Hidden Gem

Placed in the eye once per day, hydroxypropyl cellulose inserts help stabilize the tear film and reduce symptoms.

Patients who have tried a variety of dry eye treatments, only to continue experiencing discomfort that interferes with their lives, often feel that they're looking into a gritty future. For those with moderate to severe dry eye, a hydroxypropyl cellulose insert (Lacrisert) may be an effective option.

“I use Lacrisert as an adjunctive therapy for patients with moderate to severe dry eye who are already on maximal standard therapy—artificial tears, bland ointment at night, nutritional supplements, and cyclosporine (Restasis)—but are still suffering,” explains Marguerite McDonald, MD, FACS, a clinical professor of ophthalmology at NYU Langone Medical Center and a cornea and refractive surgery specialist at Ophthalmic Consultants of Long Island in Lynbrook, N.Y. “These patients are very motivated to try something new because they're tired of always thinking about their eyes, always having pain or discomfort affect their activities. I have a group of patients who couldn't function without Lacrisert.”

Insert Relief Here

Patients place the hydroxypropyl cellulose insert in the temporal aspect of their inferior cul de sac, where it slowly dissolves, keeping eyes lubricated. Patients who use an insert are often are using other therapies as well, but an insert can reduce the use of repeated therapies, such as artificial tears.

“Lacrisert is a unique, preservative-free, once-daily sustained release insert,” says Dr. McDonald. “It stabilizes the tear film, providing continual lubrication as it dissolves to protect the surface and provide relief all day. The eyes feel lubricated and retain moisture. And in several clinical trials, Lacrisert extends tear breakup time and slows, stops or reverses surface damage.”

It takes a little while for patients to get the hang of insertion. Dr. McDonald explains, “I tell patients to get a 10x-power magnifying mirror and put down a clean, dark cloth because they'll drop a few at first. It also helps to put in an artificial tear so that the cul de sac is wet, because the insert will be attracted to the moisture and will release from the inserter more easily. I tell patients to pinch the lower lid into a triangular pocket to make insertion easier. I always tell the patients to expect a few failed insertions but to ‘stick with it’—eventually, insertion will be fast and easy.”

Proven Safe and Effective

The hydroxypropyl cellulose insert has been available for more than 20 years.

“It has never caused a vision-threatening adverse event,” Dr. McDonald says. “The only minor issues are rare corneal abrasions from improper placement or hydroxypropyl cellulose allergy.”

In FDA clinical trials, side effects were also mild and transient, including blurring, discomfort, sticky lashes, photophobia, hypersensitivity, lid edema and hyperemia.¹ Dr. McDonald points out that further FDA testing is under way for a smaller insert for those patients who don't need the full dose that is available today.

Dr. McDonald recently presented the results of a large, multicenter dry eye registry of dry eye patients using hydroxypropyl cellulose inserts—the largest dry eye registry of its kind with 520 participants.² Data was collected at the first visit, in a phone conversation on day 3, and at a second visit at 1 month.

“Patients' discomfort, burning, dryness, grittiness, light sensitivity and stinging improved. They said they were better able to comfortably read, drive at night, work on a computer and watch TV,” she says. “Mean Ocular Surface Disease Index (OSDI) scores were 21.3% better at 28 days, and patients showed improvement in Schirmer's testing, staining and tear breakup time.”

This large registry found that dry eye disease was improved both clinically and in patient reports, confirming what Dr. McDonald's patients who use hydroxypropyl cellulose inserts claim: after they've tried other treatments that do not fully resolve their moderate to severe symptoms, hydroxypropyl cellulose inserts offer relief. ■

References

1. LACRISERT [package insert] Madison, NJ: ATON Pharma, 2009.
2. Koffler BH, McDonald M, Nelinson D, Improved signs and symptoms and quality of life with dry eye syndrome: hydroxypropyl cellulose ophthalmic insert patient registry. Eye Contact Lens. 2010;3:170-176.