VIDEO: Available treatment options in dry eye

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Dry eyes can be an overwhelming condition, not only for patients, but also for clinicians. I like to categorize our current treatment modalities for dry eye disease as kind of three broad buckets. So first, there's over-the-counter therapy. These are typically reserved for patients that maybe have mild disease or certainly can be used for patients with more moderate to severe disease, but often in those patients, it's not sufficient enough to control their disease. So these are things like artificial tears, nutraceuticals, or nutritional supplements such as omegas. There's also a variety of eyelid-based health products out there, such as cleansers and devices to do warm compresses. The other category is topical prescription therapy. We have kind of our foundational drugs that help to modulate the inflammatory response on the ocular surface. So starting as the most basic, that would be for example, topical steroids.

More recently there was a newer steroid that was FDA approved called EYSUVIS that has a novel drug delivery technology that allows it to penetrate into the targeted tissues in ocular surface disease such as the cornea and the conjunctiva. We have other therapies such as cyclosporine, lifitegrast, and those are really molecules that help to modulate the T-cell response in inflammation that's related to dry eye disease. These tend to be chronic medications, and so in a topical eye drop form. And then newest to the market is actually Varenicline nasal spray which is actually a nasal spray. So this is new to ophthalmology. We're not used to treating eye disease with nasal sprays, but it modulates the nerve response of the trigeminal nerve to increase what we call a complete tear. So it stimulates the lacrimal gland to produce aqueous. It stimulates the meibomian glands actually to the, actually the muscle of Riolan to contract so that the meibom comes out into the tear film. And then last but certainly not least, stimulation of the conjunctival cells to specifically the goblet cells to release mucin. We know that the tear film, the natural tear film, has a lot of additional properties such as growth factors and antibodies that help to protect and repair the surface. And so that's the newest treatment that we have that's a pharmaceutical based approach. And I think it's been really interesting to see how Tyrvaya or Varenicline solution has really been not only a primary therapy in dry eye disease, but also a complementary therapy to the other things that we have out there. So it's always nice to be able to have novel mechanisms and new pathways to complement our existing medications.

And then last but not least, of course we know meibomian gland disease is actually a very big part of dry eye disease. And so we don't to date have a lot of topical therapies for meibomian gland disease, but we do have a number of in-office treatments. So in our clinic, we offer things like tear care which involves heating of the meibomian glands and then a customized expression. There's other treatments such as iLux, which is heating and direct visualization with expression. And then also of course LipiFlow, which has been a foundational therapy and has been, was really the first FDA approved meibomian gland interventional therapy. And then there's also things like IPL, intense pulse light therapy, which is more of a broad spectrum light that's used to target the meibomian glands and specifically the vascularity along the eyelids that brings inflammation. So that's a lot. There are these broad categories and there's thankfully a lot of options within each category. I would say that after treating dry eye patients for a long time, it's very clear that one size does not fit all. And so it's really nice to have a lot of these options for us.