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Sjögren Syndrome
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Patients with dry eyes (xerophthalmia or keratoconjunctivitis sicca) may receive tear substitutes (artificial tears [preservative-free products, hypotonic solutions, and emulsions], autologous serum eye drops and platelet releasate); secretagogues (pilocarpine, cevimeline); cyclosporine A eye drops 0.1%; short-term topical corticosteroids; and/or punctal plugs.
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Treatment is with adequate lubricating drops and in some cases temporary lacrimal punctal occlusion with silicone punctal plugs to decrease tear drainage. Tarsorraphy should also be considered. Prognosis is reasonable if treated early.
Blepharoplasty
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Keratoconjunctivitis sicca (dry eye syndrome) is most often seen in patients who have a pre-existing tear film insufficiency. This should be specifically examined for pre-operatively and the patient counselled accordingly. This can be particularly important in patients who have undergone corneal refractive procedures (e.g. LASIK) or who wear contact lenses. The consistent continued use of frequent artificial tears is imperative in these patients who may also require additional procedures at a later date (e.g. punctal plug placement or punctal cautery). Patients who require artificial tears more frequently than three or four times per day should use a preservative free preparation.
Sustained release ocular drug delivery systems for glaucoma therapy
Published in Expert Opinion on Drug Delivery, 2023
Zinah K. Al-Qaysi, Ian G. Beadham, Sianne L. Schwikkard, Joseph C. Bear, Ali A. Al-Kinani, Raid G. Alany
Punctual plugs are tiny, biocompatible devices inserted into tear ducts (canaliculi) to block tear drainage and maintain contact between the tears and the ocular surface. Punctual plugs are more comfortable than surface implants, and their insertion is less invasive. Improved efficacy and drug dose reduction are potential advantages of punctual plugs over conventional eye drop formulations. However, common drawbacks of these devices include excessive tearing, displacement, or ejection, bacterial infection from the occlusion, and foreign body sensation [4,96]. Diffusion is the mechanism by which a drug is released from a punctual plug into the tear fluid. Punctual plugs containing both solid and semisolid drug preparations have been developed with sustained-release properties of up to 3–4 months [109]. OTX-TP, Latanoprost punctual plug delivery system (L-PPDS)/Evolute are examples of such punctual plugs [52].
Sustained release glaucoma therapies: Novel modalities for overcoming key treatment barriers associated with topical medications
Published in Annals of Medicine, 2022
Aditya Belamkar, Alon Harris, Ryan Zukerman, Brent Siesky, Francesco Oddone, Alice Verticchio Vercellin, Thomas A. Ciulla
Ocular Therapeutix (OTX) (Bedford, Massachusetts) designed an intracanalicular punctal plug, OTX-TP, for the delivery of travoprost to the ocular surface. Traditionally, punctal plugs, also known as lacrimal plugs, are commonly used to treat dry eye. By preventing the drainage of tears through the nasolacrimal duct, punctal plugs help maintain the volume of tears on the eye surface [81]. Punctal plugs have the benefit of being easily inserted and removed in a clinical setting while also being largely well-tolerated by patients. Recently, it has been suggested that punctal plugs could be utilized as SR drug delivery systems by loading the plug with a specific drug, allowing the eluted drug to mix with the tear fluid for delivery to the eye surface and intraocular tissues with greater efficacy and bioavailability than eye drops.
Common systemic medications that every optometrist should know
Published in Clinical and Experimental Optometry, 2022
Anti-hypertensive medications have been reported to exacerbate dry eye symptoms. The Physicians’ Health Studies used a cross-sectional prevalence survey to estimate risk factors for dry eye disease. The risk factors leading to increased prevalence of dry eye included age, hypertension, and use of anti-hypertensives.3 Beta blockers decrease lysozyme levels and immunoglobulin A, causing a decrease in aqueous production with symptoms of dry eye.8 Additionally, diuretics cause decreased lacrimation, thus inducing dry eye symptoms.3 These associations have commonly been recorded in the literature, so eye care providers should be monitoring for dry eye signs in patients taking anti-hypertensive medications. These signs may be observed clinically with aqueous production tests, such as Schirmer’s test, phenol red test, and observation of the tear meniscus height. Patients with aqueous deficient dry eye may benefit from punctal plugs and/or artificial tears in order to increase tear volume and prevent keratitis.