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What can I do if conventional dry eye treatments don’t improve my dry eyes? 

There are therapies for people who have what are called cases of refractive dry eye disease.
One such therapy is autologous serum. This approach involves creating autologous serum tears as a natural substitute for natural tears. The serum contains bioactive protein, vitamins and lipids, which are typically present in human tears and can provide symptomatic relief in many types of dry eye disease.
Serum tears are particularly useful in marked aqueous tear deficiency. We reserve their use for those small number of patients for whom standard measures fail. We can use 20% concentrate or platelet-rich plasma tears. However, these tears are not easily accessible and have quite a high cost.
We can use an amniotic membrane. We can obtain this as a cryopreserved amniotic membrane for transplantation. These membranes display anti-inflammatory and restorative effects in many ocular surface diseases and may have a role in the management of dry eye disease.
The patient can also use contact lenses as a soft bandaged lens in many ocular surface diseases. In dry eye disease, a scleral lens which becomes fluid filled and vaults over the cornea resting on the limbus of the eye provides constant lubrication and can improve comfort and reduce dry eye symptoms. It can also improve visual acuity and is safe.
To date, only special centres can fit scleral lenses. Newer scleral lenses are coming which are easier to fit and more readily commercially available. I can recommend patients for these. However, their use is limited to only a small number of patients who may require them. They also lack availability and cost a lot. Furthermore, not all patients find them easy to handle. Over the next few years, we expect to see a lot more therapeutic options from contact lenses.
In addition to bandage high water content contact lenses, punctal plugs can also help patients with dry eyes. Punctal plugs can help maintain the tears you produce if you have aqueous deficiency dry eye disease. They are not a substitute for treating the underlying meibomian gland dysfunction present in 85% of patients with dry eye disease. But, they are highly useful for a 10-15% of patients where aqueous deficiency predominates. They can be especially helpful if patients find eye drops inconvenient, mainly if they are a young working person who might need to put in eye drops every half hour. While going this route results in having a lower punctal plug placed, dry eye sufferers can have a more tolerable life and not have to put in drops and gels so often.
At Clinica London, we insert punctal plugs for patients with dry eye disease.


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