The Information on this page is exclusively intended for Eye Doctors:
This page shows exclusively prescription medicine for the treatment of moderate to severe Dry Eye Disease by an Eye Doctor:
Corticosteroid Eyedrops (generally strong Anti-Inflammatory Action)
Cyclosporin A Eyedrops (CsA, strong Anti-Inflammatory Action through a specific inhibitor of lymphocyte cell activation)
Macrolide Antibiotic Eyedrops (Antibiotic with anti-inflammatory acivity)
Tetracycline Tablets (Antibiotic with anti-inflammatory acivity for oral application)
Some prescription drugs take time for their effective action
Inflammatory reactions are an important factor in dry eye disease
The tissue disorder and injury causes inflammatory reactions - these are actually useful attempts by the body to destroy the harmful stimulus and repair the tissue. In dry eye, however, the tear film disorder and thus the tissue irritation is chronic ... and therefore the inflammation becomes chronic. Then it turns into a negative and destructive process that becomes stronger and stronger. This creates self-reinforcing control loops ('vicious circles') of disease worsening.
A therapy of the chronic inflammatory reaction can therefore be an important part of the treatment for many patients with moderate to severe dry eye.
Some types of prescription drugs need considerable time before they can achieve their full effect
In contrast to tear supplements/ ´artificial tears´ that can often immediately, but for a limited time, improve annoying symptoms of ocular irritation some types of prescription medicines take a considerable time until they can develop a distinct effect.
This applies particularly to Cyclosorin A eyedrops which are often applied for inflammatory ocular surface irritation of the dry eye type. It is also true for Tetracyclines including Doxycylin, mostly given als pills, that are applied in chronic inflammatory blepharitis and in Meibomian gland dysfunction with modified inspissated secretum that blocks the orifice. Both of these drugs need at least about 4-8 weeks or more to achieve their full effect - that´s normal and is related to their mode of action.
Therefore, when Cyclosporin A or Tetracyclines/ Doxycyclin are used, a minimum therapy duration of typically 3 months is necessary to decide whether they are effective in a particular individual with and his/her condition or maybe not.
=> Here is some Deeper Insight into inflammatory processes
Corticosteroid Eyedrops
A local therapy on the eye surface for inflammatory dry eye can be carried out with cortisone eye drops, for example. Typically, this is already fast and effective against irritation and redness of the eye.
However, it must be remembered that cortisone in the eye can lead to well known side effects, such as possible cataract progression and the development or worsening of increased eye pressure. Corticosteroids are unsuitable as long-term therapy for dry eye.
Therefore, it is usually recommended that cortisone eye drops are not given permanently and not in high doses in Dry Eye Disease. Corticosteroids, which due to their high molecular weight do not penetrate into the eye well and thus act mainly on the surface of the eye, can be used preferentially.
A suitable alternative for immune-modulation in inflammatory dry eye disease is topical Cyclosporin A (CsA).
=> Here is some Deeper Insight into Corticosteroids
Cyclosporin A (CsA) Eye Drops
Cyclosporin A is a very potent immunosuppressive agent that works by inhibiting the activation of T-lymphocytes.
The chronic inflammation in moderate to severe dry eye leads to progressive tissue destruction. This breaks the natural immunological tolerance of the ocular surface and deregulates and activates the mucous membrane immune system.
It has been shown in studies that the initial subclinical inflammation in dry eye thus becomes a chronic T-cell regulated inflammation that can be very persistent. Therefore, immunosuppression specifically directed against T-cell activation may be indicated, as is the case with Cyclosporine A. Other drugs that inhibit T-cell activation are e.g. Tacrolimus and Piomecrolimus.
When applied locally to the eye as drops, the risk of side effects is considered to be low compared with systemic application. It should be noted, that due to the mode of action Cyclosporin A typically takes several weeks (about 4-8) until an effect can occur !
=> Here is some Deeper Insight into Cyclosporin A
Macrolide Antibiotics
Macrolide antibiotics have an antibiotic and also an anti-inflammatory effect. Their primary indication is bacterial conjunctivitis. However, excessive bacterial growth also appears to play a role in chronic eyelid inflammation/blepharitis and in Meibomian gland dysfunction (MGD), which is considered the most common primary cause of dry eye disease. Studies have shown that this can be a usefuloff-label indication for macrolide antibiotics.
In this context, the macrolide antibiotic azitromycin can be applied therapeutically locally to the eye as eye drops.
Azithromycin
Azithromycin offers a broad spectrum of antibiotic activity against the most common pathogens of bacterial conjunctivitis: Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Chlamydiae.
In addition, azithromycin offers several other advantages when applied topically, such as high intracellular penetration, long bioavailability, rapid distribution in tissue, long residence time in superficial eye tissue.
=> Here is some Deeper Insight into Azithromycin
Tetracycline systemically as tablets
Low-dose Tetracyclines including Doxycyclin and Minocyclin below the antibiotic threshold in tablet form has long been recommended for the treatment of chronic blepharitis and Meibomian gland dysfunction with inspissated secretum that blocks the gland orifice.
When administered chronically for months, one of the essential mechanisms of action is the inhibition of bacterial enzymes which decompose the oil of the meibomian glands within the gland and on the edge of the eyelid. Tetracyclines therefore have a normalizing effect on the meibomian gland oil and on glandular function. In addition, the formation of tissue-irritating fatty acids and other inflammatory lipid mediators is prevented, which explains the anti-inflammatory effect of tetracycline therapy.
Apart from chronic eyelid inflammation/blepharitis, as well as rosacea, which is often associated with this disease, the Meibomian oil gland dysfunction (MGD) itself, which is considered the most common primary cause of dry eye, is also favourably influenced.
Attention: With tetracyclines, the various negative side effects must always be considered. These are for example the deposition in the hard tissues of the body (bones and teeth). There are therefore contraindications for use in pregnancy, breastfeeding and in children, among other things. In addition, good sun protection is important, as tetracyclines increase sensitivity to light !
=> Here is some Deeper Insight into Tetracyclines