Treatment: Symptom Relief «

Treatment: Symptom Relief

The first goal of treatment for moderate to severe dry eye is to relieve symptoms and restore ocular comfort. This patient’s symptomatic complaints, along with tear hyperosmolarity in the right eye and signs of ocular surface damage, indicated that she needed additional treatment.

On top of the preservative-free artificial tear drop the patient was already using, I prescribed LACRISERT^® (hydroxypropyl cellulose ophthalmic insert), which acts to lubricate the eye and is indicated to treat moderate to severe dry eye.¹

Koffler BH, McDonald M, Nelinson D. Improved signs and symptoms and quality of life with dry eye syndrome: hydroxypropyl cellulose ophthalmic insert patient registry. Eye Contact Lens. 2010;3:170-6.

In addition to its lubricating effect and efficacy in symptom relief, what features of LACRISERT^® (hydroxypropyl cellulose ophthalmic insert) do you think I considered particularly beneficial for this patient?

○	a. Once-a-day dosing (some patients may require twice-a-day dosing) Yes. The patient had been expected to use artificial tears once every hour. LACRISERT^® inserts are typically placed once daily.¹ What other features of LACRISERT may benefit this patient? Please select again. Lacrisert [package insert] Bridgewater, NJ: Valeant Pharmaceuticals International, Inc.; 2014.
○	b. Continuous ocular surface protection Yes. The polymer slowly released from LACRISERT^® can thicken and stabilize the tear film, allowing it to remain on the ocular surface longer to help protect the surface.¹ What other features may be beneficial in this case? Please select again. Lacrisert [package insert] Bridgewater, NJ: Valeant Pharmaceuticals International, Inc.; 2014.
○	c. Safety This was not a particular concern in this case. Please select again.
○	d. Both a and b Yes. In most cases, LACRISERT^® requires application of only one insert each day; some patients may require twice daily use for optimal results. Because LACRISERT dissolves slowly, it is dosed once daily and acts to lubricate and protect the eye over that time period. This can be beneficial for patients with severe dry eye from Sjögren’s syndrome. These patients typically have a highly desiccated ocular surface and defective corneal sensation, which was the case with this patient. The reduced corneal sensation in these cases means that one important cue for taking a drop is missing. Reduced corneal sensitivity due to severe ocular dryness may impact drop usage, as these patients may delay application of artificial tears until vision disturbances occur, leaving the ocular surface at risk for further damage. To be proactive about helping to prevent such damage, I encourage use of LACRISERT in all my Sjögren’s syndrome patients with moderate to severe dry eye.

Indications and Usage

LACRISERT^® (hydroxypropyl cellulose ophthalmic insert) is indicated in patients with moderate to severe dry eye syndromes, including keratoconjunctivitis sicca. LACRISERT is indicated especially in patients who remain symptomatic after an adequate trial of therapy with artificial tear solutions. LACRISERT is also indicated for patients with exposure keratitis, decreased corneal sensitivity, and recurrent corneal erosions.

Important Safety Information

LACRISERT^® (hydroxypropyl cellulose ophthalmic insert) is contraindicated in patients who are hypersensitive to hydroxypropyl cellulose.
Instructions for inserting and removing LACRISERT should be carefully followed.
If improperly placed, LACRISERT may result in corneal abrasion. Because LACRISERT may cause transient blurred vision, patients should be instructed to exercise caution when driving or operating machinery.
The following adverse reactions have been reported, but were in most instances mild and temporary: transient blurring of vision, ocular discomfort or irritation, matting or stickiness of eyelashes, photophobia, hypersensitivity, eyelid edema, and hyperemia.

Please see full Prescribing Information for LACRISERT^® (hydroxypropyl cellulose ophthalmic insert).

Douglas K. Devries, OD, is a co-founder and managing partner of Eye Care Associates of Nevada and serves as both clinical director and optometric residency program director for the state-wide practice. He is an adjunct clinical professor of optometry at Pacific University and serves on the advisory board or speakers' bureau of Abbott Medical Optics, Alcon, Allergan, Akorn, Bio Tissue, BVI Medical, Bausch + Lomb, TearLab, NiCox, OcuSoft, and Ophthalmic Resources.

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