New Advances in Tear Film Insufficiency (Dry Eye) Therapy – Dr. Aaron Glass
These are exiting days for those of us who suffer from burning, tearing, itching, blurry vision coming from a poor quality tear film. With the addition of prescription Xiidra to the marketplace in 2016, to the additional exposure that offered through Shire, we are excited to see that there are new things on the horizon.
Allergan, the maker of Restasis, has purchased and is ready to bring to market “neuro-stimulation” to help with the tear film. Before we go into the details of that product, let’s review the parts of the tear film and talk about why they are important.
The upper layer of the tear film is a specialized oil layer called ‘mebum’ that comes from vertically oriented tubes in the upper and lower eyelids. These glands are stimulated by blinking and help create an evaporation barrier so the tear film does not break down.
The middle layer of the tears is ‘aqeuous’ that is the liquid volume. But it’s not only just saline made by our lacrimal glands! There is a host of anti-inflammatory mediators and anti-oxidants that help fight off would-be assailants to our corneas, like bacteria.
The innermost layer is the anchor / foundation of the tear film, a mucous layer called “mucin” produced by goblet cells. This layer is important because the cells of the cornea naturally do not like water (hydrophobic) and the tears are full of water. This acts like a ‘surfactant’ and makes the tears stick to something that they are not supposed to stick to naturally!
So we can treat with artificial tears which have synthetic components of all three layers, but there is not “mother’s milk” goodness with the anti-inflammatory mediators.
We can have the patient do hot compresses, take omega-3 supplements and perform blink exercises that stimulate the meibomian glands to create a better oil layer for protection of the tears.
We can also prescribe Xiidra and Restasis that are designed to stop the cycle of inflammation of dry eye and help the body produce more natural tears and higher quality tears, but these medications can take a month to 90 days of continual use before the patient notes any major significant changes in how their eyes feel!
BUT, what if we could use something like a “tens unit” and stimulate through electrical pulse ALL THREE LAYERS of the tear film and start to provide immediate relief??? The field of neuro-stimulation has been growing rapidly for years. That product is called “TruTear” and we should begin to see it within a few months of the publication of this blog!
Before you get images of something ‘shocking’ you like “the machine” from “The Princess Bride,” let’s talk about patient experience in trials done in Arizona. The instrument is handheld and has a replaceable tip that is placed into the nostrils of the nose to stimulate the “tri-geminal” ganglion which is the neurological gateway to tear production. Apparently 10 minutes of gentle stimulation two times a day creates an increase in production of all three layers of the tear film which greatly reduces symptoms. In the terms of a recent speaker for Allergan in Raleigh, NC, “the oils just started gushing out of the glands.” The 350 people or so who participated in the study were NOT happy when the study was over and the units had to be collected.
We will have a unit in our offices shortly for patients suffering with dry eye to try and purchase if they desire. The tips are replaceable for sanitary reasons and from what we understand will be connected to your smart phone via Bluetooth for control of the time and strength of the signal.
If you are suffering from concerns with dry eye, do not wait to get treatment as it is a chronic condition and it will only get worse on its own. Once the oil glands in the eyelids have atrophied (died) due to non use we cannot get them back!
Call our office today to schedule an appointment with Dr. Aaron Glass, and God bless you!