The NuLids Starter Kit – Nulids at-Home Dry Eye Treatment and Relief – Convenient & Easy to Use Handheld Device for Relief from Dry Eye, Blepharitis, MGD Symtpoms - Includes 30 Day Supply Of Soft Tips

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Senchyna M, Green-Church K, Kamat M, et al. Effect of intranasal neurostimulation on total tear lipid and total protein concentrations in subjects with dry eye. Optom Vis Sci. 2017. E-abstract 175289 Recently, Cequa (CsA ophthalmic solution 0.09%, Sun Pharma) joined Restasis (CsA 0.05% ophthalmic emulsion, Allergan), an immunomodulatory agent, and Xiidra (lifitegrast ophthalmic solution 5%, Takeda-Shire), an LFA-1 antagonist, as the third DED prescription drug approved by the FDA in 15 years. Like Restasis, Cequa is indicated for the treatment of keratoconjunctivitis sicca with the familiar BID dosage and supplied in single-use vials. 6 Valencia-Nieto L, Novo-Diez A, Blanco-Vázquez M, et al. Therapeutic instruments targeting meibomian gland dysfunction. Ophthalmol Ther. 2020:9(4):797-807. Cequa is a first-in-class topical formulation with the highest FDA-approved concentration of cyclosporine and a novel nanomiceller technology, which overcomes the longstanding challenges of cyclosporine’s delivery to ocular surface tissues. 6 The high hydrophobicity of the lipophilic CsA impedes the drug’s ability to penetrate the aqueous layer. 6,7 Cequa’s nanomiceller formulation overcomes this barrier by forming small micelles or aggregates of amphiphilic molecules where the water-loving polar heads form an outer shell that faces the aqueous, while the non-polar, water-hating tails are sequestered inward to form a hydrophobic core. 6

Corticosteroids. Soft topical steroids are valuable for dry eye management, especially in acute flare-ups that necessitate rapid relief. However, the potential side effects of elevated intraocular pressure (IOP) and cataracts limit their use. KPI-121 (0.25% loteprednol etabonate ophthalmic suspension, Kala Pharmaceuticals) could be the first FDA-approved product for the short-term, two-week treatment of DED.Wirta DL, Torkildsen GL, Moreira HR, et al. A clinical phase 2 study to assess efficacy, safety and tolerability of CyclASol for treatment of dry eye disease (DED). Ophthalmology. January 28, 2019. [Epub ahead of print]. Evans D, Baba S, Holdbrook M, et al. Effectiveness and safety of intranasal tear neurostimulation for subjects with dry eye disease. Optom Vis Sci. 2017. E-abstract 175272. RF: Data from our in-house NuLids I study was presented as a poster at ASCRS 2017. It showed statistically significant reductions in dry eye signs and symptoms; among these were an improved tear-film breakup time from 6 seconds to 10.8 seconds. Novel nasal spray therapy for dry eye shows promise [press release]. Oyster Point Pharma. July 17, 2018.

Currently, in-office MGD therapies are not fully covered by insurance, leaving patients with a large portion of the financial burden. Patient education regarding the benefits of in-office treatment in addition to home therapy is critical in establishing buy-in when it comes to cost and compliance. As practitioners, we must stay abreast of the latest technology and look to clinical data to determine which procedures to implement in our practices for the betterment of our patients’ lives. Maskin SL, Testa WR. Growth of meibomian gland tissue after intraductal meibomian gland probing in patients with obstructive meibomian gland dysfunction. Br J Ophthalmol. 2018;102(1):59-68. National Center for Advancing Translational Sciences. Development of P-321 for chronic dry eye. October 26, 2018. https://ncats.nih.gov/bridgs/projects/complete/p-321-chronic-dry-eye. Accessed February 9, 2019. In 2015, Toyos and colleagues published a retrospective review of 91 patients presenting with dry eye symptoms who were treated with IPL. They found that 93% of patients had improvement in symptoms and 87% improvement in TBUT over a median of four follow-up visits. Thirteen percent of patients reported adverse events, mostly related to localized redness and swelling, but there were no significant adverse events. 31 In addition, several other retrospective studies published have also indicated improvement in signs and symptoms of dry eye disease following IPL therapy. 33, 34

'Deep cleaning' devices for dry eyes

Connor CG, Narayanan S, Miller W. Reduction in inflammatory marker matrix metalloprotenaise-9 following lid debridement with BlephEx. Invest Ophthalmol Vis Sci. 2017;58:498. In 2010, Maskin reported a novel probing technique for treating MGD using a beveled, 2mm solid stainless steel probe directly into meibomian gland orifices. 47 He reported that 24 out of 25 patients had immediate relief in tenderness and all patients had persistent relief 4 weeks later. Repeat treatments were only required in 5 of the patients with an average follow-up of 11.5 months. 47 In 2018, Maskin et al reported post-probing meibography results of 50 eyelids from 28 patients. The authors reported that 36% of lids appeared to have signs of individual gland growth with a mean follow-up time of 10 months, while detailed analysis of 13 lids demonstrated a 6.23% increase in mean individual gland area. The authors recognized not only lengthening of shortened glands but also partial restoration of faded glands and speculated that there was possible new gland growth. 48 Also published in the last year, Incekalan et al. evaluated both effectiveness and speed of relief among 80 eyes of 20 patients treated with either conventional meibomian gland disease treatments (consisting of warm compresses, eyelid massage and cleansing, artificial tears, topical antibiotics, oral omega-3 supplementation, and oral azithromycin) or a combination of conventional treatments above with a single session of intraductal meibomian gland probing performed at first visit. 49 Patients were followed for three months after the initial visit or procedure. OSDI, Schirmer testing, tear film breakup time, Oxford grading of ocular surface, and both meibum expressibility and quality improved in both groups, though the subgroup treated with probing had significantly faster improvement in all measurements. 49 Perfluorohexyloctane. NovaTears (Novaliq) is a one-component eye drop containing 100% perfluorohexyloctane. This unique lubricant is a water- and preservative-free lipophilic liquid. NovaTears stabilizes the lipid layer and can improve signs of meibomian gland dysfunction (MGD), as well as symptoms and signs of DED ( Figure 3). 42-44 NovaTears is currently available in Europe and Australia in multidose bottles and is in Phase II clinical trials in the United States. 45

While Lipiflow is a first-of-its-kind device to treat MGD-associated DED, several new treatment approaches are on the way that also hold promise for providing relief. Steven P, Scherer D, Krosser S, et al. Semifluorinated alkane eye drops for treatment of dry eye disease—a prospective, multicenter noninterventional study. J Ocul Pharmacol Ther. 2015;31:498-503. Choi MG, Yeo JH, Kang JW, et al. Effects of botulinum toxin type A on the treatment of dry eye disease and tear cytokines. Graefes Arch Clin Exp Ophthalmol. 2019;257(2):331-38. Although the reported mild to moderate adverse reactions of these DED medications are similar, responses to a drug, whether suboptimal or optimal, depend on the individual. 6

NuLids range for blepharitis and meibomian gland dysfunction

Geerling G, Tauber J, Baudouin C, et al. The International Workshop on Meibomian Gland Dysfunction: report of the Subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2011;52(4):2050-64. International Workshop on Meibomian Gland Dysfunction: report of the Definition and Classification Subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930-7.