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Dry Eye/OSD
- Dry Eye/OSD
Prescribing Acetylcysteine
Indication
Unlabeled use for vernal and giant papillary conjunctivitis, filamentary keratitis, aqueous-deficient dry eye, corneal melt
Mechanism of Action
Intracellular effect on goblet cells during mucin formation softens mucuous, anti-collagenase effect may promote reepitheliazation
Available Quantities
Varies
Dosage/Instructions
Dilute to 2% to 5% with artificial tears or saline for use as in aqueous deficient dry eye. Dilute to 10% to 20% and use 4-6x.day for use as an anti-mucolytic or collagenase-inhibiting agent for treatment of ocular burns, filamentary keratopathy, corneal melt, etc.
Safety Info for Acetylcysteine
Pregnancy & Nursing
Limited data; potential risks to the fetus not well established
Pediatric Use
No studies
Contraindications, side effects, etc.
Contraindications: Allergy to acetylcysteine.
Warnings/Precautions: Inform medical caregivers if you have a stomach ulcer, stomach bleeding, high blood pressure, congestive heart failure, or kidney disease. Caution advised if you are pregnant or breastfeeding.
Common Side Effects: Mild nausea, stomach upset, vomiting, rash, fever. In rare cases, severe or ongoing vomiting, coughing up blood, and signs of liver damage (such as upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice) may occur.Acetylcysteine 5%, 10%, 20%ophthalmic solution - Dry Eye/OSD
Prescribing Cequa®
Indication
Increasing tear production in cases of keratoconjunctivitis sicca where tear production is suppressed due to ocular inflammationMechanism of Action
Calcineurin inhibitor, modulates T-cell functionAvailable Quantities
0.25 ml vials (60 vials per box)Dosage/Instructions
1 drop in each eye twice daily, 12 hours apartSafety Info for Cequa®
Pregnancy & Nursing
No adequate studies in pregnant womenPediatric Use
≥18 yearsContraindications, side effects, etc.
Contraindications: Hypersensitivity to cyclosporine or any components of the formulation. Warnings/Precautions: Not indicated for use in patients with active ocular infections. Caution in patients with a history of herpes keratitis. Contact lenses should not be worn during administration. Common Side Effects: Eye pain, stinging, redness, and tear film instability. Rarely, allergic reactions and growth of eyelashes.Cyclosporine 0.09%ophthalmic solution - Dry Eye/OSD
Prescribing Eysuvis®
Indication
short-term (up to two weeks) treatment of the signs and symptoms of dry eye disease.Mechanism of Action
Exerts anti-inflammatory effects by inhibiting phospholipase A2, leading to decreased formation of arachidonic acid derivatives like prostaglandins and leukotrienes. This action reduces inflammation and helps alleviate the symptoms of dry eye disease.Available Quantities
8.3 mlDosage/Instructions
Shake for 2 to 3 seconds. Use 1 or 2 drops four times daily, up to 2 weeks if neededSafety Info for Eysuvis®
Pregnancy & Nursing
Fetal malformations noted in rabbits with oral administration of 1.4 times the human ophthalmic dose. Use cautiously during pregnancyPediatric Use
No studiesContraindications, side effects, etc.
Contraindications: Hypersensitivity to loteprednol etabonate or any components of the product. Warnings/Precautions: Use with caution in patients with glaucoma, cataracts, corneal or scleral thinning, bacterial/viral/fungal ocular infections. Prolonged use may increase intraocular pressure and risk of cataract formation. Common Side Effects: Minor burning or stinging upon instillation, blurred vision, dry eyes, and headache.Loteprednol etabonate 0.25%ophthalmic suspension - Dry Eye/OSD
Prescribing Lacrisert®
Indication
Moderate to severe dry eye syndromes, including keratoconjunctivitis sicca, exposure keratitis, and recurrent corneal erosionsMechanism of Action
Stabilizes and thickens the precorneal tear film and prolongs the tear film breakup time.Available Quantities
60 units per boxDosage/Instructions
Insert 1 rod daily into the lower conjunctival sac. The insert dissolves slowly over the day, providing continuous lubrication and protection.Safety Info for Lacrisert®
Pregnancy & Nursing
Feeding of hydroxypropyl cellulose to rats at levels up to 5% of their diet produced no gross or histopathologic changes or other deleterious effects.Pediatric Use
No studiesContraindications, side effects, etc.
