clinical-application-intense-pulsed-light-therapy-radio-frequency-for

Clinical Application of Intense Pulsed Light Therapy and Radio Frequency for Treatment of Ocular Surface Diseases

Dry eye disease (DED) is a multifactorial condition in which tear film instability and inflammation play important roles in its etiology. DED can cause ...

neuromodulation-with-botulinum-toxin-eyelid-associated-ocular-surface

Neuromodulation with Botulinum Toxin in Eyelid-Associated Ocular Surface Disease

Ocular surface disease (OSD) encompasses a range of conditions that not only include the well-described dry eye disease (DED) components - such as ...

Periman Eye Institute

To investigate the efficacy of a micro-emulsion (ME) lipid layer artificial tear in improving tolerance of immunomodulator eye drops for the treatment of dry eye disease.

Improving Tolerance and Compliance with Topical Immunomodulators Using Micro-Emulsion Lipid Layer Artificial Tears.

Dry eye disease (DED) is a multifactorial disease of the ocular surface and tear film that has gained awareness as a public health problem. Characteristics of DED include tear film instability, hyperosmolarity, and ocular surface inflammation, which can occur independently or may be a sequela of numerous ocular diseases, ocular surgery or contact lens wear. Much has been learned about the impact of the disease to help affected individuals who report symptoms of poor vision, pain, and tearing. Recently, new research highlights the importance of the role of ocular surface inflammation and damage in DED-leading to a vicious cycle of inflammation as well as loss of tear film homeostasis. DED immunopathophysiology is characterized by four stages: initiation, amplification, recruitment, and re-initiation. Cyclosporine is proven to be a valuable ophthalmic therapeutic for DED through its immunomodulatory actions and regulation of the adaptive immune response. Cyclosporine mechanism of action is well described in the published literature and the myriad of benefits in all four stages lend a broad-based immunomodulatory function particularly suitable for addressing DED. Furthermore, cyclosporine has unique goblet cell density improvement capabilities as well as anti-apoptotic properties. Topical formulations of cyclosporine are centered around addressing the highly lipophilic nature of the molecule. The poor aqueous solubility of cyclosporine traditionally presented technical challenges in drug delivery to the ocular surface. Newer formulations such as cationic emulsions and nanomicellar aqueous solutions address formulation, tissue concentration, and drug delivery challenges.

A Review of the Mechanism of Action of Cyclosporine A: The Role of Cyclosporine A in Dry Eye Disease and Recent Formulation Developments.

In the United States, women are at a higher risk of developing vision impairment or a serious eye disease (such as age-related macular degeneration, thyroid eye disease, or chronic dry eye disease) than men. Disparities in eye diseases due to biology widen even further when considering factors such as social determinants of health; gaps in research data, literature, and policy; insufficient provider and patient education; and limitations in screening and treatment options. Sex and gender disparities in eye health are clinically under-addressed and burdensome on both patient quality of life and the health care and economic systems, resulting in a pressing population health issue that negatively impacts women.

The roles of sex and gender in women's eye health disparities in the United States.

Meibomian glands are modified oil-producing glands that produce meibum and can become dysfunctional and negatively affect the lipid layer in the tear film, resulting in ocular surface diseases such as evaporative dry eye. Abnormal keratin production and aggregation at the meibomian gland orifice has been implicated in the pathogenesis of meibomian gland dysfunction (MGD). Current treatments largely ignore the role of keratin proteins. This review paper synthesizes various publications on hyperkeratinization and its role in MGD pathogenesis and proposes a novel treatment strategy for MGD that involves the use of keratolytic agents commonly used in dermatological treatments.

Meibomian Gland Dysfunction: A Dermatological Perspective on Pathogenesis and Treatment Outlook.

Dry eye disease (DED) is a multifactorial disorder characterized by loss of tear film homeostasis with an estimated worldwide prevalence of 5% to 50%. In DED, dysfunction of the ocular structures that create and regulate the tear film components-including the lacrimal glands, meibomian glands, cornea, and conjunctiva-causes a qualitative and/or quantitative tear deficiency with resultant tear film instability and hyperosmolarity. This initiates a vicious cycle of ocular surface inflammation and damage that may ultimately impair the quality of life and vision of affected patients. Many factors can contribute to the development of DED, including ocular and systemic diseases, topical and systemic medications, and environmental conditions. Because DED is a chronic disorder, treatment is most often long term and may utilize both pharmacologic and nonpharmacologic interventions to address all etiologic components. The long-term management of DED can be challenging and most often should involve eye care specialist referral. However, primary care clinicians (PCCs) are often the first points of contact for patients with DED and importantly provide initial diagnosis and preliminary patient education about the disease process. Consideration of DED is also vital for the practice of various specialties due to the large number of comorbidities and medications that can contribute to DED pathogenesis and progression. Therefore, it is important that PCCs and clinical specialists be aware of the etiology of DED and its available therapeutic options. This manuscript provides an overview of DED pathophysiology and treatment and discusses specific considerations regarding DED management for PCCs and clinical specialists.Key messagesSuccessful management of dry eye disease often requires the use of various pharmacologic and/or nonpharmacologic therapies, as well as environmental and lifestyle modifications, to mitigate the underlying etiologies and restore tear film homeostasis.Primary care clinicians play an essential role in dry eye disease management by establishing a diagnosis, educating patients about the disorder, and providing referrals to eye care specialists for initiation of specialized treatment and long-term follow-up.Primary care clinicians and clinical specialists should consider prescribing medications with fewer ocular surface effects whenever possible in patients at risk for or with existing dry eye disease.

