Published in Ocular Surface

When to Consider Ocular Surface Lavage

Damon Dierker, OD, FAAO

Damon Dierker, OD, FAAO

Andrew Zagelbaum, OD

Andrew Zagelbaum, OD

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Join Damon Dierker, OD, FAAO and Andrew Zagelbaum, OD, for a discussion of the benefits of ocular surface lavage in dry eye management.

When to Consider Ocular Surface Lavage
Welcome back to Dry Eye Fireside Chat! In this installment, Damon Dierker, OD, FAAO, sits down with Andrew Zagelbaum, OD, to discuss the latest innovations in ocular surface lavage and how—and when—you can effectively utilize them within your practice.
Dr. Zagelbaum is the owner of the Dry Eye Center of Arizona.

Addition through subtraction

Although much of dry eye management is adding treatments to a patient’s regimen, Dr. Dierker says that sometimes balancing the equation requires the removal of pro-inflammatory material from the surface of the eye. This is where ocular surface lavage, in particular using RINSADA, can be beneficial.

Fast facts: RINSADA

  • RINSADA is an irrigating eyelid retractor created by a retinal specialist who noted positive patient feedback regarding the feel of their eyes after he had washed off the betadine used during retinal injections.1
  • The device screws into the luer lock of a standard 10cc plungered syringe and features a curved retractor, enabling the targeting of typically unreachable areas, such as underneath the eyelids and the fornices, with three openings at its crest.
  • Because these perforations are small in size, RINSADA is able to provide a pressurized distribution of saline solution, in a manner demonstrated to be superior to a standard manual irrigation.1
  • Each treatment only takes a minute or two, with a standard regimen treating the upper and lower eyelids of both eyes.
  • Although there’s promising data regarding ocular surface lavage and both the reduction of matrix-metalloprotein-9 and improvement of dry eye symptoms,2,3 it’s not featured within the TFOS DEWS III report. Alongside this, both doctors would like to see even more data highlighting RINSADA's efficacy.

Patient selection for ocular surface lavage

There are several patient groups Dr. Zagelbaum notes can particularly benefit from RINSADA. The first are those experiencing an acute symptomatic episode of ocular discomfort.
One example he gives is that of a patient who complained of a foreign body sensation after a fiber from her wig got into her eyes. Use of ocular surface lavage here can help to dislodge and flush out debris that patients might have been trying to remove using artificial tears.
“One case that sticks with me is a gentleman that had chronic irritated eyes who was literally putting in preserved eye drops 40 to 50 times a day,” recalls Dr. Dierker. “Ocular surface lavage and moving to a more reasonable ocular surface-friendly regimen were life-changing for him.”
RINSADA can also aid patients with allergies or those who are experiencing other inflammatory-driven events that result in a high inflammatory ocular appearance Dr. Zagelbaum characterizes as “red, steamy eyes.” He’s found using RINSADA here can reset the ocular surface of these patients.
There are also some more niche use cases, for example, in patients with filamentary keratitis—especially when these filaments are proving difficult to remove—or those who are very symptomatic with conjunctival concretions.
Finally, Dr. Zagelbaum also uses RINSADA in combination with treatments such as microblepharoexfoliation to ensure any debris is effectively removed.

Discussing ocular surface lavage with patients

So, when and how should you offer RINSADA to your patients? Dr. Zagelbaum likes to do a treatment early on, primarily because often patients are on some form of combination therapy, and early intervention can prevent the escalation of a positive feedback loop between tear film stability and inflammation.
He frames RINSADA to patients as an option that can give him a head start in tackling both ocular inflammation and its underlying causes. In his office, because it costs a lot less than many other in-office treatments, Dr. Zagelbaum is able to offer RINSADA as a cash-pay option to patients that can be bundled in with other treatments, such as NuLids.
And, because he himself is a dry eye patient, Dr. Zagelbaum is able to lean into his personal experience when recommending RINSADA to patients—something Dr. Dierker reminds us can be really useful for patients.
“Sharing our experience for what a treatment is and what to expect can help patients to better understand our recommendations and what is likely to occur,” he says. “I also think having that personal experience is great for getting doctors motivated to bring this into their practice.”

Conclusion

If you’re intrigued, Dr. Zagelbaum highlights that RINSADA is often on the exhibition floor at major conferences, giving practitioners the opportunity to experience it for themselves. “It’s something I recommend, just to see how it feels,” he advises.
“Because when I had it done on myself, I was blown away by the cooling feeling and how great my eyes felt. It’s one of the few things you can offer to patients where they’ll walk out of your practice feeling better than when they walked in.”
  1. WR Bloom, SSA Kondapalli. Utility of a novel eyelid retractor and irrigation instrument in minimizing patient-reported discomfort after intravitreal injection. Retina. 2023;43(9):1633–1635. doi:10.1097/IAE.0000000000003124.
  2. Diaz-Llopis M, Pinazo-Duran MD, Diaz-Guiñon L, et al. Efficacy of isotonic seawater solution of inflammation of the ocular surface in matrix metalloproteinase MMP-9-Positive Dry Eye Disease Patients. Open J Ophthalmol. 2020;10(3): 211–219. doi:10.4236/ojoph.2020.103023.
  3. Diaz-Llopis M, Pinazo-Duran MD, Diaz-Guiñon L, et al. A randomized multicenter study comparing seawater washes and carmellose artificial tears eyedrops in the treatment of dry eye syndrome. Clin Ophthalmol. 2019;13:483–490. doi:10.2147/OPTH.S185409.
Damon Dierker, OD, FAAO
About Damon Dierker, OD, FAAO

Dr. Dierker is Director of Optometric Services at Eye Surgeons of Indiana, an adjunct faculty member at the Indiana University School of Optometry, and Immediate Past President of the Indiana Optometric Association. Dr. Dierker is the Co-Founder and Program Chair of Eyes On Dry Eye, the largest event for eyecare professionals in the industry. He has made significant contributions to raising awareness of dry eye and ocular surface disease in the eyecare community, including the development of Dry Eye Boot Camp and other content resources across dozens of publications.

More by Damon Dierker, OD, FAAO
Damon Dierker, OD, FAAO
Andrew Zagelbaum, OD
About Andrew Zagelbaum, OD

Andrew Zagelbaum, OD, was born and raised on Long Island, New York, and received his BA degree from Hunter College City University of New York in Manhattan. Growing up on Long Island, Dr. Zagelbaum spent more than 10 years working in eyecare prior to attending optometry school at the New England College of Optometry in Boston, Massachusetts.

Dr. Zagelbaum has spent time working with professional athletes across the National Football League as well as the National Hockey League, and has published research on peripheral awareness and reaction time in professional football players in the N.F.L.

After optometry school, Dr. Zagelbaum moved from the east coast to Phoenix, Arizona, where he worked at Phoenix Eye Care and the Dry Eye Center of Arizona. In October of 2025, Dr. Zagelbaum went on to purchase and take ownership of the Dry Eye Center of Arizona, moving the practice to Scottsdale, Arizona. Dr. Zagelbaum has now focused his practice solely on the diagnosis and treatment of dry eye and ocular surface disease.

Dr. Zagelbaum is a member of the American Optometric Association and sits on the board of directors for the Arizona Optometric Association. He also serves as a lecturer, consultant, and writer, advocating for dry eye patients and care.

More by Andrew Zagelbaum, OD
Andrew Zagelbaum, OD
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