The world of dry eye disease (DED) is exploding, with an estimated 40 million Americans having the condition.1 The good news—the recent release of new products into the market has dramatically improved our ability to treat patients. Yet, there are a number of lesser known products you should know about. Taking a page from Oprah Winfrey, listed below are my favorite things (in ocular surface disease).

New Kids on the Block

The three most recent OSD/DED drugs made a big impact in the short time since FDA approval. Xdemvy (lotilaner ophthalmic solution 0.25%, Tarsus Pharmaceuticals) has shown remarkable success in eradicating Demodex blepharitis and lid erythema, as well as in improving meibomian gland dysfunction (MGD). Miebo (perfluorohexyloctane, Bausch + Lomb), which targets tear evaporation, has had incredible patient uptake. By preventing evaporation four times more than healthy meibum, this drug has achieved that feat. Finally, Vevye (cyclosporine 0.1%, Harrow Health) is showing rapid results on symptoms and ocular surface staining, greater bioavailability compared to the original cyclosporine 0.05% and with few, if any, side effects.  

Lesser Known But Equally Impressive

Speaking of Demodex, one of the more impressive hygiene products for Demodex blepharitis maintenance is based on a very effective anti-parasitic known as Manuka honey extract—MyboClean (Danelli Ocular Creations). Manuka was found to be equal to tea tree oil in effectiveness, but unlike tea tree oil, there is no burning, discomfort or irritation.2 In fact, the combination of Manuka, aloe and coconut oil in MyboClean makes it a comfortable treatment.

Another addition is light modulation low-level light therapy, which works as a stand-alone or adjunctive therapy to intense pulsed light (IPL) therapy. I regularly see resolution of hordeola and early chalazion for MGD, and when combined with IPL, it dissolves ocular rosacea signs and symptoms. I am partial to IPL systems that have self-cooling heads and don’t require conductive gel, as they allow treatment of far more skin types, no messy gel removal and, in my experience, excellent results. It’s one of the few technologies that can take patients with no MG expression and after four weekly treatments have them functioning at optimal expression levels.

The Dry Eye Drink (Bruder Healthcare) has greatly helped my dry eye patients, especially those with Sjögren’s  syndrome. These nutritional hydration drinks show significant increased water absorption combined with key anti-inflammatory ingredients. Sjögren’s syndrome patients frequently tell me they have decreased the need for water intake.

Vitamin A ointment QHS (Hylo Night, Optase) has been a savior for many patients when it comes to mucin-deficient DED.3,4

Inadequate lid seal, the number one cause for non-responsive DED, is highly underdiagnosed. Morning symptoms are pathognomonic, and the hypoallergenic, oxygen-permeable, latex-free SleepTite/SleepRite (Eye SleepTite) night seals have “cured” more dry eye than almost any product in my clinic.

Oldies But Goodies

I continue to be impressed with the improvement in MG secretions after patients use the Bruder Moist Heat Eye Compress (Bruder Healthcare).

Punctal plugs have risen to a new level with tapered six-month dissolvable plugs (Oasis Medical) and Form Fit long-term intracanalicular plugs (Oasis Medical). The latter innovation has moved me away from surface plugs that have poor retention and may irritate the ocular surface. Vertical canal punctal occlusion technologies have provided a solid treatment option for patients with a negligible tear meniscus, with little to no complications.

DED is optometry’s domain, which is confirmed with the fact that our profession prescribes over 60% of all OSD and DED drops. Managing this immensely large patient population takes knowing about the new and effective options.

Dr. Karpecki is medical director for Keplr Vision and the Dry Eye Institutes of Kentucky and Indiana. He is the Chief Clinical Editor for Review of Optometry and chair of the New Technologies & Treatments conferences. A fixture in optometric clinical education, he consults for a wide array of ophthalmic clients, including ones discussed in this article. Dr. Karpecki's full list of disclosures can be found here.

1. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the beaver dam offspring study: prevalence, risk factors and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806.

2. Frame K, Cheung IMY, Wang MTM, et al. Comparing the in vitro effects of MGO Manuka honey and tea tree oil on ocular Demodex viability. Cont Lens Anterior Eye. 2018;41(6):527-30.

3. Tseng SC, Maumenee AE, Stark WJ, et al. Topical retinoid treatment for various dry eye disorders. Ophthalmology. 1985;92(6);717-27.

4. Kim EC, Choi JS, Joo CK. A comparison of vitamin A and cyclosporine a 0.05% eye drops for treatment of dry eye syndrome. Am. J Ophthalmol. 2009;147(2):206-13.e3.