Dry eye disease: identification and therapeutic strategies for primary care clinicians and clinical specialists.

This study compares outcomes of therapy with OC-01 (varenicline solution) for dry eye disease in study eyes and nonstudy fellow eyes of participants in 2 pivotal clinical trials.

Bilateral Effect of OC-01 (Varenicline Solution) Nasal Spray for Treatment of Signs and Symptoms in Individuals with Mild, Moderate, and Severe Dry Eye Disease.

Patients with Demodex blepharitis have a considerable symptomatic burden that negatively impacts their daily activities and well-being. Despite chronic manifestations of and problems associated with blepharitis that resulted in multiple visits to eye care providers, Demodex blepharitis remained underdiagnosed or misdiagnosed.

The impact of Demodex blepharitis on patient symptoms and daily life.

Dry eye disease (DED) is a prevalent condition affecting over 16 million patients in the USA. DED and the symptoms of ocular discomfort are debilitating and a significant burden on patients. If left untreated, DED can progress to cause severe pathology. Treatment is often initiated by patients without consulting a healthcare professional. This study investigated the safety and efficacy of a novel lipid-containing eye drop (BTC), which might better mimic the components of natural tears.

Efficacy and safety of a lipid-containing artificial tear compared with a non-lipid containing tear: a randomized clinical trial.

Perfluorohexyloctane ophthalmic solution (Miebo) and water-free cyclosporine ophthalmic solution 0.1% (Vevye) are recently approved treatments for dry eye disease (DED). Perfluorohexyloctane (PFHO) uses a novel approach to treat evaporative DED, whereas water-free cyclosporine (CsA 0.1%) is formulated to increase ocular delivery of its active ingredient to improve tear production. The two medications utilize the distinctive properties of two different semifluorinated alkanes (SFAs) to elicit their therapeutic effects. PFHO consists of 100% active ingredient and forms a monolayer on the surface of the tear film to inhibit evaporation. CsA 0.1% utilizes a vehicle consisting of perfluorobutylpentane (PFBP) and ethanol to facilitate delivery of cyclosporine to ocular tissues. The structure of these SFAs determines their differing behaviors and functions. The longer chain length of PFHO results in a slower evaporation rate and facilitates formation of a stable monolayer on the ocular surface. In vitro, PFHO demonstrated a substantially lower evaporation rate versus PFBP or human meibum, as well as a significantly longer ocular surface residence time. Ex vivo, PFHO demonstrated a longer ocular surface residence time than PFBP. The shorter chain length of PFBP enables it to better solubilize cyclosporine and improve drug delivery to ocular tissues. Although both of these ophthalmic drops utilize SFAs, their differences-in physicochemical properties and the mechanisms by which they are understood to intervene in the DED cycle-are important considerations in treatment selection for patients with DED.

Differentiating Between Perfluorohexyloctane Ophthalmic Solution and Water-Free Cyclosporine Ophthalmic Solution 0.1% for Dry Eye Disease: A Review of Preclinical and Clinical Characteristics.

Lotilaner ophthalmic solution (0.25%) is the first United States Food and Drug Administration (US FDA)-approved drug for treating Demodex blepharitis. In pivotal trials, it was found to be well tolerated and demonstrated a significant reduction in collarettes and mite density after a 6-week treatment regimen. This study aimed to report the safety and efficacy profile of lotilaner ophthalmic solution (0.25%) from a pooled analysis of two pivotal trials in patients with Demodex blepharitis.

Safety and Efficacy of Lotilaner Ophthalmic Solution (0.25%) in Treating Demodex Blepharitis: Pooled Analysis of Two Pivotal Trials.

