close screening of the patient.

Identifying the right treatment

How a patient is treated depends on the severity of their dry eye and an accurate diagnosis can help determine the most effective treatment.

 

According to results of a Delphi panel approach led by the Wilmer Eye Institute, their recommendations are based on "levels of severity". This with the combined use of the Ocular Protection Index (OPI) can help quantify the level of severity. An OPI of less than 1.0 represents an unprotected ocular surface with a severity level of three or four.

 

Level of Severity Treatment

First Level:

Mild to moderate symptoms and signs

Preserved tears, allergy drops, lifestyle changes and environmental management (avoiding smoky or poorly ventilated areas, low humidity, alcohol, drugs that cause dryness, i.e. oral antihistamines and antidepressants)

Second Level:

Moderate symptoms defined as tear film and visual signs and conjunctival and mild corneal staining

Unpreserved tears, gels or ointments, corticosteroids or Restasis

Third Level:

Marked corneal punctuate staining, central corneal staining and filamentary keratitis

Restasis, punctual plugs, tetracycline or topical steroids

Fourth Level:

Severe symptoms and corneal staining and erosions and conjunctival scarring

 Patients may respond to Restasis, but may require surgery, punctual cautery, acetylcysteine or contact lenses

 
Published by SafeGuard Health Plans, Inc. August 2005.