Allergy

Blepharitis

COVID-19

Cataract

Comanagement

Comprehensive Eye Exams

Conjunctivitis

Contact Lenses

Cornea

Diabetic Eye Disease

Dry Eye

Geographic Atrophy

Glasses

Glaucoma

LASIK

Lens Technology

Lid and Lash

Myopia

Nutrition

Ocular Surface Disease

Optic Relief

Patient Care

Pediatrics

Presbyopia

Ptosis

Refractive Surgery

Retina

Technology

Therapeutic Cataract & Refractive

News

All News

Practice Management

Media

All Videos

Expert Interviews

Podcasts

Medical World News

Viewpoints

Insights

Case Based Roundtable Series

Case Studies

Case of the Quarter

Practice Ownership

Rapid Readout

What’s Your WhEYE?

Conferences

Conference Coverage

Conference Listing

Conference Recaps

Blog

Publications

Digital Edition

Supplements And Featured Publications

iTech

Partners

Resources

Job Board

Subscribe

Sheryl brings a wealth of editorial experience to MJH Life Sciences’ Eye Care Network, having engaged with the readers and the greater ophthalmic community of 

for more than 20 years. As Group Editorial Director, Sheryl’s purview extends across the print and digital network of 

Ophthalmology Times, Ophthalmology Times Europe, Modern Retina 

 Prior to ophthalmology, Sheryl previously covered the fields of audiology and confectionery science/technology/manufacturing.

Sheryl is also passionate about the mission, vision and values of Ophthalmic World Leaders (OWL) and recently completed her term on its Board of Directors. She continues to volunteer as Editor-in-Chief of the organization’s 

Magazine. In 2013, she was honored with the group’s inaugural Rising Star Award.

In addition, she has served as a judge for 

 Health Care Heroes Awards program as well as the Jesse H. Neal National Business Journalism Awards.

Articles

The novel corrective eye drop can be prescribed through pharmacy partners BlinkRx or Medvantx.

Orasis Pharmaceuticals’ prescription pilocarpine hydrochloride ophthalmic solution 0.4% (Qlosi) for presbyopia available in the US

Nordic Pharma plans to announce commercialization details in the near future for the dry eye disease treatment.

Canalicular gel Lacrifill from Nordic Pharma receives CE Mark

Methylphenidate is a central nervous system stimulant that is used to treat ADHD, a very common diagnosis in children in the US.

Study finds methylphenidate may impact corneal cells in children with ADHD

Healing properties can accelerate and improve outcomes for patients.

A history of amniotic membrane use in eye care

The leading source of breaking news, news analysis, and emerging research reports in optometry, Optometry Times® disseminates practical content by optometrists for optometrists that can be immediately applied to improve the clinical experience.

Advertise

About Us

Editorial

Contact Us

Terms & Conditions

Privacy

Do not sell my Information

Optometry Times | Clinical News & Expert Optometrist Insights

Facebook

Instagram

LinkedIn

Spotlight

Clinical

Myopia- Management

1rem

Authors

Optometrist
Eye Care Consultants of Colorado
Conifer, Colorado

Contact lenses that can keep pace with a dynamic world.

Introducing AIR OPTIX® plus HydraGlyde Contact Lenses

 is a common ocular condition marked by a loss of homeostasis anywhere in the cycle, causing or worsening tear film instability, hyperosmolarity, and inflammation of the ocular surface.

 This condition significantly impairs visual quality, leading to challenges in daily activities such as driving, reading, and computer use.

 Addressing DED is crucial for improving patient satisfaction and quality of life and maintaining practice efficiency.

Supportive care often falls short for patients with DED

Patients with DED frequently report symptoms including burning, stinging, grittiness, foreign body sensation, light sensitivity, ocular pain, and blurred vision.

 These symptoms negatively impact quality of life and may also reduce visual function and productivity.

 If left untreated, DED may lead to recurring patient complaints,

 persistent discomfort, and long-term ocular damage.

 Early diagnosis and intervention are essential to prevent these adverse outcomes and improve the patient’s visual function and overall well-being.

DED can be identified through comprehensive evaluations, including clinical assessments like corneal staining

Management strategies often include artificial tear supplements, prescription therapies targeting various causative factors, and lifestyle modifications.

