Dry Eyes: Classical "Treatment"

 

The current classisical treatment of dry eyes should be called palliative care rather than real treatment. Artificial tears are either capable of partially reducing dryness without bringing all the biological benefits of natural tears (régeneration, cleansing, lubrication and complete hydration) or avoid too much evaporation of the remaining tears. In any case, the current treatments are unable to re-estalish the normal functioning of tears, to restore the quality of tears or mimick all their porperties. One might wonder why treating dry eyes is so expensive then and why so many eye lubricatns still have preservative in them... when these require very frequent use all day long.

Caution! Even if some drugs are available without a prescription, they should exempt its consummer to consult a doctor or an ophthalmologist. Any type of eye disorder requires consideration and an appropriate control. Please consider this list as a check-list to question your ophthalmologist regarding other leads to follow if your are unable to control your symptoms currently.  In any case, whatever the substance or brand, you should not consider it as a recommendation from our part.

The palliatives: Tear Supplements

Artificial tears without preservatives (unit-dose, single use vials or unpreserved bottles)

The main substances are:

• carboxyl methylcellulose sodium: Celluvisc

• Carbomer 974 P: Lacryvisc, Gel-Larmes by Théa

• Polyvinyl alcohol or povidone: Refresh unidoses

• Hyaluronate sodium, hyaluronic acid: Vismed, Hyal Drop, Hylocomod, Hyluprotect, Blink

• Carbopol 980: Aqualarm,

• Povidone: Nutrivisc, Unifluid

• Hydroxypropyl Methylcellulose, Hypromellose: Artelac;

• etc.

There are many types of artificial tears or many brands (however, these frequently contain the same ingredients/substances but are seldom innovative). it's very difficult to provide adequate advice since some people will feel better with one particular drop whilst other cannot tolerate it. Dry eye care is frequently done in a trial and error basis and based upon individual sensitivies and preferences. However, one can say that more visocus drops are more useful for severe cases since its lubricating effect lasts longer (which could less than 10 minutes in some cases).  The more viscous the drops is the more it will probably blur vision as well. As said, finding the best drop is usually done in an empirical way... and soemtimes the best solutions may be a combination of two drops.

There are many other artificial tears but many of them contain preservatives and are not advisable since these induced cytotoxic effects that may seriously harm the cornea.  It's difficult to understand why so many preserved eye drops are preserved and are meant to be used very frequently. Please read our website on the consequences of preservatives: Preserve our Eyes, not our Drops!

Some saline physiological tears (in sum, sterile salt water at a 0,9% concentration) are also useful to wash the eye but their lubricating effect is very limited.  If there are some signs of meibomian gland dysfunction, allergies or impurities in the eye these may be very useful to wash away those aggravating factors. After washing the eye one can almost put another more viscous or artificial tear.

• sodium chloride: Larmabak, Unilarm, Chlorure de sodium de Gilbert, etc

Gels & ointments:

• greasy eye ointments

          - Vitamin A ointment (it's very useful for night-time use but certainly too blurry for daily use)

• Gels

         - Lacrifluid, Lacrinorm, Civigel, Gel-Larmes, Lacrigel, Siccafluid, etc (beware that some of these may contain preservatives)

Ophtalmic inserts:

• Lacriserts (hydroxypropylcellulose): these small pellets palced in the conjunctival sac dissolve themselves during the day.  

Puncta plugs:

• temporary plugs destined for a trial.  

• so-called definitive plugs (but these may fall after some time).

• Cauterization of the puncta (definitive surgical procedure).  

Trreatment of meibomian gland dysfunctions/blépharitis:

• Lid Hygiene with either diluted baby shampoo, sodium bicarbonate, bébé ou parfois du bicarbonate or some specific solutions for the lid hygiene such as Bléphasol ou Bléphagel.

• Warm compresses on the lids.

• Cleansing the eye with saline unpreserved solutions.

• Doxycycline and sometimes local antibiotherapy.

Cyclosporine

Cyclosporine has become the reference treatment for reducing ocular surface inflammation and notably that of dry eyes. It has progressively become the main dry eye treatment, through a commercial version at 0.05% concentration, Restasis®. In some other countries it has been used in eyedrops made by compouunding pharmacies (notably for or within hosptials) at doses ranging between in 0.05 et 2% in oily emulsion (either ricn, maize or castor, etc). There are other commercial forms of cyclosporine (notably in India and other are currently being teste (notably one in France).

to be completed...

 

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  copyright © Keratos 2005-2007