New approaches to dry eye disease

Clinicians now have multiple options at their disposal in the treatment of dry eye disease (DED), including topical over-the-counter medications and a growing range of devices that target Meibomian gland dysfunction, according to Jose M. Benitez-del-Castillo MD, PhD. “We have more treatment options for DED than ever before and there are many more in the pipeline. However, the success of any treatment depends on the correct diagnosis and appreciation of the underlying aetiology,” Dr Benitez-del-Castillo said at the World Ophthalmology Congress 2020 Virtual. In a broad overview of current treatments for DED, Dr Benitez-del-Castillo, Professor and Chairman of Ophthalmology at Hospital Clinico San Carlos and Clínica Rementería, Madrid, Spain, said it was important to appreciate dry eye in the context of the revised TFO Dews II definition. “We need to understand dry eye as a multifactorial disease of the ocular surface characterised by a loss of homeostasis of the tear film and accompanied by ocular symptoms in which tear film instability and hyperosmolarity, ocular surface inflammation and damage and neurosensory abnormalities play aetiological roles,” he said. Over the counter (OTC) artificial tears have traditionally been the first line of treatment for dry eye syndrome and dry eye‐related conditions, and more are coming on the market every year, said Dr Benitez-del-Castillo. "We tend to use treatments today combining different viscosity-enhancing agents such as hyaluronic acid (HA), carboxymethyl cellulose (CMC), hydroxypropyl-guar (HP-guar) and trehalose for optimal effect,” he said. A wide range of biological tear substitutes are now available, said Dr Benitez-del-Castillo, including autologous serum, adult allogenic serum, umbilical cord serum, platelet preparations, mucolytic agents and TRPV1 receptor antagonists. Tear preservation strategies to treat DED may include punctal plugs, surgical punctal occlusion and moisture chamber spectacles and humidifiers. Other options include secretagogues, in oral or topical formulations, designed to stimulate aqueous and/or mucin secretion, and nasal neurostimulation, which aims to induce normal tear production via stimulation of the nasolacrimal reflex, he said. Fostering good lid hygiene and treating lid abnormalities where appropriate is a key part of DED management in many patients, noted Dr Benitez-del-Castillo. As well as specific treatments for Demodex mite lid infestation, a wide range of warming/massage devices are now available to try to regulate and improve Meibomian gland function, including LipiFlow (Johnson & Johnson Vision), iLux (Alcon), IPL (Lumenis) and others, he said. Dietary modifications as part of a holistic approach to DED may also be helpful, and it is important to consider patient education encompassing environmental, health, lifestyle and psychological factors that may all play a role in managing the condition, he concluded.

Tags: dry eye disease