Therapeutic pearl

The primary initial goal of treatment is to improve meibomian gland function with eyelid hygiene, warm compresses, oral omega-3 fatty acid supplementation, and azithromycin ophthalmic solution 1% (Azasite), an antibiotic that exhibits anti-inflammatory effects, enhances meibum production, and improves tear stability. After eyelid inflammation is controlled, additional topical ophthalmological treatments to reduce inflammation and enhance the tear film can be introduced. Lifitegrast 5% ophthalmic solution inhibits T-cell-mediated inflammation by blocking the interaction between the ligand intercellular adhesion molecule-1 and lymphocyte function–associated antigen-1.

Cyclosporine 0.1% ophthalmic emulsion is another anti-inflammatory agent that can be used safely in conjunction with lifitegrast for treatment of chronic dry eye (Zirwas et al., 2018). Bepotastine 1.5% solution is an antihistamine that relieves the pruritus and redness associated with dry eye by blocking histamine H1 receptors, stabilizing mast cells, and preventing degranulation. Other antihistamines that may be used are azelastine 0.05% solution, epinastine 0.05% solution, alcaftadine 0.25% solution, and olopatadine. 0.1% solution (taking into consideration that antihistamine drops may exacerbate dry eye while alleviating ocular pruritus).