Dry Eyes Presentation
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Transcript of Dry Eyes Presentation
![Page 1: Dry Eyes Presentation](https://reader034.fdocuments.net/reader034/viewer/2022042522/55a72a911a28ab885e8b4860/html5/thumbnails/1.jpg)
Demystifying
Tear Substitutes
--Dr. C.A.P Prabhu
Sushrutha Eye Hospital
Mysore
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Goal:
• Alleviate symptoms
• Reduce ocular morbidity
• Prevent complications
• Improve the quality of life
• Improve productivity
• Maximize benefits at minimum cost
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Management of “Dry” Eyes
• Tear replacement
• Warm compresses
• Education & Lifestyle modification
• Control of inflammation
• Tear conservation
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How to keep “Dry” eye ‘not’ “Dry” ?
Can we use:
• Water?
• Saline?
• Tear Substitute?
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Tear Substitutes:
Gives relief of symptoms
Improve vision
Helps in restoration of normal ep. of cornea
and conj.
Improves the quality of life
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Which Tear Substitute ?
• So many formulations…
• So many companies…
• Are they all same?
• How to choose?
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Which drops?
Cause of dry eye
Severity
FormulationsCost and
affordability
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Demystify Tear Substitutes
• Components
• When to prefer?
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Ideal Tear Substitute
Works like normal tears
Should not alter the
clarity
Lower surface tension of the
tear film
Forms a hydrophilic
layer
Enhances the tear volume
Should not react with the tear proteins
Should not alter the lipid
layer
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Ideal tear substitute
pH: 6.5 to 7.5
Refractive Index: 1.336
Surface Tension: 40.1
+/- 1.5 dyne/cm
Osmolarity: 302 +/- 6.3 mosm /
L
Viscosity: 6-12 cps
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Anatomy of an artificial tear
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Demulcent?
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FDA - 6 groups of Ophthalmic Demulcents
• Cellulose derivatives
• Liquid polyols
• Dextran 70
• Gelatin
• Povidone
• Hyaluronic acid
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Cellulose Derivatives
• CMC: 0.25 - 2%
• HPMC: 0.2% -0.3%
• Oil in water emulsion
• Also helps Mucin and lipid deficiency
• Can be blended with Glycerine, Carnitine, Erythritol
• Refresh tears: 0.5% lower conc. -less blurring
• Refresh liquigel: 1.00%
• Momentary Blurring
• HPMC is found in Alcon brand lubricants
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Cellulose Derivatives
• Celluvisc 1% High viscosity CMC
• Refesh liquigel is a blend of 0.35% high visc. CMC +0.65%medium visc.
• Contrast sensitivity 24 min for celluviscvs 13 min for refresh liquigel
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Cellulose derivatives
Viscosity Retention time on eye surface
Celluvisc 350 + + + + + +
Liquigel 70 + + +
Systane 10 + + +
Refresh Tears 1 +
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Polyols
Sugar hydrogenated carbohydrates-polyhydric alcohols
Propylene glycol (PG)0.3%
Polyethylene glycol 400 0.4%(PEG 400)
Does not increases the viscosity
Combined with HP guar
Together forms a cross linked Mucomimetic layer
Increase Retention time
Protects corneal surface & promotes repair
Better lubricity > HPMC > CMC
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Dextran 70
High mole.wt.polysacharide
Enhances the demulcent nature of HMC
Tears Naturale: 0.3% HPMC +0.1% dextran 70
More viscous & Soothing drop
Increases the retention time
Evaporative dry eyes
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Glycerine
Polyols
Glycerine 0.2%
Absorbs water
Polysorbate 80 used oil incorporated emulsions
Refresh endura, Soothe etc.
Inactive ingredient in restasis along with cyclosporine A
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Poly Vinyl Alcohol
One of early lubricants . Hydrophilic
polymer
All purpose lubricant
Almost doubles TUBT
0.1% to 4%
Tears plus
Can be combined
with PEG 400 or povidone
(0.6%)
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Povidone(Poly Vinyl Pyrollodine)
Iodine -antiseptic
Demulcent property
Increses solubility
Pataday -Olopatadine
2%
Increases the retention
time
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Hyaluronic
Normally found in joints, vitreous gel & tears
High water retaining property
Increases bio adhesion
Example: Blink tears, Hyla, Hyvisc, etc.
More useful in Aqueous deficiency
acid
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Carbomer 980
Cross linked Poly
Acrylate Polymer
High clarity & viscosity
Short flow properties
High retention time on
eye
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• Reliable viscosity agent
• Seldom used
Gelatin
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Osmoprotectants
L Carnitine
Erythritol
Taurine
Trehalose, etc.
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Bi-carbonate
Normal component of natural tears
It helps in maintaining Mucin layer everywhere
It helps in repairing and maintaining epithelial layer
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Potassium
It helps in maintaining Corneal Thickness
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Ointments
Mineral oil
White petrolatum
HPMC
Preservative
Night application
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Mild- 0.5 % CMC, 0.3% HPMC or Carbomer
Moderate -polyols +/-
gelling agents
Severe - 1% CMC ,
hyaluronic acid, with osmo protectants
Combination of 2 different
tear substitutes
Totally preservative
free
Ointments, gels
Which Tear Substitute?
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How Refresh Liquigel is beneficial
Extra Protection
A blend of high and medium – molecular
weight CMC polymers for optimum viscosity 6
With added electrolytes 6
6. Simmons et.al, Refresh Liquigel A New Approach to the treatment of persistent dry eye, Ophthalmic Pract, 2002;20(2):77-80
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How Refresh Liquigel is beneficial
Extra Action
Superior mucoadhesivity due
to its polyanioniccharge 6
Mimics the natural mucins of ocular
surface 66. Simmons et.al, Refresh Liquigel A New Approach to the treatment of persistent dry eye, Ophthalmic Pract,
2002;20(2):77-80
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How Refresh Liquigel is beneficial
Extra Relief
Brings about significant reduction in signs and symptoms of dry eye 7
Provides continued improvement over time 6
Brings about Goblet Cell Regeneration
6. Simmons et.al, Refresh Liquigel A New Approach to the treatment of persistent dry eye, Ophthalmic Pract, 2002;20(2):77-80,7. Simmons et. al, Clinical performance of a mid-viscosity artificial tear for dry eye treatment,
Cornea. 2007 Apr;26(3):294-302.
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Thank you