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New Hope for Extreme Dry Eye

Nishika Reddy, MD, right, and a patient discuss a new treatment option for extreme dry eye available at the Moran Eye Center.
Nishika Reddy, MD, right, and a patient discuss a new treatment option for extreme dry eye available at the Moran Eye Center.

Three new treatments are among the options available for this complex condition that affects millions.

Dry eye disease affects almost 20 million people in the U.S. yet remains notoriously misdiagnosed and underrated.

That is, in part, because dry eye is a complex condition with a range of potential causes and symptoms, explains John A. Moran Eye Center ophthalmologist Nishika Reddy, MD.

“It can manifest if your tear gland doesn’t make enough tears. It can also happen if tears don’t contain enough oil, which causes them to evaporate too quickly. For some people, the condition causes mild irritation and redness. For others, it can bring on blurry vision and eye pain that can disrupt everyday life,” Reddy says. “Fortunately, we have access to some highly effective new treatments for patients experiencing that kind of disruption.”

Reddy, a corneal specialist, uses her expertise to diagnose patients, consider underlying causes, and guide them through their options.

“Often what’s successful is a variety of ongoing treatments,” she says. “Unfortunately, right now, most health insurers do not cover the newest treatments, but for some patients, it’s worth the out-of-pocket expense.”

Latest FDA-Approved Options for Dry Eye

On the extreme side of dry eye, Reddy treats patients with meibomian gland dysfunction (MGD), a condition caused by the dysfunction of a few dozen tiny eyelid glands that help make the oil layer of tears. This layer, one of three that keep the eye surface from drying out too quickly, is critical. When the meibomian glands get clogged, less oil reaches the eye surface, and tears dry out too quickly.

“Not all patients with dry eye have MGD, so they need a good exam to make sure that’s the condition. Often, it’s patients with significant symptoms who have not had good results with over-the-counter treatments such as artificial tears, warm compresses, and eyelid scrubs,” says Reddy.

“In these cases, I may recommend TearCare—a painless procedure where we place a noninvasive, comfortable device on both eyelids for 15 minutes to gently warm the meibomian glands. While the device is doing its work, the patient can just relax. Then, while the glands are nice and warm, I come in and express, or ‘clean out,’ the glands.”

Patients need to repeat the procedure in three months, and Reddy cautions the treatment does not negate the need for drops or other medications.

Excessive tear evaporation can trigger a chronic cycle of inflammation and friction, damaging the ocular surface and disrupting the intricate balance among the many layers of the eye’s surface. For some people, that includes a chronic stinging sensation, a feeling that something foreign is in the eye, or other irritations.

“Studies have shown that Miebo, a prescription eye drop that directly targets excessive tear evaporation instead of tear formation, is highly effective,” Reddy says. "The solution, called perfluorohexyloctane, is designed to mimic a key natural function where meibomian glands produce a lipid-rich secretion that forms the tear film lipid layer and helps to maintain a healthy ocular surface.”

Tyrvaya (Varenicline solution) offers another option for patients whose eyes don’t make enough tears. It’s a nasal spray that kick-starts your body to produce its own natural tears.

“Tyrvaya works by activating glands and cells connected to a nerve inside your nose that is part of the pathway for controlling tear film production,” explains Reddy. “In some cases, it can help relieve symptoms for people who haven’t had success with other therapies.”

What Causes Dry Eye

When a person blinks, a protective layer called the tear film spreads across the surface of the eyes to provide protection and nourishment.

When one or more of the three layers of the tear film are out of balance, it can trigger the cycle of disruptive dry eye. 

The tear film is made of three layers:

  • The aqueous layer helps distribute natural tears over the eyes, keeping them moist and free of foreign particles. 
  • The lipid layer keeps the aqueous fluid from evaporating so the eyes stay lubricated.
  • The mucin layer helps distribute tears over a person’s eyes and keeps the tears on the surface.
Dry Eye Graphic

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