GenTeal Gel eases dry eye in post-LASIK patients

Small amounts of gel may be more convenient for patients suffering from dry eye.

ByDavid Schonfeld

PITTSBURGH — GenTeal Gel (hydroxpropyl methylcellulose 0.3%, Novartis Ophthalmics) can be a helpful alternative to drops in post-LASIK and other dry eye cases, according to a refractive surgeon here.

“I think one of the advantages is that it lasts longer,” said Lisa R. Battat, MD, director of cornea and refractive surgery at the Everrett & Hurite Ophthalmic Association. “It stays in the eye longer.”

According to Dr. Battat, using a small amount of the gel product is beneficial for patients with dry eye.

“The trick is by using a little bit, it doesn’t disturb their vision and it keeps them comfortable for much longer,” she said.

All types of dry eye

Dr. Battat said she does not like to use artificial tears that contain irritating preservatives. GenTeal Gel is transiently preserved using sodium perborate, which breaks down into water and oxygen within seconds of entering the tear film.

“I have a lot of dry eye patients in my practice, patients with medical problems giving them dry eye, long-term contact lens wearers and patients who have dry eye as a consequence of refractive surgery. I never use artificial tears that have preservatives because the preservatives are toxic to the corneal epithelium. It can be very irritating to an eye with an already-compromised surface. It’s nice to use a product that has either no preservative or a transient preservative,” she said.

Dr. Battat prefers to have her dry eye patients use GenTeal Gel in their eyes in small amounts. She has been dispensing the gel to patients for about 2 years.

“I think one of the things that is wonderful about GenTeal is the gel formula,” she said. “The trick with getting good results with the gel is to instruct the patient to put the tiniest amount in the eye and have them blink several times. If you put a large amount in the eye, then the vision is blurry and patients don’t tolerate that. But if you can put a very tiny amount, then it lasts for a long period of time, and many patients who are very dry find it much more beneficial than just an artificial tear drop that goes away more quickly.”

Another good thing about the gel, according to Dr. Battat, is its compatibility with cosmetics.

“Another advantage is for women patients who are wearing eyeliner or mascara,” she said. “It’s very difficult to put in artificial teardrops when they run down your face along with your eyeliner and mascara. That really is an advantage, enabling women to lubricate their eyes without disturbing their makeup.”

LASIK dry eyes

According to Dr. Battat, GenTeal Gel is helpful for patients with dry eye brought on by refractive surgery.

“I think for LASIK-induced dry eye, the important factor is to use either a nonpreserved or a transiently preserved artificial tear,” she said. “For patients who are very dry after refractive surgery, GenTeal Gel has the advantage over the drop for patients who can use it because it lasts longer and it keeps the surface smooth. Any disruption of the tear film causes fluctuating vision. For instance, if you were so dry that you had to put an eye drop in your eye every 5 minutes, that’s tough if you are driving.”

Unlike some other surgeons, Dr. Battat does not have patients use drops preoperatively before LASIK.

“There is no evidence that using artificial tears preoperatively makes a difference. Dry eye status post-LASIK stems from cutting the corneal nerves with the microkeratome. Therefore, preoperative instillation of artificial tears shouldn’t make a difference, as it doesn’t enhance lacrimal function or corneal sensation,” she said.

According to Dr. Battat, dry eye symptoms arise from two distinct problems.

“I think of tears in two ways. I think of tear quantity and tear quality. Many patients who are dry just don’t have enough tears, so it’s a quantity problem. Those patients may benefit from topical artificial tears or punctal occlusion or in some cases topical cyclosporine,” she said.

The other problem occurs when patients are not dry, but rather have irritants in their tears.

“If it turns out that when you test patients with dry eye symptoms, they are not dry, eg Schirmer-1 is greater than 10 mm, then the problem is poor quality of tears,” she said. “This can be from a number of factors. If you don’t blink enough then your tears hang around longer and they tend to accumulate inflammatory mediators, such as metalloproteinases (MMP-3, MP-9) and interleukin-1.

“These inflammatory mediators stay on the ocular surface longer and cause irritation. Technically, those patients aren’t dry, they just have irritative symptoms. So in a patient like that you should not use a punctal plug because that only makes bad quality tears stay around longer. Those patients benefit from nonpreserved artificial tears or transiently preserved artificial tears because those tears will wash away that debris.

“Oral doxycycline and topical anti-inflammatory medications may also be beneficial in this situation,” Dr. Battat said.

For Your Information:

Lisa R. Battat, MD, can be reached at 1400 Locust St., Suite 3103, Pittsburgh, PA 15219 U.S.A.; +(1) 412-288-0885; fax: +(1) 412-391-5012; email: lb2c123@ aol.com. Dr. Battat has no direct financial interest in the products mentioned in this article, nor is she a paid consultant for any companies mentioned.

Novartis Ophthalmics can be reached at Granzstrasse 10, CH-8180 Bulach, Switzerland; +(41) 1-864-15-70; fax: +(41) 1-862-08-10.