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BLOG: What ‘dry eyes’ need is not water
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“It’s better to look good than to feel good,” said Billy Crystal’s interpretation of Fernando Lamas, and it’s unfortunate that some of our patients have to choose between these two in their use of beauty products. In the cover story of this issue of Ocular Surgery News, Cynthia Matossian, Chris Starr and Ashley Brissette present this little talked about topic in dry eye — the role of cosmetics and cosmetic products in causing ocular surface irritation. It is extremely well written and complete and is worthwhile reading for both eye care professionals and primary care providers.
To be honest, most of us physicians who treat dry eye probably do an inadequate job of educating patients on the side effects of these popular products. They can cause contact allergy or mechanical irritation, and they frequently leave behind residues that augment the eye’s natural biofilms and serve as a hiding place for bacteria to proliferate and cause damage to the lipid-secreting meibomian glands. Dysfunction and destruction in these glands then lead to lipid deficiency that is thought to underlie most cases of dry eye, according to experts’ evolving thinking on this subject.
While the mainstay of treatment of dry eye has long been artificial tear supplements, we now realize that “dry eyes” are more in need of a healthy lipid layer to stabilize the water that is already present. Treatments such as microblepharoexfoliation with BlephEx interrupt this cycle of dry eye by removing these biofilms. Procedures such as LipiFlow (Johnson & Johnson Vision) and iLux (Tear Film Innovations) warm and evacuate the meibomian glands to jumpstart lipid flow. These treatments are becoming popular among dry eye specialists because they target what eyes need most, a healthy lipid layer.
We may soon have a direct supplement to the lipid layer in a water-free artificial tear. While several companies have attempted to produce liposome-bound (or otherwise emulsified) lipid supplements, these have not enjoyed widespread popularity. Oral omega-3 supplements help, but not enough for most patients. A new product from Novaliq, a German company, contains a novel, water-free hydrocarbon bound to a perfluorocarbon that is approved and receiving increasing interest in Europe and may be available in the U.S. in the next 2 years. NOV03 is a low surface tension liquid with a drop volume of about 10 µL, one-fifth the size of a typical eye drop. This combination of characteristics makes it almost imperceptible when it’s applied to the eye, yet it quickly spreads to cover the surface of the eye with a super-thin, lipophilic layer that rests on top of the aqueous layer, boosting the thickness of the lipid layer. Because of its lipophilicity, it may also be ideally suited to deliver drugs such as cyclosporine that are generally difficult to deliver through an aqueous preparation. The company’s phase 2 trials for cyclosporine delivery show impressive results. And because the vehicle is water-free, it requires no irritating preservative to keep it stable and free of microbes during long-term storage.
When patients ask me if they need to give up their makeup, I always say the same thing: “I don’t ever stand between a lady and her beauty products.” This always gets a chuckle, and it really is my hope that we can help patients to both look good and feel good. Choosing cosmetic products wisely is a good start, and it’s very reassuring that we have a growing list of tools to treat lipid deficiency that may be most needed by these special patients.
Disclosure: Hovanesian reports he is a consultant to Johnson & Johnson Vision, Tear Film Innovations, BlephEx, Novartis, Allergan and Novaliq.