Essential omega-3 fatty acids
Essential omega-3 fatty acids may decrease ocular irritation, reduce symptoms, and improve ocular surface health compared with placebo.[3]Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017 Jul;15(3):276-83.
https://www.sciencedirect.com/science/article/pii/S1542012417301192?via%3Dihub
http://www.ncbi.nlm.nih.gov/pubmed/28736335?tool=bestpractice.com
[57]Barbino S, Rolando M, Camicione P, et al. Systemic linoleic and gamma-linolenic acid therapy in dry eye syndrome with an inflammatory component. Cornea. 2003 Mar;22(2):97-101.
http://www.ncbi.nlm.nih.gov/pubmed/12605039?tool=bestpractice.com
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For adults with dry eye disease, how do oral long‐chain omega‐3 polyunsaturated fatty acids (PUFAs) compare with placebo?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2974/fullShow me the answer In one large multi-centre, double-blind clinical trial, patients with dry eye disease (DED) who received omega 3 fatty acids for 12 months did not have significantly better outcomes than patients in the placebo group.[58]Dry Eye Assessment and Management Study Research Group, Asbell PA, Maguire MG, et al. n-3 fatty acid supplementation for the treatment of dry eye disease. N Engl J Med. 2018 May 3;378(18):1681-90.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952353
http://www.ncbi.nlm.nih.gov/pubmed/29652551?tool=bestpractice.com
Further research is needed to understand the role of essential omega-3 fatty acids in the management of DED.[59]Downie LE, Ng SM, Lindsley KB, et al. Omega-3 and omega-6 polyunsaturated fatty acids for dry eye disease. Cochrane Database Syst Rev. 2019 Dec 18;12(12):CD011016.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011016.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/31847055?tool=bestpractice.com
Perfluorohexyloctane ophthalmic solution
Perfluorohexyloctane ophthalmic solution targets evaporative DED. Randomised controlled trials report statistically significant reductions in signs and symptoms of DED compared with saline control.[60]Sheppard JD, Kurata F, Epitropoulos AT, et al. NOV03 for signs and symptoms of dry eye disease associated with meibomian gland dysfunction: the randomized phase 3 MOJAVE study. Am J Ophthalmol. 2023 Aug;252:265-74.
https://www.ajo.com/article/S0002-9394(23)00098-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/36948372?tool=bestpractice.com
[61]Tauber J, Berdy GJ, Wirta DL, et al. NOV03 for dry eye disease associated with meibomian gland dysfunction: results of the randomized phase 3 GOBI study. Ophthalmology. 2023 May;130(5):516-24.
https://www.aaojournal.org/article/S0161-6420(22)01016-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/36574848?tool=bestpractice.com
[62]Tian L, Gao Z, Zhu L, et al. Perfluorohexyloctane eye drops for dry eye disease associated with meibomian gland dysfunction in Chinese patients: a randomized clinical trial. JAMA Ophthalmol. 2023 Apr 1;141(4):385-92.
https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2802688
http://www.ncbi.nlm.nih.gov/pubmed/36929413?tool=bestpractice.com
Perfluorohexyloctane is approved by the US Food and Drug Administration (FDA) for the treatment of DED.
Meibomian gland duct probing
Opens up the occlusion caused by meibomian gland dysfunction and may facilitate regenerative growth within the ductal compartment.[63]Maskin SL, Toland C. Meibomian gland probing stimulates a proliferative epithelial response resulting in duct regeneration. Clin Ophthalmol. 2024 Mar 1:18:631-45.
https://www.dovepress.com/meibomian-gland-probing-stimulates-a-proliferative-epithelial-response-peer-reviewed-fulltext-article-OPTH
http://www.ncbi.nlm.nih.gov/pubmed/38445253?tool=bestpractice.com
[64]Maskin SL. Intraductal meibomian gland probing relieves symptoms of obstructive meibomian gland dysfunction. Cornea. 2010 Oct;29(10):1145-52.
http://www.ncbi.nlm.nih.gov/pubmed/20622668?tool=bestpractice.com
It requires anaesthetising the patient’s eyelids before passing a small blunt cannula probe into the meibomian glands.