Contraindications: Hypersensitivity to hydroxypropyl cellulose. Warnings/Precautions: Proper insertion and removal are crucial to avoid corneal abrasion. May cause transient blurring of vision; caution advised when driving or operating machinery. Common Side Effects: Blurring of vision, ocular discomfort or irritation, eyelash matting or stickiness, photophobia, hypersensitivity, eyelid edema, hyperemia.Hydroxypropyl Cellulose 5 mgophthalmic insert - Dry Eye/OSD
Prescribing Miebo®
Indication
Treatment of dry eye diseaseMechanism of Action
Perfluorohexyloctane forms an amphiphilic, physiologically inert monolayer at the air-liquid interface, reducing evaporation and stabilizing the tear film. It enhances the lipid layer of the tear film in dry eye disease.Available Quantities
3 mlDosage/Instructions
1 drop four times daily (QID)Safety Info for Miebo®
Pregnancy & Nursing
No adequate and well-controlled studies in pregnant women. No evidence of embryofetal toxicity or teratogenicity in rats at 160x human ophthalmic dose.Pediatric Use
≥18 yearsContraindications, side effects, etc.
ontraindications: Hypersensitivity to perfluorohexyloctane. Warnings/Precautions: Limited data available on use during pregnancy and breastfeeding. Contact lenses should be removed before use and reinserted after at least 30 minutes. Common Side Effects: Blurred vision and eye redness.100% perfluorohexyloctaneophthalmic solution - Dry Eye/OSD
Prescribing Muro 128® 2%
Indication
Temporary relief of corneal edemaMechanism of Action
Creates a hypertonic environment to reduce corneal edemaAvailable Quantities
15 mlDosage/Instructions
1 to 2 drops in the eye every 3 to 4 hoursSafety Info for Muro 128® 2%
Pregnancy & Nursing
Limited data; potential risks to the fetus not well establishedPediatric Use
No studiesContraindications, side effects, etc.
Contraindications: Allergy to sodium chloride or any other part of Muro 128. Warnings/Precautions: Inform healthcare providers if you’re using Muro 128, especially if you are pregnant, plan to become pregnant, or are breastfeeding. Use caution when driving or doing tasks that require clear eyesight. Common Side Effects: Eye irritation and burning sensation. In rare cases, severe side effects like allergic reactions (rash, itching, swelling), changes in eyesight, eye pain, or very bad eye irritation may occur.Sodium Chloride 2%ophthalmic solution - Dry Eye/OSD
Prescribing Muro 128® 5%
Indication
Temporary relief of corneal edemaMechanism of Action
Creates a hypertonic environment to reduce corneal edemaAvailable Quantities
15 mlDosage/Instructions
1 to 2 drops in the eye every 3 to 4 hoursSafety Info for Muro 128® 5%
Pregnancy & Nursing
Limited data; potential risks to the fetus not well establishedPediatric Use
No studiesContraindications, side effects, etc.
Contraindications: Allergy to sodium chloride or any other part of Muro 128. Warnings/Precautions: Inform healthcare providers if you’re using Muro 128, especially if you are pregnant, plan to become pregnant, or are breastfeeding. Use caution when driving or doing tasks that require clear eyesight. Common Side Effects: Eye irritation and burning sensation. In rare cases, severe side effects like allergic reactions (rash, itching, swelling), changes in eyesight, eye pain, or very bad eye irritation may occur.Sodium Chloride 5%ophthalmic solution - Dry Eye/OSD
Prescribing Muro 128® Ointment 5%
Indication
Temporary relief of corneal edemaMechanism of Action
Creates a hypertonic environment to reduce corneal edemaAvailable Quantities
VariesDosage/Instructions
Apply a small amount in the eye every 3 to 4 hours or as directed. Generally reserved for nighttime use.Safety Info for Muro 128® Ointment 5%
Pregnancy & Nursing
Limited data; potential risks to the fetus not well establishedPediatric Use
No studiesContraindications, side effects, etc.
