Updated Dry Eye Options Listed By Categories

Innovations in Dry Eye treatments, continue to expand. 

As with any new drugs/treatment, first check with your eyeMD and PCP before starting.

Each item below has risks and benefits. I have had many patients swear some non-preserved artificial tear (NPAT) made them feel worse. NPATs are one of the least risky options below but some patients can be sensitive to a seemingly innocuous product or procedure. 

Most eye doctors cannot keep up with all the new options on the market in 2020. The below list may need to be updated in a couple of weeks. 

A. Treatment of ocular surface disease

1. Increase Tear production

– Use of Preservative-Free Artificial Tears
2. Increase Tear Retention
 Punctal plugs, moisture goggles; contact lenses: may help keep tear on cornea but can damage goblet cells and meibomian glands in long term.
3. Treatment of lids and ocular surface disease
– Treat blepharitis with lid hygiene, warm compresses
– Refractory cases: Meibomian Gland Probing, Lipiflow (ThermoPulsation including iLux now),
Intense Pulse Lighted Therapy
4. Managing comorbid conditions
 Treat allergies, conjunctival chalasis (with Argon laser or surgery with Amniotic Membrane, lagophthalmos (especially if a patient has had eyelid surgery) and nocturnal exposure
B. Anti-inflammatory agents

1. Topical corticosteroids: steroids

2. Oral doxycycline (20mg is likely better than 100mg for its anti-inflammatory effect; Topical and oral Azithromycin helps some patients as well.
3. Xiidra (lifitegrast) works by blocking a certain protein on the surface of cells in your body. This protein can cause your eyes to not produce enough tears, or to produce tears that are not the correct consistency to keep your eyes healt
4. Cyclosporine: Restasis (takes 3months for effect), Cequa (takes 28days) 
5. Tacrolimus: https://drcremers.com/2020/01/risk-of-protopic-tacrolimus.html
6. Anakinra: a protein-based biologic agent/biopharmaceutical drug used to treat rheumatoid arthritis. It is a recombinant and slightly modified version of the human interleukin 1 receptor antagonist protein which effectively suppresses IL-1-mediated inflammation at the level of the ocular surface.
7. Androgens: topical Testosterone
C. Regenerative Therapy

1. Autologous serum eye drops (20–100%)

2. Nerve growth factor
3. Platelet rich plasma
4. Umbilical cord serum eye drops
D. Protect ocular surface when required

1. Bandage contact lenses

2. Scleral Contact Lenses (e.g., PROSE)
E. Systemic Pharmacotherapy for Pain

1. Tricyclic Antidepressants, ie, Nortriptyline, amitryptilline

2. Carbamazepine
3. GABAergic drugs (gabapentin, pregabalin)
4. SNRI like duloxetine and venlafaxine
5. Opioids like Tramadol
6. Class 1B sodium channel blocker Mexiletine
F. Complementary and alternative measures

1. Decrease Electronic Screen Use/Viewing; Blinking Exercises; type with eyes closed; 

2. Humidifier; HEPA filter near bed
3. Diet: Glute-Free, Sugar-Free; some patients benefit also by a Dairy-Free diet; fasting (ie, Dr. Longo’s Diet: discuss with PCP before significant fasting or diet changes if any medical history)
4. Omega-3 rich diet: still controversial given studies on both sides: some say it helps; some say it does not; generally 2000-4000mg per day depending on approval by PCP or cardiologist
5. Cardio- Exercise (ie, Cross Fix)
6. Ziena Dry eye glasses/google/ Moisture Chamber Googles
7. Acupuncture: I have a few patients who really feel this helps: Recommended by patient (I have not met them): Cyntia Siu 917-992-6889 in NYC; Kate Yonkers 2027839404 in DC.
8. Transcranial Magnetic Stimulation
9. Scrambler Therapy
10. Implantable neuromodulators

Other: Non-FDA Approved Options:

1. Diquafosol (tradename Diquas) is a pharmaceutical drug for the treatment of dry eye disease. It was approved for use in Japan in 2010.[1] It is formulated as a 3% ophthalmic solution of the tetrasodium salt. Its mechanism of action involves agonism of the P2Y2 purinogenic receptor.[2]

Company states: “functions as an agonist at the P2Y2 receptor, stimulating the release of natural tear components targeting all three mechanisms of action involved in tear secretion – mucin, lipids and fluid.”
FDA failed to approve it stating: clinical trials of diquafosol tetrasodium ophthalmic solution failed “to demonstrate adequate replication of results for the efficacy endpoints and therefore are insufficient to establish efficacy,” according to a press release from Inspire Pharmaceuticals, the drug’s developer.

References: https://www-ncbi-nlm-nih-gov.proxy1.library.jhu.edu/pmc/articles/PMC5607443/

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