How to Solve Dry Eye

Tear reformulations are relatively simple and cannot approach the complex composition and structure of normal tear film.

Tear reformulations are relatively simple and cannot approach the complex composition and structure of normal tear film. Their delivery is also cyclical rather than continuous. Almost all are based on the water phase of the tear film replacement. There is no substitute for mucus; paraffin is only an approximation of the effect of tears. The optimal frequency of infusion varies with agent and severity


Drops and gels. There is plenty of preparation to choose from. A drug or class of preparations has not yet been shown to be superior, and individual patients often prefer specific drugs, but for limited reasons.


Cellulose derivatives (e.g., hydroxypropyl methylcellulose, methylcellulose) are suitable for mild cases.


Carbomer gel adheres to the eye surface and is therefore more durable, but some patients are bothered by a slight blurring.


Other reagents include polyvinyl alcohol (PVA), which increases tear film persistence, and can be used for mucin deficiency, sodium hyaluronate, povidone, glycerin, propylene glycol, polysorbitol, etc.


Diquafosol is a novel drug that can be used as a topical secreting agent.


Ointments containing petroleum jelly (paraffin) mineral oil can be used at bedtime to supplement daytime drops or gel drops; A noticeable blur hampers daytime use. Some practitioners do not prescribe these for long-term use.


Eyelid sprays are applied to closed eyes and often contain a lipofect-based agent that stabilizes the tear film and reduces evaporation.


Artificial tear inserts, which are inserted once or twice a day, prolong treatment and are favored by some patients.


Mucilage dissolver. 5% acetylcysteine drops may be useful in patients with filaments and mucous plaques, where acetylcysteine dissolves; It may cause tingling during drip. Acetylcysteine has a foul odor and a limited shelf life. Manual debridement of filaments may also be useful.


Preservatives can be a potent source of toxicity, especially after the lacrimal point is occluded. Many non-antiseptic drops are now available, including some multi-dose products, and preservative-containing preparations should generally be preferred over mild illness or more than three to four drops per day. If possible, patients with dry eye should also use preservative-free preparations when other topical medications are required, such as in the treatment of glaucoma. Newer preservatives such as Polyquad® and Purite® appear to have lower ocular surface toxicity than older preservatives such as Benzalkonium chloride.


Blood-derived therapies have been used to treat serious ocular surface diseases, including graft-versus-host associated dry eye disease, sjogren's syndrome, persistent epithelial defects in dry eye after LASIK, and recurrent erosion (see below).


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