This report explores the management of an otherwise healthy 31-year-old Caucasian female with chronic, refractory dry eye disease (DED) unresponsive to extensive conventional therapies. The initial treatment included artificial tears, cyclosporine, hypochlorous acid spray, and thermal eyelid pulsation, which provided limited relief. Progressive therapeutic interventions, such as intense pulsed light, varenicline nasal spray, perfluorohexyloctane drops, platelet-rich plasma, and topical antibiotics, resulted in only modest improvement over 15 months. Persistent symptoms and corneal staining prompted the implementation of a novel treatment: high-pressure ocular surface lavage using an irrigating eyelid retractor (Rinsada®) with preservative-free saline. Post-lavage, the patient experienced immediate and significant symptomatic relief, with marked improvement in corneal staining noted on slit lamp examination. Continued improvement was observed over two weeks following the procedure. This report underscores the potential of high-pressure saline irrigation for addressing inflammatory mediators and biofilm on the ocular surface. The irrigating eyelid retractor enabled precise and effective lavage of the palpebral conjunctiva and fornices, reducing the inflammatory load and resetting the ocular surface. This technique represents a promising adjunctive therapy for recalcitrant DED, offering rapid symptom relief and improved clinical outcomes. Further studies are warranted to validate these findings and optimize patient care.

Recalcitrant Dry Eye Disease in a 31-Year-Old Female: Favorable Outcomes Following Complete Ocular Lavage Facilitated by an Irrigating Eyelid Retractor.

 blepharitis (DB) is a chronic eyelid disease caused by an infestation of  mites. The objective of this chart audit study was to characterize the patient journey and burden of illness associated with DB from an eye-care provider's perspective.

The patient journey and burden of disease in  blepharitis in the United States.

To reach consensus on  blepharitis (DB) treatment approaches using a modified Delphi process involving 15 ocular surface disease experts.

The  Expert Panel on Treatment and Eyelid Health (DEPTH) Consensus Regarding the Preferred Treatment for  Blepharitis.

Topical pharmacologic treatments for dry eye disease (DED) address different aspects of tear film deficiency by decreasing ocular surface inflammation, stimulating mucin secretion, increasing tear production, or reducing excessive evaporation. This systematic review evaluated randomized controlled trials (RCTs) and prospective observational studies of topical ophthalmic medications for DED.

ArticleTotal : 2	Year
Publication title	2025
Publication title	2025

Article	Year
Improving Tolerance and Compliance with Topical Immunomodulators Using Micro-Emulsion Lipid Layer Artificial Tears. Clinical ophthalmology (Auckland, N.Z.)\| PubMed ID: 32753836	2020
A Review of the Mechanism of Action of Cyclosporine A: The Role of Cyclosporine A in Dry Eye Disease and Recent Formulation Developments. Clinical ophthalmology (Auckland, N.Z.)\| PubMed ID: 33299295	2020
The roles of sex and gender in women's eye health disparities in the United States. Biology of sex differences\| PubMed ID: 34670620	2021
Meibomian Gland Dysfunction: A Dermatological Perspective on Pathogenesis and Treatment Outlook. Clinical ophthalmology (Auckland, N.Z.)\| PubMed ID: 34785886	2021
Dry eye disease: identification and therapeutic strategies for primary care clinicians and clinical specialists. Annals of medicine\| PubMed ID: 36576348	2023
Bilateral Effect of OC-01 (Varenicline Solution) Nasal Spray for Treatment of Signs and Symptoms in Individuals with Mild, Moderate, and Severe Dry Eye Disease. Clinical therapeutics\| PubMed ID: 36763994	2022
The impact of Demodex blepharitis on patient symptoms and daily life. Optometry and vision science : official publication of the American Academy of Optometry\| PubMed ID: 38546756	2024
Efficacy and safety of a lipid-containing artificial tear compared with a non-lipid containing tear: a randomized clinical trial. BMC ophthalmology\| PubMed ID: 39379885	2024
Differentiating Between Perfluorohexyloctane Ophthalmic Solution and Water-Free Cyclosporine Ophthalmic Solution 0.1% for Dry Eye Disease: A Review of Preclinical and Clinical Characteristic... Ophthalmology and therapy\| PubMed ID: 39775405	2025
Safety and Efficacy of Lotilaner Ophthalmic Solution (0.25%) in Treating Demodex Blepharitis: Pooled Analysis of Two Pivotal Trials. Ophthalmology and therapy\| PubMed ID: 39873946	2025
Recalcitrant Dry Eye Disease in a 31-Year-Old Female: Favorable Outcomes Following Complete Ocular Lavage Facilitated by an Irrigating Eyelid Retractor. Cureus\| PubMed ID: 40062090	2025
The patient journey and burden of disease in blepharitis in the United States. Journal of medical economics\| PubMed ID: 40314599	2025
The Expert Panel on Treatment and Eyelid Health (DEPTH) Consensus Regarding the Preferred Treatment for Blepharitis. Clinical ophthalmology (Auckland, N.Z.)\| PubMed ID: 40551956	2025
Topical pharmacologic treatments for dry eye disease: A systematic review. The ocular surface\| PubMed ID: 40749992	2025

Laura M. Periman

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