Contraindications: Allergy to sodium chloride or any other part of Muro 128. Warnings/Precautions: Inform healthcare providers if you’re using Muro 128, especially if you are pregnant, plan to become pregnant, or are breastfeeding. Use caution when driving or doing tasks that require clear eyesight. Common Side Effects: Eye irritation and burning sensation. In rare cases, severe side effects like allergic reactions (rash, itching, swelling), changes in eyesight, eye pain, or very bad eye irritation may occur.Sodium Chloride 5%ophthalmic ointment - Dry Eye/OSD
Prescribing Oxervate®
Indication
Treatment of neurotrophic keratitisMechanism of Action
Replicates action of endogenous NGF controlling neurotransmitter and neuropeptide synthesis, influences neuronal plasticity affecting innervation density, axonal terminal sprouting, and dendrite arborizationAvailable Quantities
7 multiple-dose vialsDosage/Instructions
1 drop in the affected eye(s) every 2 hours, 6 times a day for eight weeks.Safety Info for Oxervate®
Pregnancy & Nursing
Administration to pregnant rats or rabbits during organogenesis did not produce adverse fetal effects at clinically relevant dosesPediatric Use
≥2 yearsContraindications, side effects, etc.
Contraindications: Allergy to cenegermin or any part of Oxervate. Warnings/Precautions: Patients should inform their healthcare providers if they take Oxervate. It’s important to use caution when driving or doing other tasks requiring clear eyesight. Discuss the benefits and risks of using Oxervate if you are pregnant or breastfeeding. Common Side Effects: The most commonly reported side effects include eye pain, ocular hyperemia (enlarged blood vessels in the eye), eye inflammation, and increased lacrimation (tear production). Other side effects may include decreased vision, feeling of having something in the eye, irritation, pain, redness, or swelling of the eye, and tearing.Cenegermin-bkbj 0.002%ophthalmic solution - Dry Eye/OSD
Prescribing Restasis®
Indication
Increase tear production in keratoconjunctivitis sicca due to ocular inflammationMechanism of Action
Cyclosporine is a calcineurin inhibitor immunosuppressant. It modulates T-cell function and increases goblet cell density in the conjunctiva, contributing to increased tear production and decreased ocular inflammation in dry eye disease.Available Quantities
0.4 ml vials (30 or 60 vials per tray), 5.5 ml in 10 ml bottleDosage/Instructions
1 drop twice daily, 12 hours apart (Shake emulsion)Safety Info for Restasis®
Pregnancy & Nursing
Category C. Teratogenic in rats at 5000x the human dose. Use cautiously during pregnancyPediatric Use
≥16 yearsContraindications, side effects, etc.
Contraindications: Known hypersensitivity to cyclosporine or any of the ingredients in the formulation. Warnings/Precautions: Not recommended for use in patients with active ocular infections or with a history of herpes viral infections of the eye. Contact lens wearers should remove lenses prior to application and wait 15 minutes before reinsertion. Common Side Effects: Ocular burning, conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging, and visual disturbance.Cyclosporine 0.05%ophthalmic emulsion - Dry Eye/OSD
Prescribing Tyrvaya®
Indication
Treatment of the signs and symptoms of dry eye diseaseMechanism of Action
Tyrvaya activates the trigeminal parasympathetic pathway, resulting in increased tear production. It is a partial nicotinic acetylcholine receptor agonist of α4β2, α4α6β2, α3β4, and α3α5β4 receptors and a full α7 receptor agonist.Available Quantities
Carton contains 2 spray bottles – 4.2ml each (60 sprays per bottle)Dosage/Instructions
1 spray in each nostril twice dailySafety Info for Tyrvaya®
Pregnancy & Nursing
At high doses (4864 times the normal dose), rats exhibited reduced body weight. Use cautiously during pregnancyPediatric Use
No studiesContraindications, side effects, etc.
