The head oscillates rapidly. It takes fifteen seconds to treat one eyelid. All four eyelids take about one minute. One clinical studyfound that: 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

Mucin secretogogues. Mucins play a vital role in stabilizing the tear film and helping the tear film adhere to the ocular surface. Tavilermide (MIM-D3 ophthalmic solution, Mitogen Pharmaceuticals/Allergan) is a peptidomimetic that stimulates mucin-like production by activating mitogen-activated protein kinase systems involved with mucin production, which can also potentially aid in corneal healing. 23 In clinical trials, this topical medication improved symptoms and signs of DED in 28 days and had a favorable safety profile. 23 Thus far, the drug seems promising. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions. At-home gland expression (0). For maintenance, patients may perform manual gland expression at home. While looking down, the patient should apply mild force on the nasal upper lid in a downward motion toward the lash line, progressing laterally across the lid to express all glands. The bottom lid should be expressed similarly with the patient looking up. Appropriate supraduction or infraduction during massage prevents direct mechanical force to the cornea, which could lead to corneal deformation. Alternatively, patients may squeeze sections of the upper and lower lids between their index finger and thumb. 36 Take-home Message CyclASol is a promising cyclosporine that uses a non-aqueous perfluorobutylpentane technology based on semifluorinated alkanes. This formulation may improve bioavailability of CsA and onset of efficacy. In a Phase II study, CyclASol showed a significant reduction in corneal and conjunctival staining compared with both the vehicle and Restasis with an onset of effect at two weeks. 7

In-home device targets meibomian gland dysfunction/stasis and blepharitis

Trigeminal nerve. OC-02 (Oyster Point Pharma) is a nasal spray of a nicotinic acetylcholine receptor agonist that stimulates the trigeminal nerve to increase natural tear production. 37 In Phase II trials, tear production and symptoms improved significantly. 37 The Dry Eye Device Boom

NuLids is comfortable and easy to use. Nulids offers a comfortable treatment that is convenient to use everyday.

Schaumberg DA, Nichols JJ, Papas EB, et al. The International Workshop on Meibomian Gland Dysfunction: report of the Subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci. 2011;52(4):1994-2005. The self-regulating design halts the movement of the NuLids soft tip if too much pressure is applied to the eye. Treatment takes just 1 minute A major advantage of the eyeXpress is that it’s not user dependent,” he continues. “You can put it on the eyes and leave. Some of the other devices need a technician and/or have to be held up to the face by the patient. Lacrimal glands. Lacriprep (lacritin, TearSolutions) is another promising topical DED medication curently in clinical trials. It is a fragment of the lacritin protein, which is a glycoprotein released from the lacrimal glands. Research shows reduced levels of this protein are associated with dry eye signs. 31-33 Lacritin can promote basal tearing in eyes of rabbits and rescue cultured human corneal epithelial cells from inflammatory cytokine stress in dry eye patients. 33 A Phase II clinical trial of patients with Sjögren’s-associated DED is underway. 34 Llamas-Moreno JF, Baiza-Durán LM, SaucedoRodríguez LR, Alaníz-De la O JF. Efficacy and safety of chondroitin sulfate/xanthan gum versus polyethylene glycol/propylene glycol/hydroxypropyl guar in patients with dry eye. Clin Ophthalmol 2013;7:995-9