Managing Dry Eye Flares

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In this installment of Interventional Mindset, Dr. Jackson reviews how ophthalmologists can treat dry eye flares.

Dry eye flares are a common occurrence in patients with dry eye disease (DED), and determining a treatment approach specifically for these acute exacerbations of inflammation is vital to providing long-term symptom relief.

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Considering external factors that cause dry eye flares

Clinicians should keep factors such as systemic diseases and the environment in mind when treating dry eye flares, as these often contribute to flare-ups. Changes in environmental conditions can trigger an acute inflammatory response; common irritants include seasonal changes, allergies, changes in humidity, overuse of contact lenses, using air conditioners or fans, and more.
Additionally, with the combination of increased screen time, the COVID-19 pandemic, and a general cultural shift to working online, patients are spending much longer periods of time in front of a screen, which too can trigger dry eye flares.

Managing dry eye flares in patients with systemic diseases

Autoimmune and systemic diseases can also trigger acute flare-ups. Conditions such as rheumatoid arthritis (RA), thyroid disease, systemic lupus erythematosus (SLE), and more can be associated with dry eye flares. So when treating dry eye patients, clinicians should ensure to record a thorough patient history that documents any systemic diseases.
Doing so allows the eyecare practitioner (ECP) to quickly identify potential root causes for the flare-up and efficiently determine a treatment approach before the disease progresses and causes the patient’s vision quality to deteriorate.

How do you treat dry eye flares?

The first step to addressing dry eye flares is to get control of the inflammation. Patients often try to self-treat a flare by using preservative-free artificial tears to improve lubrication and potentially reduce inflammation. Then the focus shifts to eliminating any potential insulting causes for the flare-up. This can be done by adjusting environmental factors, for example, recommending to patients that they reduce screen time or avoid allergens if possible.
Topical steroids can be an essential tool to rapidly suppress inflammation in the setting of an acute flare. Further, for patients with systemic diseases, it’s important to simultaneously treat the recurrence of any chronic symptoms related to the disease. Clinicians should recommend that the patient see an appropriate specialist to help manage the long-term treatment for their condition and coordinate care with this specialist to ensure the continuing health of the patient.

Using Eysuvis to treat dry eye flares

When a patient presents with signs of acute inflammation, such as redness or keratitis, a topical steroid is essential to rapidly resolve symptoms. Additionally, it has been suggested that treating acute flares allows the immune system to ramp down so as to potentially lead to fewer flares over time. As an acute therapy for dry eye flares, Eysuvis (0.25% loteprednol etabonate ophthalmic suspension, Alcon) was approved by the FDA in October 2020.
This topical steroid effectively and rapidly treats dry eye flares and is unique compared to generic steroids because it penetrates into target tissues (cornea and conjunctiva) more rapidly and avoids delivery of the drug to the aqueous humor, thereby lowering the incidence of IOP elevation. Eysuvis with AMPPLIFY Drug Delivery technology uses small (~300nm), mucus-penetrating particles to improve the efficacy of penetration into the tissues.
Additionally, studies have shown that there is a low rate of adverse events, such as intraocular pressure (IOP) elevation, in patients who use Eysuvis, making it a potentially safer steroid to use in acute flare disease.

Conclusion

To treat dry eye flares, combining Eysuvis with other pharmaceutical therapies, environmental changes, and/or treating flare-ups of systemic diseases is an effective way of quickly providing lasting symptom relief and concurrently treating the underlying cause.
Mitchell A. Jackson, MD
About Mitchell A. Jackson, MD

Mitchell A. Jackson, M.D., is a board-certified ophthalmologist specializing in cataract and refractive surgery. He received his medical degree from Chicago Medical School, completed his internship at Columbus Hospital and his Ophthalmology residency at University of Chicago Hospitals. Currently, Dr. Jackson is the Founder/Medical Director of Jacksoneye and is also a clinical assistant at the University of Chicago Hospitals.

Mitchell A. Jackson, MD
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