Lifitegrast ophthalmic solution
A lymphocyte function-associated antigen 1 (LFA-1) antagonist, lifitegrast reduced corneal and conjunctival staining, eye dryness score, and ocular discomfort in clinical trials.[65]Tauber J, Karpecki P, Latkany R, et al. Lifitegrast ophthalmic solution 5.0% versus placebo for treatment of dry eye disease: results of the randomized phase III OPUS-2 study. Ophthalmology. 2015 Dec;122(12):2423-31.
https://www.aaojournal.org/article/S0161-6420(15)00777-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/26365210?tool=bestpractice.com
[66]Sheppard JD, Torkildsen GL, Lonsdale JD, et al. Lifitegrast ophthalmic solution 5.0% for treatment of dry eye disease: results of the OPUS-1 phase 3 study. Ophthalmology. 2014 Feb;121(2):475-83.
https://www.aaojournal.org/article/S0161-6420(13)00835-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/24289915?tool=bestpractice.com
[67]Holland EJ, Luchs J, Karpecki PM, et al. Lifitegrast for the treatment of dry eye disease: results of a phase III, randomized, double-masked, placebo-controlled trial (OPUS-3). Ophthalmology. 2017 Jan;124(1):53-60.
https://www.aaojournal.org/article/S0161-6420(16)31406-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/28079022?tool=bestpractice.com
Instillation site reactions were common in clinical trials.[68]Nichols KK, Donnenfeld ED, Karpecki PM, et al. Safety and tolerability of lifitegrast ophthalmic solution 5.0%: pooled analysis of five randomized controlled trials in dry eye disease. Eur J Ophthalmol. 2019 Jul;29(4):394-401.
https://journals.sagepub.com/doi/10.1177/1120672118791936
http://www.ncbi.nlm.nih.gov/pubmed/30112930?tool=bestpractice.com
Lifitegrast is approved by the FDA for the treatment of signs and symptoms of dry eye.
Reproxalap ophthalmic solution
Reproxalap is a reactive aldehyde species (RASP) inhibitor. A phase 3 dry eye trial is ongoing to address the FDA's request for at least one additional well controlled study demonstrating a positive effect on the treatment of ocular symptoms in patients with dry eye.[69]Aldeyra Therapeutics, Inc. Aldeyra therapeutics completes enrollment in phase 3 clinical trial of reproxalap in dry eye disease. Jun 2024 [internet publication].
https://ir.aldeyra.com/news-releases/news-release-details/aldeyra-therapeutics-completes-enrollment-phase-3-clinical-trial
Varenicline nasal spray
A nicotinic acetylcholine receptor agonist, varenicline nasal spray is approved by the FDA for the treatment of DED. In a vehicle-controlled clinical trial, varenicline significantly improved signs and symptoms of DED.[70]Wirta D, Vollmer P, Paauw J, et al. Efficacy and safety of OC-01 (varenicline solution) nasal spray on signs and symptoms of dry eye disease: the ONSET-2 phase 3 randomized trial. Ophthalmology. 2022 Apr;129(4):379-87.
https://www.aaojournal.org/article/S0161-6420(21)00836-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/34767866?tool=bestpractice.com
Bevacizumab
Bevacizumab is an anti-vascular endothelial growth factor (VEGF) monoclonal antibody. It significantly improved tear film stability, corneal staining, and symptoms in a placebo-controlled randomised clinical trial.[71]Kasetsuwan N, Chantaralawan K, Reinprayoon U, et al. Efficacy of topical bevacizumab 0.05% eye drops in dry eye disease: a double-masked, randomized trial. PLoS One. 2020 Jun 5;15(6):e0234186.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234186
http://www.ncbi.nlm.nih.gov/pubmed/32502179?tool=bestpractice.com