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General information on dry eyes/tears dysfunction syndrome

Aug 27, 2015 - 2 comments

General Information on Dry Eyes-Now known as Tears Dysfunction Syndrome.

June 2014 UPDATE: A new product "OcuSOFT Lid Scrubs PLUS has worked extremely well for the condition called blepharitis (oil and debris and irritation along margin of eyelid) associated with dry eyes. The PLUS product works much better than the regular OcuSOFT Lid Scrub plus the PLUS product is left on the lids and does not have to be dried off.   RESTASIS continues to be the medication of choice for moderate or severe dry eyes.

September 2013 UPDATE:  Restasis has become the #1 most prescribed eye drop in the USA and most other developed countries. It is the preferred treatment for moderate or severe dry eyes. Improvement can occur for up to 1 year.  It works for the eye with no tears or the eye that waters all the time. If often stings or burns when first starting and many ophthalmologists use a mild steroid eye drop for a couple of weeks to reduce swelling. Restasis is not an artificial tear but is cyclosporin. Over 4-6 months Restasis reduces inflammation on the surface of the eye and improves the quality and quantity of the tear  (which has a protein, a fat (lipid) and a watery (aqueous) component.

Also recent research has documented the effect of omega 3 fatty acids taken orally 2 or 3/day.  This includes high quality enteric coated fish oil or other ocean based Omega 3 such as made from krill or calamari. Omega 3 helps dry skin, dry mouth and dry hair.  This also often takes 3-6 months to get maximum benefit and needs to be continued. Important to understand NO IMPROVEMENT MAY OCCUR FOR 4-6 MONTHS.

Both Restasis and Omega 3 are normally taken for life.  A recent study stating fish oil increased risk of prostate cancer in men is wrong.  Omega 3 does NOT increase the risk of prostate cancer *See Missouri Medicine medical journal July/August 2013.


a Schirmer test of zero indicates that severe dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical compies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops. Eye drops for dryness are classified as preserved drops (individual vials that must be used within 24 hrs), preserved drops, gels and ointments. The preserved drops are more expensive and usually only help the small percentage of people that are really allergic to preservatives. Gels and ointments are normally used at night since regular tears won’t last all night.   There is also an over the counter spray for dry eyes called “Tears Again”.  Tears may need to be used as often as 6 times/day.

If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 6 months of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes four months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. Improvement often continues for up to 12 months.

If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.

Be sure to try Nature’s Tear’s Eyemist a spray for dry eyes that works for many people. It is available without a prescription.

Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.

Ask your ophthalmologist (Eye MD) about Lacriserts. These were unavailable for several years and are now on the market by Aton Pharma. They are very tiny pellets of hydroxypropyl cellulose that are placed between the eye lid and the eye and slowly dissolve over 24 hours coating the eye with a moisturizing coat.  They are a prescription medication.

In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.

If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.

If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise. A final new treatment that they can often do is “Autologist Platelete-rich plasma” therapy. This uses eyedrops made out of your blood products. (reference Ocular Surgery News: November 1, 2007 page 46  lead author Jorge Alio MD.

Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.

Original MedHelp Blog - Dec 11, 2009

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177275 tn?1511755244
by JohnHaganMD, Jul 04, 2018
2018 Update.    For severe or moderate dry eyes of both the aqueous deficiency or lipid deficiency type where a wide variety of artificial tears have been tried without success or have to be used most days more than 4 times pere day Restasis has been the only medication of it’s type.  Note twice/day for the rest of your life and 4-6 months before its fully effective.  Now a second medicine Xiidra has been introduced and is being widely marketed using Jennifer Aniston as spokesperson.    Xiidra has not been shown to be more effective than Restasis and is much more expensive.  The only advantage of Xiidra is that they are allowed to say the drug becomes effective in 2-4 months as opposed to Restasis 4-6 months. For a drug you are taking for the rest of your life that 2 months is not a big deal especially when its much more expensive.  I have not had the success with Xiidra in my practice that I have had with Restasis *(which my wife and I have been on for over 5 years with great success) and several people that like it said it was unaffordable after the discount coupons for the first refills ran out.

2018 mid-year update: This is from review of ophthalmology. Cequa will be the 3rd FDA approved eye drops for severe dry eyes along with Restasis and Xiidra. It has the same medication as Restasis but is 80% more concentrated. Experience is limited, costs are yet unknown.

The News Feed
Published August 16, 2018 • RO Staff
Cequa Gets Approved for Dry Eye
Its active ingredient is familiar, but it comes with a higher concentration and a solution vehicle.
Starting today, cyclosporine is no longer synonymous with Restasis for eye doctors, as a second agent in that class was just approved by the FDA. Sun Pharma’s drug Cequa (cyclosporine ophthalmic solution 0.09%), indicated to increase tear production in dry eye patients, joins the ranks of Restasis and Xiidra (lifitegrast) as only the third Rx product approved for this patient population in 19 years.

Cequa's 0.09% concentration of cyclosporine A (CsA) is the highest on the market, and the product includes a unique ‘nanomicellar’ formulation that Sun Pharma says “allows the CsA molecule to overcome solubility challenges, penetrate the eye’s aqueous layer and prevents the release of the active lipophilic molecule prior to penetration.” Micelles are gelatinous aggregates of amphipathic (both hydrophobic and hydrophilic) molecules, Sun explains in a press release, and the small size of the nanomicelles allows entry into corneal and conjunctival cells, “enabling delivery of high concentrations of CsA.”

In the Phase III confirmatory trial, Cequa showed statistically significant improvement in the primary endpoint of Schirmer’s score (p< 0.01) after 12 weeks of treatment, the company reports. Improvements in secondary endpoints of ocular staining began one month after initiating treatment, the company adds.

Cequa is dosed twice daily and will be available as a single-use vial. It will be commercialized in the US by Sun Ophthalmics, the company’s branded ophthalmics division.

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