Contraindications: Allergic reactions to varenicline or other ingredients in the formulation. Warnings/Precautions: Patients should inform their healthcare provider if they are pregnant, planning a pregnancy, or breastfeeding. The medication is for nasal use only. Common Side Effects: Sneezing, cough, throat irritation, nose irritation. Most side effects are mild, and less than 2% of patients in clinical trials discontinued treatment due to side effects.0.6 mg/mL (0.06%) varenicline solutionnasal spray - Dry Eye/OSD
Prescribing Vevye®
Indication
Treatment of the signs and symptoms of dry eye diseaseMechanism of Action
Cyclosporine is a selective immunomodulator that prevents T-cell activation. It inhibits calcineurin, reducing inflammatory cytokine production, thus improving tear production and ocular surface health in dry eye diseaseAvailable Quantities
2 mlDosage/Instructions
1 drop in each eye twice daily, 12 hours apartSafety Info for Vevye®
Pregnancy & Nursing
No adequate and well-controlled studies in pregnant women. Teratogenic to rats at high dosesPediatric Use
≥18 yearsContraindications, side effects, etc.
Contraindications: Allergic to cyclosporine. Warnings/Precautions: Avoid touching the dropper on any surface to prevent contamination. Do not use while wearing contact lenses; wait 15 minutes after administration to reinsert them. The safety of Vevye during pregnancy and breastfeeding is not established. Not approved for use in children and young adults under 18 years old. Common Side Effects: Mild burning or stinging in the eyes, mild redness or itching, blurred vision, feeling like something is in the eye. Less common side effects include bladder pain, body aches, cough, fever, sore throat, and unusual tiredness or weakness.0.1% cyclosporine ophthalmic solutionophthalmic solution - Dry Eye/OSD
Prescribing Xdemvy®
Indication
Treatment of Demodex blepharitisMechanism of Action
Inhibits GABA-gated chloride channels in mites, causing paralytic action leading to their death.Available Quantities
1.5 ml, 10 mlDosage/Instructions
Instill 1 drop in each eye twice daily (approximately 12 hours apart) for 6 weeks. If more than 1 topical ophthalmic drug is being used, administer at least five minutes apart.Safety Info for Xdemvy®
Pregnancy & Nursing
No adequate and well-controlled studies in pregnant women. Animal studies showed no adverse developmental effects at clinically relevant doses.Pediatric Use
≥18 yearsContraindications, side effects, etc.
Contraindications: Allergy to cenegermin or any part of Oxervate. Warnings/Precautions: Healthcare providers should be aware of the need for proper instruction on the administration of Oxervate. It’s important to monitor for common ocular side effects like eye pain, ocular hyperemia, inflammation, and increased lacrimation, and manage these appropriately. Common Side Effects: Eye pain, ocular hyperemia, eye inflammation, and increased lacrimation are common. Other side effects may include decreased vision, feeling of having something in the eye, eye irritation, redness, swelling, and tearing.Lotilaner Ophthalmic Solution 0.25%ophthalmic solution - Dry Eye/OSD
Prescribing Xiidra®
Indication
Treatment of the signs and symptoms of dry eye diseaseMechanism of Action
Lifitegrast binds to leukocyte cell surface protein LFA-1, reducing T-cell activation and inflammatory cytokine secretion. It’s believed to prevent the formation of an immunologic synapse, inhibit T cell activation, reduce cytokine release, and down-regulate inflammation mediated by T lymphocytes.Available Quantities
Cartons of 60 single-use containers (each carton has 12 pouches, with 5 single-use containers)Dosage/Instructions
1 drop in each eye twice dailySafety Info for Xiidra®
Pregnancy & Nursing
Teratogenic in rats at high doses. Use cautiously during pregnancyPediatric Use
≥17 yearsContraindications, side effects, etc.
Warnings/Precautions: Inform your doctor if you use other eye drops, wear contact lenses, are pregnant, or breastfeeding. Not approved for use in individuals under 17 years. Common Side Effects: Blurred vision, eye discomfort, eye irritation, unusual or unpleasant taste in the mouth.Lifitegrast ophthalmic solution 5%ophthalmic solution
