Dry eye research reveals impact of disease, potential new treatments
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NEW ORLEANS — Low-dose naltrexone decreased ocular pain and improved quality of life in patients with neuropathic corneal pain, according to Pam Theriot, OD, of Blink Eye Spa, who evaluated recent dry eye clinical research at SECO 2022.
Researchers from Tufts University published a study in Ocular Surface that evaluated one daily dose of 4.5 mg of naltrexone in patients with neuropathic corneal pain, which is caused by damage or disease of the somatosensory nervous system that innervates the cornea (Dieckmann et al.).
“This is a drug that’s been around for a long time,” Theriot said. “It’s used in much higher doses to get patients off opioids and alcohol.”
The study showed that after 30 days of use, the average pain score decreased from 6 points to 3 out of 10.
“Think about patients who are constantly feeling this on a daily basis,” Theriot said. “That’s huge that you’re getting a 50% reduction on that ocular pain score. It also increased the quality of life score because they’re not constantly thinking about their eyes. How many of you have patients with dry eye who say they think about their eyes all day long?”
The study showed few side effects, which included dreams, headache and stomachache.
“It was very well tolerated,” she added.
“This might be one of the pivotal studies that will bring this treatment to our patients,” Theriot said. “When I’m giving the 2026 update, we’ll be talking about a commercially available drug based on this study. We’re hoping this helps our patients with neuropathic corneal pain. If you have patients with this pain, you know it’s a difficult disease to manage, because that’s the one that’s ‘pain without stain.’”
Theriot cited a study from Nichols and colleagues, published in Investigative Ophthalmology & Visual Science, showing a 4% reduction in workplace productivity in patients with dry eye disease.
“The decrease was not related to signs, but the patient’s symptoms,” she said. “How the patient is feeling is how they’re performing at work. Whether or not they’re staining is irrelevant. They’re taking a break from the computer, rubbing their eyes, taking their attention off work. Continually rubbing eyes and adding drops is distracting.”
Dry eye is a chronic condition that progresses, Theriot said.
“People who are having symptoms today will have them 10 years from now, and those symptoms will be worse,” she added.
A systematic review and meta-analysis that evaluated 32 studies on depression and anxiety (Basilious et al.) showed that “depression and anxiety and ocular surface disease go hand in hand,” Theriot said.
The study found that 40% of dry eye patients had depression, which was 1.8 times more prevalent than in controls, and 39% had anxiety, which was 2.3 times higher.
“It was interesting to note that it was better correlated to the symptoms than the signs,” Theriot said. “So the way the patient thought they were doing much more correlated with the way the doctors were able to track their dryness.”
Theriot referred to this as a “vicious cycle.”
“You have dry eye, it makes you feel depressed, you can’t do the things you want to do,” she said. “You go to the doctor for an antidepressant, and your eyes get more dry.”
Polyfluoroalkyl substances (PFAS), which are added to North American cosmetics to increase durability and water resistance, also pose challenges for dry eye patients, Theriot said. She cited a 2021 study by Whitehead and colleagues that detailed the problem.
“These compounds are used in our cosmetics, and companies making them are not reporting the presence of them in their ingredient list,” she said. “That’s the big problem. In the U.S. it’s hard to know whether or not your products will have these compounds in them.”
They can be found in mascara, foundation and liquid lipstick, she said.
“They’re thought to be ‘forever compounds.’ They don’t break down in the body or in our water and rivers.”
The study authors called for better regulation to limit the widespread use of PFAS in cosmetics.
References:
- Basilious A, et al. Eur J Ophthalmol. 2021;doi:org/10.1177%2F11206721211060963.
- Dieckmann G, et al. Ocul Surf. 2021;doi:org/10.1016/j.jtos.2020.12.003.
- Nichols KK, et al. Invest Ophthalmol Vis Sci. 2016;doi:org/10.1167/iovs.16-19419.
- Whitehead HD, et al. Environ Sci Technol Lett. 2021;doi:org/10.1021/acs.estlett.1c00240.
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Theriot P. Ocular surface disease update. Presented at: SECO; March 9-13, 2022, New Orleans (hybrid meeting).
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