Sustained-release lubricating insert offers more convenient relief of post-LASIK dry eye
August 11, 2008
Artificial tears often provide comforting relief from dry eye problems after LASIK, PRK, epi-LASIK and other laser vision correction procedures.
But there's one problem: Most people forget to use them often enough or find it very inconvenient to use the drops several times a day.
A convenient once-daily dry eye treatment
A sustained-release prescription insert for dry eye prevention and treatment, called Lacrisert (Aton Pharma), may be the answer for many dry eye patients.
The insert is made of hydroxypropyl cellulose, a material similar to ingredients in some liquid artificial tear products. Inserted once-daily under the lower lid, the preservative-free insert lubricates the eye and stabilizes the tear film while it slowly dissolves over a period of several hours.
For severe dry eye, a second Lacrisert may be recommended for nighttime use.
The Lacrisert device has been available for years, but it has been in scarce supply until recently, when Aton Pharma bought the rights to distribute the product from Merck.
With refractive surgeons looking for effective and convenient way to treat dry eye after LASIK, there is increasing interest in this unique device.
Lacrisert use after LASIK and PRK
In a recent article in Ophthalmology Times, Bruce H. Koffler, MD, associate clinical professor at the University of Kentucky and medical director, Koffler Vision Group (Lexington, KY), explained that LASIK and PRK patients could benefit from the Lacrisert device.
Because laser vision correction (including LASIK, PRK, LASEK and epi-LASIK) damages corneal nerves that provide feedback to help the body produce enough tears to keep our eyes moist and comfortable, it's common for patients to experience dry eyes after these procedures until the corneal nerves regenerate. This process can take 3 to 6 months or longer.
During this period, use of the sustained-release Lacrisert device can prevent or alleviate dry eye problems until the patients' tear production increases.
According to Dr. Koffler, patients who have undergone PRK may benefit from the insert even more than LASIK patients in the days immediately following surgery. Since a surface procedure like PRK removes the corneal epithelium, a new layer of surface cells must grow back to replace it. (Loss of the epithelium frequently occurs during LASEK and epi-LASIK procedures as well.)
Keeping the eye lubricated after surgery may help the epithelium grow back faster. "Anything that we can do during that period of time to help the epithelium resurface and make the patient more comfortable is a real positive thing," says Dr. Koffler.
Other uses
Other uses for the Lacrisert device include the prevention and treatment of dry eye in patients with Bell's palsy or other conditions that interfere with normal blinking and lid closure or tear production.
The lubricating device is also useful for patients who undergo Botox (Allergan) injections and chemical peels of their face for cosmetic reasons.
Because these procedures tighten the skin around the eyes, these patients may not be able to blink their eyes properly or keep their lids closed during sleep for a period of time, leading to dry eye problems.