Treatment Of Severe Dry Eye Disease Research Articles

A comparative study of efficacy of chloroquine phosphate 0.03% and sodium carboxymethylcellulose 1% in dry eye

Dry eye disease (DED) is a multifactorial disease of the tear film which leads to ocular discomfort, visual disturbances and damage to ocular surface. The objective of treatment of DED has now shifted from managemnt of ocular symptoms and patient relief to attainment of normal physiological composition of the tear film.Aim of this study was to compare the efficacy of chloroquine phosphate 0.03% (CQP) eye drops with sodium carboxymethyl cellulose 1% (CMC) eye drops in the management of DED.A single blind, prospective and comparative study including 100 patients of dry eyes was planned. The patients were randomly divided into two groups, each comprising of 50 patients. Group-1 patients were given CMC 1% eye drops 4 times a day for 12 weeks and Group-2 patients were given CQP 0.03% eye drops as the treatment modality 2 times a day for 12 weeks. The efficacy of both the drugs was compared and evaluated statistically.The study showed that both CQP and CMC eye drops are effective in treating DED, although faster onset of action was observed with CQP on ocular surface staining tests and Schirmer’s test. Also, it was noted that patients with severe DED showed least improvement in both the groups suggesting that mono-drug therapy is least effective in treatment of severe DED and multi drug therapy should be used early in treatment of severe DED.

Methods of drug therapy for severe dry eye disease

Treatment of chronic dystrophic diseases of the ocular surface always requires concomitant correction of severe dry eye disease (DED). The purpose of this publication was to analyze the literature data illustrating the current trends in the development of drug therapy for severe dry eye disease of non-Shegren’s etiology.The search for thematic publications was carried out in the PubMed database. The query “(dry-eye-disease AND treatment) NOT Sjögren” (filter: clinical trials, randomized controlled clinical trials, meta-analyzes) found 56 results since 2019.The review included 11 publications describing the results of clinical studies of the effectiveness of drug methods in the treatment of severe DED.In the treatment of severe DED, the prevailing direction of research is the relief of inflammation in the ocular surface tissues. Among the non-steroidal immunomodulatory drugs, the majority of studies were dedicated to cyclosporine, including its nanoemulsion form, diquafosol and bevacizumab. Their effectiveness and safety have been proven. In the Republic of Belarus, there is no unified approach to the management of patients with severe and comorbid DED. The main focus is on the activation of regenerative processes. Platelet rich plasma and subconjunctival administration of low molecular weight sodium hyaluronate demonstrated high efficiency.

Autologous serum eye drops versus lacrimal gland injection of platelet-rich plasma for severe dry eye

Aim The aim of this study was to evaluate the use of autologous serum (AS) eye drops versus lacrimal gland injection of platelet-rich plasma (PRP) in the treatment of severe dry-eye disease (DED).Setting and design This is a prospective comparative interventional study that was carried out at Eye Tech Centre, Alexandria, Egypt.Patients and methods The study included 40 eyes of 20 patients with severe DED. They were randomized into two groups: group A received lacrimal gland injection of PRP transcutaneously into the external one-third of the orbital rim at a depth of 4 mm to the superior area on days 0, 30, 60, and 90, while group B received AS eye drops five times daily for the duration of the study. Both groups received preservative-free artificial tears eye drops (hyaluronic acid) —three to five times daily for the study duration. The patients were followed up for 12 weeks after the first injection or the initiation of AS eye drops for the subjective changes in symptoms and in ocular surface parameters.Results The patients’ age ranged from 46 to 71 years (mean=56.0±8.2 years). Both groups showed a significant improvement of dry-eye symptoms (P<0.05) using the Ocular Surface Disease Index scoring with group B having more significant improvement of symptoms compared with group A patients after 3 months of follow-up (P<0.05). Schirmer’s test I showed a statistically significant improvement in both groups over the follow-up period (P<0.05), with no statistically significant difference between the two groups after 3 months (P>0.05). The other ocular surface parameters, using the ocular surface analyzer, including the noninvasive tear breakup time, tear-meniscus height, and lipid-layer thickness, showed significant improvement in both groups (P<0.001), while the meibomian gland loss area showed no statistically significant change throughout the follow-up period, with no statistically significant difference between the two groups after 3 months (P>0.05).Conclusions Both AS and lacrimal gland injection of PRP proved the safety and efficacy in the treatment of severe DED and were comparable. More studies are needed to confirm these results.

Severe Dry Eye Disease – Facing the Treatment Challenges

Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear instability with potential damage to the ocular surface. It is often accompanied by hyperosmolarity of the tear film and inflammation of the ocular surface. The symposium ‘Severe Dry Eye Disease – Facing the Treatment Challenges’ held at the International Symposium on Ocular Pharmacology and Therapeutics (ISOPT) included four presentations from ophthalmological experts. The first presented a clinicalbased approach to facilitate the evaluation of DED in clinical practice and to provide ophthalmologists with straightforward tools to address objective signs of the disease and to alleviate subjective patients’ symptoms. This was followed by a description of a stepwise approach to anti-inflammatory treatment of severe DED, highlighting the usefulness of topical ciclosporin for treating inflammatory conditions of the ocular surface such as severe DED. This was illustrated by the third speaker who presented the results of a clinical study (SICCANOVE) showing that, compared with vehicle, treatment with ciclosporin 0.1% yielded reduced corneal damage in patients with severe DED that appeared to be enhanced in patients with more severe keratitis. Last, a diagnostic algorithm of severe DED provided by a group of European experts (ODISSEY) was presented to facilitate important decision-making in advanced stages of the disease. The need for a consensus in diagnosis, terminology and therapy at a European and international level was emphasised. Aside from the intention to make diagnosis less complicated and technically advanced, the aspects of immunomodulatory treatment were addressed as an area for future research. Other future objectives in the treatment of DED include detection of possible precursor stages to offer the possibility of preventative care. Social economic effects are also important and increased international collaboration will be needed to address global inconsistencies in treatment.