Nasal spray activates tear film production

Patients who have dry eye disease now have another treatment option, namely varenicline solution nasal spray 0.03 mg (Tryvaya, Oyster Point), which is FDA approved for the treatment of the signs and symptoms of dry eye disease.

“There are patients who struggle to use drops because of dexterity issues, preservatives or contact lens wear,” says Josh Johnston, OD, FAAO, clinical director at Georgia Eye Partners, in Atlanta, who has started prescribing the nasal spray. “I find that this treatment is a welcomed addition to our dry eye disease armamentarium for these patients.”

OVERVIEW

Tryvaya is a selective cholinergic agonist that activates basal tear production. It is delivered b.i.d. in each nostril. Specifically, the nasal spray is believed to bind to cholinergic receptors, which activate the trigeminal parasympathetic pathway. This results in increased basal tear production.

“There has been plenty of curiosity regarding Tryvaya because it’s administered differently than the other treatments for dry eye disease, and its mechanism of action is allowing Mother Nature to tend to the condition,” explains Dr. Johnston.

The efficacy and safety of Tryvaya was studied in over 1,000 patients who had mild, moderate, or severe dry eye disease (DED) via clinical trials. Specifically, patients who used the nasal spray showed statistically significant improvements in tear film production, Schirmer’s score and Eye Dryness score compared to vehicle-treated patients. Regarding safety, 82% of patients reported sneezing, and 5% to 16% of patients reported cough, throat irritation, and instillation-site (nose) irritation.

“It does typically cause a sudden sneeze, which is something to give patients a heads-up about, but I have been using it since November, and I have trained myself not to sneeze,” remarks Pamela Theriot, OD, FAAO, of Lusk Eye Specialists in Shreveport, La.

She adds that she and her patients notice the moisture from the nasal spray all day long vs. just upon instillation.

SUCCESSFUL ADMINISTRATION

Douglas Devries, OD, of Eye Care Associates of Nevada in Sparks, Nev., says patients can achieve symptomatic relief from their DED by aiming the nasal spray toward the ear on the side the patient is spraying vs. sniffing it in, which is the action step for other nasal sprays.

“Proper administration reaches the mucosal passages to activate the trigeminal nerve and stimulate tear production,” he explains.

Dr. Theriot says Oyster Point facilitates the proper use of Tryvaya with a six-step handout that patients can take home.

“There is also a video that provides a demonstration if patients would like to watch it on their own time,” she adds. (See the video at bit.ly/TryvayaVideo .) OM