Do prescription dry eye medications really work?
If you have seen an eye doctor for your dry eye complaints in the last 3 years, then probably your doctor has explained to you the benefits of using a prescription dry eye medication. In my book, Alleviate Dry Eye, I advocate a 4 step treatment process. All four arms of the treatment need to be addressed for your personalized treatment plant to be successful.
The four parts of a complete dry eye treatment plan are to tackle: inflammation, biofilm, obstruction, and tear film. Prescription dry eye medications reduce the inflammation component of your dry eye symptoms. To see the chart of all 4 parts of the In-office and Prescription Treatment options, please look at Table 2.1 in the book, or download the workbook that accompanies the book for free here. You will find the table on page 18 of the workbook.
Why is conquering inflammation so important?
I like to tell a quick story to illustrate this point. When I was in optometry school I lived in a house with 5 other girls. We were all attending the University of California at Berkeley in some program or another. As most of you know, the cost of housing in the Bay Area is astronomical even back in the late 1990s when I was there. So, I lived in a big house with lots of roommates.
Well, one of my roommates got bronchitis one winter. She coughed and coughed and lost sleep. She saw the doctor but just couldn't seem to shake the illness. She began to get more weak as the illness went on. She lost sleep from all the coughing. We couldn't understand why she wasn't getting any better. When I asked her about the treatment the doctor had prescribed she told me that a steroid pill was recommended, but she didn't want to take it. She thought that steroids had too many side effects, and she didn't want to take something that could cause her to gain weight and have mood swings.
I explained to her that medications are prescribed by your doctor to be taken together to get the full benefit of the treatment. This is why we refer to it as a treatment plan. You need to take all the parts to get well in lots of cases. She couldn't only take the antibiotic, without the steroid, as fully recover from her bronchitis.
Inflammation is a natural by-product of your body's immune system. The inflammation in my friend's lung was making it difficult for her to breathe. The antibiotic may have killed off the infection which started the inflammation, but her immune system was keeping the inflammation around. She was not feeling better because of the inflammation. And, she would not get better completely until the inflammation was gone.
I like to explain the pain or discomfort of dry eyes to my patients like this:
Inflammation = Swelling = Pain
We have all twisted our ankle or knee in our lifetime. We know that when we injure those joints, they swell. That swelling is the inflammation caused by our immune system when it is activated to repair the injury. And, we all know that the swelling hurts. The pain is unlikely to subside until the swelling does as well.
The same is true in your eye. The lack of moisture in your eye is not the usual state of your eye. Your immune system goes in to fix the situation and inflammatory factors are released. These factors cause the discomfort associated with your dry eyes. The discomfort will not completely subside until the inflammation does.
You may temporarily make the pain or discomfort feel better by using an artificial tear to flush your eyes. However, you have noticed that the discomfort returns when the inflammatory factors are released again. In lots of cases, this only takes minutes to return.
Anti-Inflammatory Medications
Scientists believe that inflammation on the surface of the eye plays a big role in causing both the symptoms you feel with your dry eyes and also chronicity of the disease. Inflammation is your immune system's response to stress on your eyes, irritation from lack of tears or lack of blinking, an over-growth of bacteria, toxins released from these bacteria or improper use of makeup and skincare products around the eyes. There are many different causes of the stress on your eyes which leads to them feeling dry. And, most of us encounter several of these stresses daily.
Why Xiidra?
Xiidra is an anti-inflammatory medication that is safe to use over long periods. Remember in the example above of my friend with her bronchitis. She was afraid to use the prescribed steroids because of their side effects.
Steroids are potent anti-inflammatory medications which can work quickly to reduce pain and swelling in the body. Steroid eye drops are often prescribed as part of a dry eye treatment plan.
Using an anti-inflammatory medication to treat dry eye is important in patients who have moderate to severe levels of dryness. Your symptoms won't resolve until the inflammation is gone. However, steroid eye drops have several serious side effects: they can cause both cataracts and glaucoma.
While a patient is taking a steroid, they must be followed closely by a doctor to ensure these side effects do not occur. The risks of developing these side effects can be low, so often the benefit of their use can outweigh the risks. Especially when the patient takes the steroids for only a short time.
Xiidra is an anti-inflammatory medication that is safe to use over long periods. It is used to alleviate the signs and symptoms of dry eyes.
How do I take Xiidra?
Xiidra is a preservative-free eye drop which should be taken twice a day. Studies have shown that patients begin to notice a reduction in their symptoms after 2 weeks - 3 months of use. You may find that you do not need to use artificial tears as often with prolonged use of these prescription medications. There are a few side effects commonly associated with these medications. All of these are normal side effects and they will diminish with continued use.
These side effects are:
- Stinging and burning upon use
- Transient blurred vision
- Metallic taste in the mouth
Best Practices for Xiidra Use
To minimize side effects and get the biggest benefit from the use of Xiidra, I recommend:
- Use it twice a day, every day
- Keep it refrigerated
- Place your index finger in the nasal corner of your eye for 1 minute after putting the drop into your eye
Results
In a recent study by Atallah, Castanos, and Najac, Xiidra was shown to reduce the signs and symptoms of moderate to severe dry eye after 6 months of use. The symptoms studied consisted of: tearing, pain, dryness, burning, itching, grittiness, fluctuation in vision, foreign body sensation, and contact lens intolerance
Conclusion
Reducing inflammation is an important step in the healing process of most illnesses. Dry eye disease has its root cause in inflammation. Steroids are useful in eliminating inflammation; however, they can have serious side effects. Long term steroid use is not generally recommended in dry eye sufferers.
Xiidra is a safe and effective drug, which reduces the signs and symptoms of dry eye in patients who use it for at least 6 months. Xiidra can be used long term to continually treat dry eye by inhibiting inflammatory mediators that bind to the front surface of the eye.
Xiidra can only be obtained with a prescription. Please see your eye care provider is you feel Xiidra would be a nice addition to your dry eye treatment plan.
