We have been having early success with PRP injections into the meibomian glands thus far, but we are waiting to see if this is a temporary help or a long term solution or even cure for meibomian gland dysfunction.
Still there are patients, particularly my patients with Sjögren’s syndrome and other autoimmune diseases where the body’s underlying inflammation continues to attack the meibomian and lacrimal glands.
A new treatment called ACTHAR may help this underlying inflammation in dry eye patients.
It is approved for chronic inflammatory conditions, such as non-infectious uveitis (internal eye inflammation), scleritis, ocular pemphigoid, sarcoidosis, optic neuritis, etc: listed below in photos.
I believe that many patients with dry eye have underlying inflammation and this medication may help.
ACTHAR essentially is subcutaneously (under skin) or intermuscular injections of ACTH —given 2x per week—which is a melanocortin peptide that binds to melanocortin receptors: this tricks the body into stimulating the body’s own endogenous (internal) steroids without the big negatives that oral and topical steroids can cause, such as high eye pressures, glaucoma, weight gain. There are still risks of high blood pressure, water retention, and increased fat pad density—Cushinoid appearance—which appears to go away when done with medication. I’m not sure they know if cataracts risk increases long term yet. ACTHAR has been used to get patients off other medications, such as methotrexate, plaquenil, oral steroids.
It apparently was FDA approved in the 1950’s and the side effect profile is well understood per the reps.
I am concerned not all the side effects are know yet as it is a relatively new drug to the dry eye community.
Still it could be a good option for patients with severe dry eye that really need steroid drops or pills to feel relief and have no pain.
Dr. Marguerite McDonald in NJ has started treating 20 patients with this apparently and I hope to contact her to see if this has helped and what the real side effects are.
A positive is that most insurances cover this. The negative is that a vial which lasts about a month appears to cost $35000!! Shocking!! Apparently the company will cover patients in many cases whose insurance will not cover it or do not have insurance. Not sure how long this option will last.
It is not a risk-free treatment and it has not been proven to be helpful in dry eye patients yet. However, if you feel you cannot live without your steroids, this is potentially a less dangerous and risky option.
Additionally, for all our pterygium patients with severe underlying inflammation or multiple recurrences that need long term steroids but have eye pressure spikes, this may be a much better option. The down side also is the 2x weekly subcutaneous injections.
Sandra Lora Cremers, MD, FACS
