This article was originally published in a sponsored newsletter.

Remember that one thing your grandma always told you to do when you were a child, no matter what your ailment was? My grandma swore by hot tea: tea for stomachaches, tea for sore throats, tea for sadness, tea for almost everything. Tea really is good for many things, but there are times when it’s not a cure-all.

Lid wipes for eye issues are much the same. They’re good for dry eye, meibomian gland dysfunction, allergies, infections, chalazion, hordeola and more. However, when my patients need additional treatment, I’m able to offer them several options. I always follow the TFOS DEWS II report as my next step. However, in challenging cases where patients’ conditions still don’t respond to traditional prescriptions, we may need to create our own with help from compounding pharmacies.

How do you choose a compounding pharmacy? I have found that it is best to use a pharmacy that is owned by a company with an outstanding reputation. Of course, check that they have the necessary 503A and 503B accreditation before sending a prescription. These accredited compounding pharmacies are held to FDA standards in addition to specific state standards, so we can be certain that our patients will receive the medication we prescribe, as we prescribe it. You can e-prescribe to a compounding pharmacy once you add it to your EHR system, and most accept faxed prescriptions when necessary. The need for compounding will still be limited for most practices, but knowing that we have a safe option for targeted treatment may be a game-changer for your patients who don’t respond to typical prescriptions.

Compounded drugs that you may find helpful as starting points for eyelid disease are:

1. Lid spray with azithromycin dihydrate 1% with OCuSOFT Lid Scrub Plus Eyelid Cleanser.
2. Add diclofenac sodium 0.1% to the azithromycin dihydrate 1% lid spray and OCuSOFT Lid Scrub Plus Eyelid Cleanser above. This prescription is an antibiotic, anti-inflammatory, and eyelid cleanser all in one.

As our understanding of dry eye continues to expand, it is important that we add to the tried-and-true treatment of lid wipes because, as good as they are, they are not always enough. Follow the stages of dry eye treatment from TFOS, but also be ready to use additional, targeted treatment for patients who need more.

APRIL JASPER, OD, FAAO graduated from Nova Southeastern University College of Optometry with highest honors in 1995. She is the owner of Advanced Eyecare Specialists in West Palm Beach, FL. Dr. Jasper completed her residency in primary care, ocular disease and contact lenses in Boston, MA where she also held a position as adjunct professor at NEWENCO. Dr. Jasper has served her patients and colleagues as president of the Florida Optometric Association 2016 to 2017. She continues to share her knowledge and expertise around the world authoring numerous publications, lecturing and as chief editor of Optometric Management magazine.