instrumental strategies

Dry Eye Insert Alert

Ophthalmic insert offers convenient relief of dry eye symptoms.

PAUL M. KARPECKI, O.D.

Artificial tears are an excellent means of lubricating the ocular surface and, therefore, alleviating the painful and annoying symptoms of dry eye (i.e. stinging, blurry vision, grittiness, etc.). However, some dry eye patients have to instill these products between six to 10 times daily to achieve symptom relief. This constant instillation has not only interfered with their daily activities — diminishing their quality of life — but, in some cases, caused additional ocular surface damage as the result of prolonged exposure to the benzalkonium chloride (BAK) preservative some of these products contain.

I've been able to restore these patients quality of life and quell their BAK-induced eye irritation by prescribing Lacrisert (hydroxypropyl cellulose ophthalmic insert), from Aton Pharmaceuticals.

Overview

Lacrisert is a Food and Drug Administration (FDA)-approved, tiny preservative-free, once-daily, sustained release rod-shaped ocular insert that the patient places. It slowly dissolves through the course of the day to retain moisture, stabilize and thicken the pre-corneal tear film and prolong tear-film breakup time. As a result, the device usually reduces the signs and symptoms of moderate to severe dry eye, such as conjunctival hyperemia, exudation, burning, foreign-body sensation, itching, photophobia, smarting, dryness, blurred or cloudy vision and corneal and conjunctival staining, as evident with Rose Bengal dye.¹ In addition, no known interactions with other ocular medications exist. Many of these patients will also benefit from the concomitant use of anti-inflammatory treatments, such as cyclosporine or corticosteroids.

Lacrisert ACTIVE INGREDIENT: 5mg of hydroxypropyl cellulose DIAMETER: 1.27mm LENGTH: 3.5mm DOSES PER BOX: 60 unit doses TOOLS: Two applicators (one is a spare) with applicator storage container. PATIENT COST: $175 to $200 not including co-pay)

I've found that most patients achieve symptom relief from once-daily usage, though some patients do achieve optimum relief with a second dosage. Regardless, those patients to whom I've prescribed Lacrisert have expressed gratitude, as they're no longer required to instill several artificial tears throughout the day to achieve symptom relief.

Researchers observed the amelioration of symptoms generally associated with keratoconjunctivitis sicca, such as itching, photophobia, foreign-body sensation, etc., in most patients treated for more than one year with Lacrisert.¹

In addition, studies conducted on healthy volunteers often revealed a thickened precorneal tear film via slit lamp exam while Lacrisert was present in the conjunctival sac.¹

Lacrisert has been particularly beneficial for some of my contact-lens dropouts, as it has quelled their dryness, enabling them to wear lenses again.

Patient education

Although Lacrisert comes with illustrated instructions, I suggest you have the patient read the directions while in the exam room and then practice insertion and removal prior to leaving. This ensures the patient knows precisely where he should place it — namely deep in the inferior cul-de-sac beneath the base of the tarsus.

If the patient incorrectly places the insert, it will be expelled into the intrapalpebral fissure and may cause foreign-body sensation or corneal abrasion.

In addition, educate the patient to avoid rubbing the Lacrisert eye(s), so he doesn't dislodge or expel it, causing him to have to use additional inserts (a waste).

I've discovered that some patients find insertion a bit challenging at first, but with training and encouragement, nearly all patients succeed, including my elderly patients. In fact, many of my arthritic patients have told me they prefer the once-daily insertion routine Lacrisert, as opposed to frequent artificial tear use.

Because some dry eye patients have to instill artificial tears multiple times throughout the day to achieve symptom relief — hindering their quality of life — and sometimes placing themselves at risk for BAK-induced ocular surface damage, they're thankful when we can provide them with an alternative therapy — Lacrisert.

In fact, their appreciation for this and other alternative ocular therapies has generated several referrals for my services. OM

1. Aton Pharma. Sterile Ophthalmic Insert Lacrisert (hydroxypropyl cellulose ophthalmic insert) http://www.lacrisert.com/attachments/Lacrisert_PI.pdf. Accessed Oct. 9, 2008.