Proactive management can alleviate symptoms, enhance visual function, and reduce risk of increased follow-ups.

DED is commonly categorized as aqueous deficient, evaporative, or mixed. Excessive tear evaporation due to meibomian gland dysfunction is the leading cause, affecting approximately 90% of patients with DED.

Prescription treatments target the insufficient tear production, inflammatory pathways, or excessive evaporation that perpetuate DED. Cyclosporine-based therapies (Restasis, AbbVie; Cequa, Sun Ophthalmics; Vevye, Harrow) act by inhibiting T-cell activation through the calcineurin-phosphate pathway, resulting in increased tear production and protection of conjunctival goblet cells.

 Cequa employs nanomicellar technology to enhance cyclosporine delivery

 whereas Vevye uses a semifluorinated alkane (SFA), perfluorobutylpentane (PFBP or F4H5), as a vehicle.

Lifitegrast ophthalmic solution 5% (Xiidra; Bausch+Lomb) addresses ocular inflammation through mechanisms such as inhibiting T-cell activation, blocking T-cell recruitment to the ocular surface, and reducing inflammatory cytokine secretion.

Lifitegrast binds to lymphocyte function-associated antigen-1, a protein found on the surface of leukocytes, preventing its interaction with its ligand intercellular adhesion molecule-1.

Perfluorohexyloctane ophthalmic solution (Miebo; Bausch+Lomb) targets the evaporative aspect of DED.

 Composed entirely of perfluorohexyloctane (PFHO or F6H8), Miebo reduces tear evaporation by forming a stable monolayer on the tear film and has a prolonged ocular surface residence time due to its low volatility.

 In doing so, PFHO compensates for deficiencies in meibum and stabilizes the lipid layer of the tear film, which results in improved tear film homeostasis.

 Although both Miebo and Vevye contain an SFA (chemically inert molecules consisting of a fluorocarbon segment and a hydrocarbon segment),

 their physiochemical properties lead to distinct functionalities. The SFA in Vevye’s formulation (PFBP) serves as a vehicle to solubilize cyclosporine better than PFHO yet does not inhibit evaporation.

 In contrast, Miebo (PFHO) exhibits antievaporative effects due to its unique chemical structure.

 The longer chain length of PFHO enables the formation of a stable monolayer at air-liquid interfaces.

 Additionally, PFHO’s higher boiling point

(indicating lower volatility) ensures slower evaporation and prolonged ocular surface residence time.

 Unlike PFBP, PFHO was shown to stabilize the tear film lipid layer in a 7-day study in rabbits.

Varenicline nasal spray (Tyrvaya; Viatris) stimulates tear production via the trigeminal parasympathetic pathway.

 Varenicline, a nicotinic acetylcholine receptor agonist, activates this pathway when administered intranasally.

Symptom reduction as a key differentiator among treatments

Clinical trials evaluating cyclosporine-based treatments for DED include randomized, vehicle-controlled studies of Restasis,

 Across these studies, cyclosporine-based eye drops showed significantly greater improvements in DED signs (eg, corneal staining, Schirmer test) compared with vehicle controls.

 However, reductions in DED symptoms were generally similar between the active treatment and control groups.

 For Restasis, no significant differences were observed between the treatment and control groups for symptoms such as eye dryness, sandy/gritty sensation, burning, stinging, itching, and pain, although a notable improvement in blurred vision was observed.

 For Cequa, changes in the global symptom score were comparable to the vehicle.

 For Vevye, the primary symptom end points (Ocular Surface Disease Index score in ESSENCE-1 and eye dryness in ESSENCE-2) were not met, although secondary analyses showed a significantly greater reduction in eye dryness for Vevye compared with vehicle in ESSENCE-1.

Lifitegrast was assessed in 4 randomized, placebo-controlled trials (phase 2, OPUS-1, OPUS-2, OPUS-3).

 Pooled results from these trials demonstrated that lifitegrast effectively addressed both prespecified end points: signs (corneal staining) and symptoms (eye dryness and discomfort) of DED, with improvements in eye dryness as early as 2 weeks after treatment initiation.

