dry eye dx and tx
A Sustained-Release Insert for Moderate to Severe Dry Eye
BY ANN LAURENZI, OD, FAAO
Lacrisert (Aton Pharmacy) is a once-daily, preservative-free, prescription ophthalmic insert made of hydroxypropyl cellulose. The inserts are small soft pellets that look like collagen plugs and are placed in the inferior cul-de-sac, where they immediately absorb fluid and dissolve slowly over the course of the day. Lacrisert inserts act to stabilize and thicken the pre-corneal tear film, increase tear breakup time and retain moisture throughout the entire day. The all-day lubrication is different from artificial tears, which can have a residence time measured in minutes.
Because dry eye syndrome is an increasingly common disease and very prevalent in contact lens wearers, practitioners need to have all therapeutic modalities available to treat patients on an individual basis.
The Lacrisert insert is FDA-approved for use in patients who have moderate to severe dry eye. This represents a large group with diverse needs such as patients who are not getting relief with frequent instillation of artificial tears or who are unable to instill artificial tears. Patients who have corneal exposure conditions such as Bell's palsy, lid trauma/surgery or abnormal blinks with incomplete closure benefit from the sustained protection provided by the insert. Patients who have ocular surface disease, Sjögren's syndrome, rheumatoid disease, superior limbic keratitis and limbal stem cell disease benefit from the gradual continued release of the polymer to lubricate the eye.
Lacrisert inserts are preservative-free, have no known drug interactions and are suitable for contact lens wearers. Lens-wearing patients should apply their contact lenses first and then place the Lacrisert insert in the inferior cul-de-sac with a plastic applicator (Figure 1) or their finger followed by a drop of artificial tears to start the dissolution process.
Figure 1. Lacrisert is placed in the inferior cul-de-sac.
Contact lens patients who are candidates for the inserts include those who have moderate symptoms of dry eye, those who are using multiple doses of rewetting drops without relief, those who are sensitive to preservatives or those who need to establish a thicker pre-corneal tear film to wear a contact lens. The latter group may include keratoconus patients who have no choice but to wear GP lenses and who experience constant mechanical trauma to an already fragile epithelium or post-surgical transplant patients who have surgically induced dry eye and need to wear a contact lens for visual rehabilitation. Thickening the precorneal tear film and sustaining it throughout the day may provide improved comfort and longer contact lens wear time for these patients. Lacrisert inserts may be used in conjunction with instillation of artificial tears or rewetting drops to provide these patients with optimum relief.
Add to Your Treatment Arsenal
Consider Lacrisert inserts as a treatment used alone or in combination with other regimens for your dry eye, diseased eye and contact lens-wearing patients who are in need of therapy. One more effective alternative therapy for this diverse and ever-growing population should always be a welcome option. CLS
Dr. Laurenzi practices at the Cole Eye Institute in Cleveland, Ohio where she specializes in refractive surgery co-management, contact lenses and clinical research.