Sx

Dry Eye

search

Dry Eye, Xerophthalmia

  • See Also
  1. Lacrimation
  2. Sjogren's Syndrome
  • Epidemiology
  1. As many as 30% of over age 50 years old complain of dry, irritated eyes
  • Causes
  1. Sjogren's Syndrome
  2. Allergic Conjunctivitis
  3. Blepharitis
  4. Decreased blinking with prolonged reading or driving
  5. Chronic exposure to dry, dusty conditions
  6. Rosacea
  7. See Medication Causes of Dry Eyes (e.g. Anticholinergic Medications, Diuretics, Estrogen Replacement)
  • Management
  1. General measures
    1. Sunglasses
    2. Room humidifiers
    3. Tobacco Cessation
    4. Take computer breaks
    5. Protect eyes from fan
    6. Avoid drying, Anticholinergic Agents (Antihistamines, Tricyclic Antidepressants, Diuretics)
    7. Use 20-20-20 rule
      1. Shift eye focus every 20 min to something 20 feet away for 20 seconds
  2. Artificial tears or ointments
    1. Preservative-free solutions are preferred (e.g. Refresh Plus), esp. if used more than 4x/day
    2. Contact Lens users may try rewetting drops (e.g. Renu rewetting, Blink Contacts)
    3. Consider eye lubricants (e.g. lacrilube) for moderate symptoms (esp. at night), but may blur Vision
    4. Avoid agents with Decongestant (e.g. Visine original)
  3. Consider Muscarinic Agonists and other agents in Sjogren's Syndrome refractory to other measures
    1. Cyclosporine twice daily (expensive, at $500/month)
      1. Remove contacts before instilling drops (and wait 15 min before reinserting)
      2. Restasis 0.05% emulsion (preferred over Ceqo)
      3. Cequa 0.09% solution
    2. Pilocarpine (Salagen)
    3. Cevimeline (Evoxac)
  4. Other options in refractory cases
    1. Lifitegrast (Xiidra)
      1. Lymphocyte function-associated Antigen-1 (LFA-1) Antagonist ophthalmic solution
      2. One drop instilled every 12 hours
      3. Expensive (>$400/month), with risk of eye irritation, altered Taste Sensation
      4. Contact Lenses must be out of eye for installation for at least 15 minutes after administration
    2. Ophthalmic Corticosteroid
      1. Short-term use only (<2 weeks) for severe Dry Eye flare
      2. Consider consult with ophthalmology
      3. Risk of Glaucoma, Cataracts and infection
      4. Eysuvis (loteprednol) 0.25% suspension is FDA approved for Dry Eyes (but costs nearly $500 per course)
      5. Dexamethasone 0.1% ophthalmic solution is <10% of Eysuvis cost and is used off-label for Dry Eyes
    3. Intranasal Varenicline (Tyrvaya)
      1. Varenicline 0.03 mg used intranasally ($600/month in 2021)
      2. Results in Cholinergic effects to increase tear production (may have a modest effect)
      3. Minimal systemic absorption (8%)
        1. Varenicline used systemically is Chantix
      4. References
        1. (2021) Presc Lett 28(12): 70
  5. Avoid measures that are unlikely to be helpful
    1. HydroEye (Omega-3 Fatty Acid) has no quality studies demonstrating efficacy
  • Diagnosis
  1. See Schirmer's Test
  • References
  1. (2021) Presc Lett 28(1): 6
  2. (2019) Presc Lett 26(5)
  3. (2016) Presc Lett 23(9)
  4. (2015) Presc Lett 22(1): 5
  5. Ono (2004) Am J Ophthalmol 138(1): 6-17 [PubMed]
  6. Whitcher (2004) Br J Ophthalmol 88(5): 603-4 [PubMed]