FORT LAUDERDALE, FLA. — Optimal management of dry eyes associated with Sjögren's syndrome isn't likely to involve just one solution.
Artificial tears come in assorted formulas, and patients can best manage their eye conditions by recognizing that a single product isn't likely to meet their various needs, William B. Trattler, M.D., said at a meeting sponsored by the Sjögren's Syndrome Foundation.
Patients who complain of burning and irritation from artificial tears should try a preservative-free formula, said Dr. Trattler, an ophthalmologist in private practice in Miami, with a special interest in external eye disease.
Preservative-free drops are typically sold as single-use vials, but a vial can be used in the morning and evening on two consecutive days if kept upright in the refrigerator, Dr. Trattler said. Refrigeration is important to inhibit the growth of bacteria, and cold drops can be more comfortable to use. However, drops with preservatives may be more convenient to keep in a pocket or purse or to carry when traveling.
Natural tears and some artificial products have an oily component to help keep liquid in the eye, Dr. Trattler said. Patients should be encouraged to select drops that meet their needs in various settings. Drops needed when working outside will be different from those needed when viewing a computer screen indoors.
If inflammation is present, patients can try cyclosporine ophthalmic emulsion (Restasis). Approved by the Food and Drug Administration in 2003, Restasis increases tear production and has anti-inflammatory properties, making it a good choice for patients with occluded tear ducts, noted Ashley Behrens, M.D., of Johns Hopkins University in Baltimore.
However, patients should be cautioned when using Restasis, since the effects of overuse of the drug are unknown. In the study that served as the basis for the FDA approval, the drops were used twice daily, but “using them more frequently won't necessarily add benefits,” Dr. Behrens said.
Both ophthalmologists, neither of whom reported a financial interest in any eye care product, recommended that Sjögren's patients use over-the-counter lubricant eye gels for periods of sleep. Warm compresses can provide relief, and specialized moisturizing goggles are available. In addition, patients should be advised to turn off ceiling fans at night.
In treatment-resistant cases, Sjögren's patients can have their tear ducts blocked with punctal plugs. The ducts drain the tears into the nose, and plugging them helps retain fluid in the eye. Cauterization of the tear ducts has the same result, but while plugs can be removed, cauterization permanently closes the ducts.
For patients who develop blepharitis, inflammation of the eyelids, Dr. Trattler recommends baby shampoo and warm compresses. The inflammation occurs when the oil that is a component of normal tears crystallizes on the lids, he explained.