PFHO was found to deliver rapid and sustained improvements in both signs (corneal staining) and symptoms (eye dryness, burning/stinging) of DED, with consistently greater effects than a hypotonic saline (0.6%) control in 2 randomized controlled trials (GOBI, MOJAVE).

Both signs and symptoms were improved by the earliest assessment time point of day 14. A postmarketing study recently demonstrated relief of patients’ symptoms as early as day 3 of treatment.

In randomized, vehicle-controlled studies (ONSET-1, ONSET-2), varenicline nasal spray outperformed the vehicle in improving Schirmer test scores, consistent with its mechanism of action), and significantly reduced eye dryness at most assessments in ONSET-1.

Identifying and appropriately treating DED is vital to ensure patient comfort and visual quality and function. Treatment decisions should consider disease etiology, symptom burden, and patient preferences. For aqueous-deficient DED, cyclosporine-based products or varenicline nasal spray may be appropriate, with patient choice guiding between a drop or nasal spray. PFHO is particularly effective for evaporative DED, whereas lifitegrast may be favored in cases involving inflammation. Products that alleviate symptoms, such as lifitegrast and PFHO, may be preferable for patients most troubled by discomfort. A personalized approach to therapy selection can optimize outcomes for individuals with DED.

Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. 

. 2017;15(3):276-283. doi:10.1016/j.jtos.2017.05.008

Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II epidemiology report. 

 2017;15(3):334-365. doi:10.1016/j.jtos.2017.05.003

Villani E, Barabino S, Giannaccare G, Di Zazzo A, Aragona P, Rolando M. From symptoms to satisfaction: optimizing patient-centered care in dry eye disease. 

. 2025;14(1):196. doi:10.3390/jcm14010196

Poon KH, Yeo S, Tong L. Lost to follow-up for appointments in a dedicated dry eye clinic. 

. 2014;8:1409-1418. doi:10.2147/PPA.S68147

Verjee MA, Brissette AR, Starr CE. Dry eye disease: early recognition with guidance on management and treatment for primary care family physicians. 

. 2020;9(4):877-888. doi:10.1007/s40123-020-00308-z

Bartlett JD, Keith MS, Sudharshan L, Snedecor SJ. Associations between signs and symptoms of dry eye disease: a systematic review. 

2015;9:1719-1730. doi:10.2147/OPTH.S89700

Uchino M, Yokoi N, Kawashima M, Ryutaro Y, Uchino Y, Tsubota K. Treatment trends in dry eye disease and factors associated with ophthalmic follow-up discontinuation in Japan. 

Pellegrini M, Bernabei F, Moscardelli F, et al. Assessment of corneal fluorescein staining in different dry eye subtypes using digital image analysis. 

Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E. The challenge of dry eye diagnosis. 

Agarwal P, Craig JP, Rupenthal ID. Formulation considerations for the management of dry eye disease. 

. 2021;13(2):207. doi:10.3390/pharmaceutics13020207

Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. 

2012;31(5):472-478. doi:10.1097/ICO.0b013e318225415a

Badian RA, Utheim TP, Chen X, et al. Meibomian gland dysfunction is highly prevalent among first-time visitors at a Norwegian dry eye specialist clinic. 

2021;11(1):23412. doi:10.1038/s41598-021-02738-6

Gao J, Sana R, Calder V, et al. Mitochondrial permeability transition pore in inflammatory apoptosis of human conjunctival epithelial cells and T cells: effect of cyclosporin A. 

2013;54(7):4717-4733. doi:10.1167/iovs.13-11681

Periman LM, Mah FS, Karpecki PM. A review of the mechanism of action of cyclosporine A: the role of cyclosporine A in dry eye disease and recent formulation developments. 

2020;14:4187-4200. doi:10.2147/OPTH.S279051

Periman LM, Perez VL, Saban DR, Lin MC, Neri P. The immunological basis of dry eye disease and current topical treatment options. 

2020;36(3):137-146. doi:10.1089/jop.2019.0060

Agarwal P, Korward J, Krösser S, Rupenthal ID. Preclinical characterization of water-free cyclosporine eye drops – factors impacting ocular penetration 

2023;188:100-107. doi:10.1016/j.ejpb.2023.05.005

Perez VL, Pflugfelder SC, Zhang S, Shojaei A, Haque R. Lifitegrast, a novel integrin antagonist for treatment of dry eye disease. 

