Chronic Dry Eye Information:

Treatment Options for the Management
of Chronic Dry Eye

It's important for patients to ask their eye doctor what options are available in addition to over-the-counter eye drops. Management options for Chronic Dry Eye include:

• Over-the-Counter Eye Drops
• Prescription Therapies
• Punctal Plugs

Over-the-Counter (OTC) Eye Drops

Your patients have various options for the management of their Chronic Dry Eye, including OTC eye drops. OTC eye drops are available in a variety of formulas, consistencies, and dispensers to meet patients’ individual dry eye needs.

Nonprescription eye drops continue to be the most widely used first-line treatment for dry eyes.1

Used to moisten the eye and thicken tears, these man-made, water-based lubricant solutions can help

• Lubricate the eyes1,2
• Maintain moisture2
• Ease symptoms, such as grittiness and dryness1
• Soothe dry eye symptoms associated with refractive surgery3

The information in this section can help you address questions and concerns your patients may have about OTC eye drops.

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Important Information About Over-the-Counter Eye Drops

Side Effects⁶

Although serious side effects from the use of eye drops are rare, advise patients to consult you immediately if they notice

• A change in vision
• Eye pain
• Worsening eye irritation and/or redness that lasts longer than 72 hours

Preservative vs Nonpreservative

• perborate
• polyquaternium-1 (Polyquad®*)
• purite®†
• benzalkonium chloride
• methylparaben
• propylparaben
• stabilized oxyborate complex (Dissipate™‡)
• phenoxyethanol
• sorbic acid EDTA
• sodium perborate
• sodium silver chloride complex
• chlorobutarol

*Polyquad is a registered trademark of Alcon Laboratories, Inc.
†Purite is a registered trademark of Allergan, Inc.
‡Dissipate is a trademark of Ocusoft, Inc.

Postsurgical Use of Eye Drops

The temporary loss of nerves on the eye surface after refractive surgery may make the eyes feel dry for up to 6 months.³ Help your patients choose eye drops that will benefit the postsurgical healing process.

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A Variety of Eye Drops for a Variety of Needs

The following is a list of available formulations, with important information about their role in Chronic Dry Eye management.

Artificial Tears

Hydrogels increase the thickness of these tears. Common hydrogels used in tears are hydroxypropyl methylcellulose (HPMC), carboxy methylcellulose (CMC), polyvinyl alcohol (PVA), carbopol, polyvinyl pyrrolidone, polyethylene glycol, dextran, hyaluronic acid, or carbomer 940 (polyacrylic acid).

These beneficial hydrogels

• Moisturize and lubricate the eye surface by attracting and holding water
• Coat the eye for temporary relief of burning, irritation, and discomfort
• Help protect against further irritation

Gels⁸

Gels are thick, nonoily products that are often recommended for nighttime use. Generally containing a higher concentration of lubricating ingredients than artificial tears, they may cause blurred vision for the first few minutes until they “melt” on the eye.

Ointments

Recommended for intermittent symptoms, including constant dryness and irritation of the eyes, ointments provide temporary relief and help the eyes stay moist.10

The lubricating ingredient in ointments is similar to petroleum jelly, which may cause prolonged blur and is not recommended when clear vision may be required. Ointments are often recommended for more severe symptoms or for nighttime use.10,11

Emulsion Eye Drops

These may be added if meibomian gland dysfunction is present to replenish a layer of oil in the tear film and reduce tear evaporation.⁸

Contact Lens Rewetting Drops

Specially formulated lens-lubricating and rewetting drops for contact lens wearers have been designed to provide the same relief and long-lasting lubrication as other eye drops, while eliminating the potentially damaging effects some ingredients may have on lenses. They do NOT contain the same ingredients as eye drops that can damage the lenses.1

Preservative-Free Vials^2,8

Preservative-free eye drops, generally dispensed in single-use vials, are available for people who are sensitive to preservatives. Use of eye drops containing preservatives may lead to medicamentosa, particularly when used frequently over a long period.

For Consideration

When suggesting eye drops to patients, take into account

• Intensity of symptoms
• Ingredients
• If the patient is using eye drops for allergies
• Whether patient wears contact lenses
• Time of day patient will use eye drops

Prescription Therapies

There are additional prescription treatment options available for dry eyes.

Punctal Plugs12,13

Punctal plugs can be inserted to close the ducts that drain tears out of the eye. Temporary plugs, which dissolve with time, can be inserted to help you decide if plugs will reduce patient’s dry eye symptoms before inserting permanent plugs. Inserting both rigid and liquid punctal plugs carry little risk. However, eye irritation, excessive tearing, and infection are possible. In any case, eye drops should be used to keep the eye moist.1

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References:
1. FDA Consumer Magazine. Dealing with dry eye. Available at: www.fda.gov/fdac/features/2005/305_eye.html. Accessed November 15, 2005.
2. Medem: Medical Library. Dry eye. Available at: www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZXQXXV1ED&sub_cat=118. Accessed November 15, 2005.
3. Mayo Clinic. LASIK and other refractive surgeries: say good-bye to eyeglasses. Available at: www.mayoclinic.com/health/lasik-eye-surgery/EY00002. Accessed January 4, 2006.
4. Multi-Sponsor Surveys, Inc. The 2005 Gallup Study of Dry Eye Sufferers: Summary Volume. August 2005:1-160.
5. Mayo Clinic. Hydroxypropyl methylcellulose (ophthalmic). Available at: www.mayoclinic.com/health/drug-information/DR202290. Accessed November 18, 2005.
6. Drug Digest. Artificial tears solution. Available at: www.drugdigest.org/DD/DVH/Uses/0,3915,6355|Artificial%2BTears%2BSolution,00.html. Accessed November 15, 2005.
7. Surviving Dry Eye Pain. Some medications and surgery might contribute to dry eye pain. Available at: www.dryeyepain.com/practical1-Med_Surg.htm. Accessed November 15, 2005.
8. AgingEye Times. Artificial tears: too many choices. Available at: www.agingeye.net/dryeyes/dryeyesdrugtreatment.php. Accessed November 8, 2005.
9. Rackow PL. Product options for managing dry eyes. Available at: http://www.visioncareproducts.com/31/special.html. Accessed January 10, 2006.
10. Drug Digest. Artificial tears ointment. Available at: www.drugdigest.org/DD/DVH/Uses/0,3915,7280%7CArtificial+Tears+Ointment,00.html. Accessed on November 15, 2005.
11. MedicineNet.com. Eye care. Available at: www.medicinenet.com/eye_care/page2.htm. Accessed November 18, 2005.
12. WebMD. Eye health: dry eyes. Available at: http://www.webmd.com/content/article/81/96835.htm. Accessed January 4, 2006.
13. AgingEye Times. Punctal plugs and moisture chambers. Available at: http://www.agingeye.net/dryeyes/plugsetc.php. Accessed January 4, 2006.