A prescription lubricant insert designed to combat dry eye syndrome can
serve as an effective alternative or adjunct treatment, especially for patients
using multiple daily doses of artificial tears, according to several
Lacrisert (hydroxypropyl cellulose ophthalmic insert, Aton Pharma) is a
preservative-free, once-daily, sustained release prescription insert indicated
for moderate to severe dry eye. Once inserted, Lacrisert softens and dissolves
slowly to stabilize the tear film, reducing discomfort, burning, itching and
other common symptoms associated with dry eye syndrome.
Effective adjunct treatment
Before prescribing Lacrisert, clinicians should consider each
patients specific condition, according to David L. Kading, OD, FAAO.
Not all dry eye patients are the same, he said in an
interview with Primary Care Optometry News. If they have meibomian
gland dysfunction, Lacrisert isnt going to give as big of a hit as it
would for a patient who has a tear insufficiency.
|Figure 1. An applicator is provided to ease insertion of the
Image: Aton Pharma
Dr. Kading said he prescribes Lacrisert to create a more thorough
and robust tear film in patients who require multiple doses of artificial
tears. He noted, however, that Lacrisert can work in patients with meibomian
gland dysfunction or inflammatory dry eye, but only as an adjunct therapy.
You can get a really big bang for your buck by adding Lacrisert to
an existing treatment regimen, but you need to use it in conjunction with other
therapy, Dr. Kading said. Lacrisert will not solve all your
Like Dr. Kading, Paul M. Karpecki, OD, FAAO believes in evaluating each
dry eye patient individually when developing a treatment plan.
When it comes to managing a dry eye clinic, its important to
have a lot of alternatives not everything works on every single
patient, he told PCON.
Dr. Karpecki considers Lacrisert an effective alternative treatment for
moderate to severe dry eye patients and said it can work well in contact lens
wearers who may suffer from dry eye symptoms.
In addition, Lacrisert has not been shown to cause adverse reactions
when used in conjunction with other eye medications, according to Dr. Karpecki.
We dont know how certain drugs absorb into the
Lacrisert, he said. But if they did, it would probably allow more
of the drug to be present in the eye, which certainly wouldnt hurt.
Blurry vision a side effect
While Lacrisert causes side effects similar to traditional artificial
tears, clinicians have found ways to work around them.
One of the drawbacks is that approximately 10% of patients will
experience blurry vision with Lacrisert, Mile Brujic, OD, said in an
interview. For those people who benefit from the product, but experience
blurred vision, I recommend using them in the evening and then removing them in
Along with blurred vision, Dr. Karpecki said some patients report a
foreign body sensation from the insert, but he claims the solution is simple.
Put them in before going to bed, Dr. Karpecki said, echoing
Dr. Brujics method for reducing blurry vision. Patients wont
have that foreign body sensation, and they will wake up with their eyes feeling
Clinical study results
At this years Association for Research in Vision and Ophthalmology
meeting, Jodi Luchs, MD, FACS, reported results of a multicenter, open-label,
prospective registry study that analyzed 418 patients with bilateral moderate
to severe dry eye syndrome. After 1 month of Lacrisert treatment, Ocular
Surface Disease Scores decreased by 29.8% in the severe group and 18.9% in the
moderate group, according to the study.
Blurry vision was the most commonly reported adverse event.
Can be easier than inserting contacts
Although it can take some practice to learn how to insert them properly,
Dr. Kading said dexterity problems should not be a determining factor for
prescribing Lacrisert, which can be inserted by using small, plastic tools
provided by the manufacturer.
We dont find that inserting Lacrisert is ever an issue with
our patients, regardless of their age, Dr. Kading said.
Theyre easier to put in than contact lenses.
Dr. Karpecki agrees, noting that even older or arthritic patients do not
have a problem inserting them. In fact, he said older patients may be better
suited for the product because their lids are looser, making them less likely
to experience the foreign body sensation.
However, for patients with persistent insertion difficulties, Dr.
Karpecki recommends punctal occlusion instead.
A few patients may have dexterity issues that prevent them from
being able to use it, such as those with severe arthritis or
Parkinsons, he said. For that group, I would look at other
therapies such as punctal occlusion, where Im taking care of the
treatment rather than the patient.
According to Dr. Brujic, punctal plugs simply help tears remain on the
eye longer, while Lacriserts provide a continuous artificial tear for 18 to 24
hours after proper placement. Depending on the patient and ocular surface
status, he said patients can use either product alone or in combination with
I have a number of patients who have punctal plugs and use
Lacriserts as well, he said. Lacrisert is a good adjunct therapy to
punctal occlusion, but I dont necessarily consider it a
Dr. Brujic added that insurance coverage for Lacrisert will vary, but he
said it is often covered at least partially by most prescription plans.
Practitioners can request samples from the manufacturer so
patients can go through a trial period before purchasing them from the
pharmacy, he said. by Courtney Preston
- Luchs JI, Nelinson DS, Macy JI. Efficacy of hydroxypropyl cellulose
ophthalmic inserts (Lacrisert) in subsets of patients with dry eye syndrome:
findings from a patient registry. Cornea. 2010. doi:
- Mile Brujic, OD, is a partner of Premier Vision Group. He can be
reached at 1222 Ridgewood Dr., Bowling Green, OH 43402; (419) 352-2502;
email@example.com. Dr. Brujic has
received honoraria for ad hoc consulting services with Aton Pharma.
- David L. Kading, OD, FAAO, can be reached at Specialty Eyecare
Group, 11830 NE 128th St, Suite 1, Kirkland, WA 98034; (425) 821-8900; fax:
(425) 814-9782; firstname.lastname@example.org.
- Paul M. Karpecki, OD, FAAO, is clinical director of corneal
services and ocular surface research for Koffler Vision Group and a member of
the PCON Editorial Board. He can be reached at 120 N. Eagle Creek Drive,
Ste 431, Lexington, KY 40509; (859) 227-7781;