Evaporative Dry Eye
As discussed in previous posts, evaporative dry eye is the most prevalent form of dry eye. As we discuss additional therapies for evaporative dry eye it is important to understand that dry eye is a chronic condition, something that needs to be managed long term. Once diagnosed initial treatment generally consists of artificial tears and other palliative measures to improve symptoms of dry eye. Specific recommendations are made in The Oily Truth – Evaporative Dry Eye. After utilizing therapies for a set amount of time, it is important to follow up with your eye doctor for a dry eye examination. These visits are tailored to evaluate the health of your ocular surface and determine if the treatments are working. From that examination your eye doctor may recommend to continue with the current therapy, or she may recommend adding additional treatment.
Treatments for Moderate Dry Eye (In no particular order)
Oral Tetracyclines are antimicrobials prescribed by eye doctors and dermatologists to help decrease the inflammation on the eyelid margins, potentially improving meibomian gland function. As opposed to the traditional use for antibiotics (to combat bacterial infection), tetracyclines are prescribed for their secondary anti-inflammatory action. Tetracyclines do have a number of well documented, specific systemic side effects. Make sure these side effects are well understood, and discussed with your eye doctor, prior to commencing oral tetracycline therapy.
Topical steroids are used to decrease eye inflammation secondary to dry eye. When utilized appropriately, and under the watchful eye of an eye care practitioner, topical steroids can be effective at decreasing the symptoms of dry eye. Due to risk of ocular side effects, steroids are prescribed for short periods of time and are not recommended for continual, chronic use.
Topical cyclosporine (Restasis®; Allergan)
Restasis®, produced by Allergan, is an FDA approved topical pharmacological therapy for the treatment of dry eye. As opposed to artificial tears, Restasis® is designed to increase tear production and help decrease the signs and symptoms of dry eye. It can be difficult to maintain compliance as patients report inflammation secondary to drop instillation, and it takes up to 90 days before the patient perceives any benefit. Despite these side effects, Restasis® can be a beneficial adjunctive therapy for dry eye.
Topical azythromycin (Azasite®; Inspire Pharmaceuticals)
Azasite® is a topical antibiotic that has been used as an off label therapy for meibomian gland dysfunction. Similar to the tetracyclines, azithromycin has a secondary anti-inflammatory effect. As opposed to the tetracyclines, azithromycin is applied topically, saving you from systemic side effects. When used in conjunction with lid hygiene and warm compresses, Azasite® has been shown to be a beneficial adjunct therapy for meibomian gland dysfunction.
Regardless of therapy, those suffering from dry eye must understand that the most important aspect of dry eye management is appropriate compliance with the treatment regimen prescribed by your eye doctor. Continue to follow our blog for further discussion on more invasive therapies for moderate to severe evaporative dry eye.
Lipiflow – An exciting new treatment for evaporative dry eye.