Treatment: Regimen of Tear Supplementation «

Treatment: Regimen of Tear Supplementation

The patient had been using topical cyclosporine for months when I first saw him. Since he saw no significant improvement, I counseled him to discontinue use of the prescription medicine.

Artificial tears can supplement the tear film and lubricate the ocular surface, but the therapeutic effect is typically brief owing to the solutions’ short retention time on the ocular surface. To relieve this patient’s dry eye symptoms while wearing contact lenses would require artificial tears to be taken at a frequency of at least 4 or 5 times per day.

Given the patient’s age and his desire not to use artificial tears multiple times each day, I considered LACRISERT^® (hydroxypropyl cellulose ophthalmic insert) a suitable lubrication therapy for him. In most cases, a single daily application of the ophthalmic insert can protect and lubricate the ocular surface to relieve dry eye symptoms.¹ Some patients may require twice daily use for optimal results. The insert’s continuous lubricating effect, in my clinical experience, is beneficial for appropriate contact lens patients with moderate to severe dry eye.

Lacrisert [package insert] Bridgewater, NJ: Valeant Pharmaceuticals International, Inc.; 2014.

I prescribed LACRISERT^® (hydroxypropyl cellulose ophthalmic insert), and instructed the patient to apply one insert each morning. What else do you think I recommended to this patient?

○	a. A preservative-free artificial tear Yes. The preservative-free artificial tear can be used both as needed for symptom relief during the day and on top of the LACRISERT^® insert to help it dissolve. What else do you think I recommended? Please select again.
○	b. A thick lubricating ointment Yes. Nighttime use of ointments can help reduce corneal exposure and dryness caused by nocturnal lagophthalmos. What else do you think I recommended? Please select again.
○	c. Rigid gas permeable lenses This was not my recommendation. The patient was able to obtain acceptable comfort and good vision in soft lenses, so I saw no reason to change them. Please select again.
○	d. Both a and b Yes. I routinely recommend applying LACRISERT^® with a drop of preservative-free artificial tear on top to help start the dissolving process. The patient can also use the artificial tear as needed during the day for extra ocular comfort. Because this patient had microlagophthalmos, nighttime treatment with an ointment is important to help protect the ocular surface from exposure and drying. For patients with moderate to severe dry eye who do not like using ointments, LACRISERT placed in the eye before bedtime can help provide needed nighttime lubrication and protection. But in this particular case, the patient had no problem using ointments at night.

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).

Jack L. Schaeffer, OD, FAAO, is president, CEO, and chief of optometry at Schaeffer Eye Center in Birmingham, AL. He is a consultant for Bausch + Lomb.

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