2016;14(2):207-215.doi:10.1016/j.jtos.2016.01.001

Vittitow J, Kissling R, DeCory H, Borchman D. In vitro inhibition of evaporation with perfluorohexyloctane, an eye drop for dry eye disease. 

2023;98:100704. doi:10.1016/j.curtheres.2023.100704

Zhuang-Yan A, Syed YY. Perfluorohexyloctane ophthalmic solution: a review in dry eye disease. 

2024;84(4):441-448. doi:10.1007/s40265-024-02016-5

Tsagogiorgas C, Otto M. Semifluorinated alkanes as new drug carriers—an overview of potential medical and clinical applications. 

2023;15(4):1211. doi:10.3390/pharmaceutics15041211

Broniatowski M, Sandez Macho I, Miñones J, Dynarowicz-Ła̧tka P. Langmuir monolayers characteristic of (perfluorodecyl)-alkanes. 

2004;108(35):13403-13411. doi:10.1021/jp0402481

Liang Y, Kociok N, Leszczuk M, et al. A cleaning solution for silicone intraocular lenses: "sticky silicone oil". 

2008;92(11):1522-1527. doi:10.1136/bjo.2008.143750

Agarwal P, Scherer D, Günther B, Rupenthal ID. Semifluorinated alkane based systems for enhanced corneal penetration of poorly soluble drugs. 

2018;538(1-2):119-129. doi:10.1016/j.ijpharm.2018.01.019

Agarwal P, Khun D, Krösser S, et al. Preclinical studies evaluating the effect of semifluorinated alkanes on ocular surface and tear fluid dynamics. 

2019;17(2):241-249. doi:10.1016/j.jtos.2019.02.010

Pflugfelder SC, Cao A, Galor A, Nichols KK, Cohen NA, Dalton M. Nicotinic acetylcholine receptor stimulation: a new approach for stimulating tear secretion in dry eye disease. 

2022;25:58-64. doi:10.1016/j.jtos.2022.05.001

Sall K, Stevenson OD, Mundorf TK, Reis BL. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. 

2000;107(4):631-639. doi:10.1016/s0161-6420(99)00176-1

Goldberg DF, Malhotra RP, Schechter BA, Justice A, Weiss SL, Sheppard JD. A phase 3, randomized, double-masked study of OTX-101 ophthalmic solution 0.09% in the treatment of dry eye disease. 

2019;126(9):1230-1237. doi:10.1016/j.ophtha.2019.03.050

Sheppard JD, Wirta DL, McLaurin E, et al. A water-free 0.1% cyclosporine A solution for treatment of dry eye disease: results of the randomized phase 2B/3 ESSENCE study. 

2021;40(10):1290-1297. doi:10.1097/ICO.0000000000002633

Akpek EK, Wirta DL, Downing JE, et al. Efficacy and safety of a water-free topical cyclosporine, 0.1%, solution for the treatment of moderate to severe dry eye disease: the ESSENCE-2 randomized clinical trial. 

2023;141(5):459-466. doi:10.1001/jamaophthalmol.2023.0709

Semba CP, Torkildsen GL, Lonsdale JD, et al. A phase 2 randomized, double-masked, placebo-controlled study of a novel integrin antagonist (SAR 1118) for the treatment of dry eye. 

2012;153(6):1050-1060.e1. doi:10.1016/j.ajo.2011.11.003

Sheppard JD, Torkildsen GL, Lonsdale JD, et al; OPUS-1 Study Group. Lifitegrast ophthalmic solution 5.0% for treatment of dry eye disease: results of the OPUS-1 phase 3 study. 

2014;121(2):475-483. doi:10.1016/j.ophtha.2013.09.015

Tauber J, Karpecki P, Latkany R, et al; OPUS-2 Investigators. Lifitegrast ophthalmic solution 5.0% versus placebo for treatment of dry eye disease: results of the randomized phase III OPUS-2 study. 

2015;122(12):2423-2431. doi:10.1016/j.ophtha.2015.08.001

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). 

An overview of prescription medications available for DED.

Scot Morris, OD, FAAO

Articles

Latest Updated Articles