Alsuhaibani AH, Eid SA. Botulinum toxin injection and tear production. Curr Opin Ophthalmol. 2018;29(5):428-33. Badawi D. A novel system, TearCare, for the treatment of the signs and symptoms of dry eye disease. Clin Ophthalmol. 2018;12:683-94. Kala Pharmaceuticals. Focus on Eye Care. http://kalarx.com/technology/focus-on-eye-care. Accessed February 7, 2019. Shrivastava S, Patkar P, Ramakrishnan R, et al. Efficacy of rebamipide 2% ophthalmic solution in the treatment of dry eyes. Oman J Ophthalmol. 2018;11(3):207-12. The Olympia study compared the safety and efficacy of TearCare with that of LipiFlow. The initial results indicated that TBUT and meibomian secretion scores saw similar improvements with both treatments, but 90% of patients in the TearCare cohort had a clinically significant decrease in Ocular Surface Disease Index (OSDI) score vs. 79% in the LipiFlow arm. TearCare participants also used 22% fewer lubricant drops post-treatment. 24

Although DED is widely encountered in eye care practices, the number of pharmaceutical agents available to combat it pales in comparison with other chronic diseases. 1-3 Fortunately, new and upcoming dry eye medications may change the landscape of DED management for the better. Here is a comprehensive look at new dry eye drugs and a preview of treatment options of the future. Trigeminal nerve. OC-02 (Oyster Point Pharma) is a nasal spray of a nicotinic acetylcholine receptor agonist that stimulates the trigeminal nerve to increase natural tear production. 37 In Phase II trials, tear production and symptoms improved significantly. 37 The Dry Eye Device Boom NuLids is a new at-home system that works by gently stimulating and rejuvenating the Meibomian glands and is an effective alternative treatment for dry eye disease.

NuLids range for blepharitis and meibomian gland dysfunction

Cequa is a first-in-class topical formulation with the highest FDA-approved concentration of cyclosporine and a novel nanomiceller technology, which overcomes the longstanding challenges of cyclosporine’s delivery to ocular surface tissues. 6 The high hydrophobicity of the lipophilic CsA impedes the drug’s ability to penetrate the aqueous layer. 6,7 Cequa’s nanomiceller formulation overcomes this barrier by forming small micelles or aggregates of amphiphilic molecules where the water-loving polar heads form an outer shell that faces the aqueous, while the non-polar, water-hating tails are sequestered inward to form a hydrophobic core. 6 In recent years, platelet-derived products have found widespread use in wound healing and tissue regeneration. 23 Application of these products in DED makes use of the numerous similarities between natural tears and serum, including lipid, proteins, antimicrobial elements, and growth factors. 23, 24 Autologous and/or allogenic serum drops have been shown across multiple studies to improve both symptoms and objective signs of dry eye disease. 25– 28 Most recently, interest has grown in the use of other blood-derived products, specifically eye-platelet rich plasma (E-PRP) and plasma rich in growth factors (PGRF). These newer products contain three to five times the platelet concentration compared to serum drops and aim to maximize the concentration of growth factors, cell adhesion molecules and alpha-granule released cytokines. 23 E-PRP and PGRF also do not contain leukocytes, which are present in serum drops and may increase levels of pro-inflammatory cytokines that are detrimental to the ocular surface. 24 These higher concentrations of growth factors and other beneficial factors may result in substantial therapeutic effects on the ocular surface.

Li B, Fu H, Liu T, et al. Comparison of the therapeutic effect of Meibomian Thermal Pulsation LipiFlow on obstructive and hyposecretory meibomian gland dysfunction patients. Int Ophthalmol. 2020;40(12):3469-79. International Workshop on Meibomian Gland Dysfunction: report of the Definition and Classification Subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930-7. But when your eyes feel dry and gritty every day — as a result of aging, underlying health conditions, certain prescription drugs or long hours staring at a computer screen— your doctor may suggest a stronger treatment. A traditional treatment involves placing tiny devices called punctal plugs into your tear ducts to keep your natural tears in your eye.

In-home device targets meibomian gland dysfunction/stasis and blepharitis

Dr. Akpek uses LipiFlow on a regular basis. “LipiFlow is expensive, but it’s also effective, especially for mild to moderate posterior blepharitis,” she says. “It’s a cleanup modality for resetting the glands. Its advantages are that it treats both the upper and lower lids and it’s painless. However, it does not treat anterior blepharitis, and in my experience, it does not work well for severe disease.”