Long-Term Management
Challenges and Strategies
Because of its chronic nature, dry eye syndrome (DES) is not an easy disease to manage. Treatment usually progresses in a stepwise fashion, starting with conservative therapies and advancing to more intensive treatments based on disease severity (see Treatment Options). Successful DES management often includes a combination of pharmacologic therapies, non-pharmacologic interventions and environmental and lifestyle adjustments to address underlying causes and restore and maintain tear film homeostasis.
Choosing the right treatment for long-term disease management has certain challenges. Eyedrops and emulsions, the most treatments for DES, rapidly enter the nasolacrimal duct and are eliminated through lymphatic flow and conjunctival blood, resulting in only 1-5% of the drug being available for absorption by the target tissue. This necessitates frequent dosing with highly concentrated drugs, which can lead to poor patient compliance, particularly for chronic…
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Challenges and Strategies
Because of its chronic nature, dry eye syndrome (DES) is not an easy disease to manage. Treatment usually progresses in a stepwise fashion, starting with conservative therapies and advancing to more intensive treatments based on disease severity (see Treatment Options). Successful DES management often includes a combination of pharmacologic therapies, non-pharmacologic interventions and environmental and lifestyle adjustments to address underlying causes and restore and maintain tear film homeostasis.
Choosing the right treatment for long-term disease management has certain challenges. Eyedrops and emulsions, the most treatments for DES, rapidly enter the nasolacrimal duct and are eliminated through lymphatic flow and conjunctival blood, resulting in only 1-5% of the drug being available for absorption by the target tissue. This necessitates frequent dosing with highly concentrated drugs, which can lead to poor patient compliance, particularly for chronic diseases like DES. Additionally, chronic exposure to preservatives in these medications is known to induce toxicity and adverse changes to the ocular surface. Benzalkonium chloride is the most frequently used preservative in these preparations; its long-term use can cause significant eye damage. To address this, newer preservatives with lower ocular surface impact have been developed, as well as preservative-free medications. Studies have shown that switching to preservative-free treatment results in significantly fewer signs and symptoms of ocular surface disease. Another challenge in treating chronic DES lies in the appropriate use of corticosteroids. Corticosteroid treatments with high to medium potency agents have been shown to be effective in reducing inflammation, but carry significant risks of serious adverse events, making long-term use inadvisable. Mild steroids like hydrocortisone are preferred for patients with DES, as they offer a safer option for long-lasting anti-inflammatory treatment. However, it is essential to monitor intraocular pressure and lens status during treatment to prevent adverse effects. Another promising option for the long-term treatment of DES are drug-loaded contact lenses. These advanced contact lens drug-delivery systems increase drug-loading capacity and control the drug-release rate, offering a potential alternative for managing DES more effectively.
For severe cases of DES unresponsive to conventional treatments, surgical and transplantation options could be a long-term management solution. Surgical procedures such as punctal occlusion, where punctal plugs are inserted to block tear drainage, can help retain moisture on the ocular surface and alleviate symptoms. More advanced options include conjunctival resection, which removes damaged tissue to improve tear film stability, conjunctival reconstruction and amniotic membrane transplantation, which promotes healing of the ocular surface.
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