Drop targets patients with meibomian gland dysfunction

Huenenberg, Switzerland-A new lubricant eye drop (Systane Balance, Alcon Laboratories) offers a new treatment option for patients with meibomian gland dysfunction (MGD).

The drop contains hydroxypropyl guar, borate, sorbitol, propylene glycol, and a proprietary emulsion technology (LipiTech System, Alcon) of mineral oil and an anionic phospholipid that holds the components in suspension to deliver more than 2 hours of relief from symptoms of dry eye. It is available without a prescription at retailers in the United States and will be available in Latin America later this year.

David Kading, OD, in private practice in Seattle, WA, said the lubricant eye drop enhances the oil layer of the tear film and improves stability of patients' vision. Meanwhile, it "anchors itself down" into the basement layer and slowly releases more oil for prolonged relief.

"This really creates that outer layer that helps enhance the tear film so it doesn't evaporate as rapidly," said Dr. Kading, who is an adjunct faculty member at Pacific University College of Optometry.

Another benefit is that the drop does not blur vision upon administration, said Michelene Todd, OD, in private practice in Danbury, CT. Also, immediate and prolonged relief experienced by patients requires fewer doses.

"Most patients were using an artificial tear every 2 hours, but with [this drop] they seem to get relief with using it two to three times a day," Dr. Todd said. "Women who wear eye makeup or contact lenses like this.

"I also like the decreased dosage for my male patients with MGD/rosacea," she said. "Men, especially, are not tolerant of putting in drops every couple of hours or they have trouble getting them in their eyes in the first place."

In severe cases of anterior and posterior blepharitis, Dr. May said he first treats patients with a steroid antibiotic (such as tobramycin 0.3%–dexamethasone 0.05% ophthalmic suspension [TOBRADEX ST, Alcon]) for 7 to 10 days. In moderate cases, he prescribes azithromycin ophthalmic solution 1% (Azasite, Inspire Pharmaceuticals) off-label for 30 days. In both cases, as well as mild cases, he then begins treatment with Systane Balance and hot compresses, four times a day for the first several days, then scaling back to two times a day followed by the use of hot compresses, warmed with tap water, for 5 or 10 minutes each time.

In his patients with MGD, Dr. Kading prefers to combine products for maximum effectiveness. He recommends patients use Systane Ultra (Alcon), designed for dry eye with aqueous-deficient patients, to enhance the basement layer and Systane Balance to enhance the lipid layer.

"I feel those can be used in conjunction in supporting all of the layers of the tear film," he said.

Both Drs. May and Kading encouraged the use of hot compresses, for 5 to 10 minutes each time, to help the drops spread across the eye.

Dr. Todd noted that the product's purple packaging makes it easy to locate among the many over-the-counter dry eye products on pharmacy shelves.

Relief for chronic conditions

Alcon's chief medical officer said the company is committed to finding treatments for chronic conditions such as dry eye.

"Meibomian gland dysfunction is a significant cause of dry eye symptoms, and now patients who suffer from dry eye associated with MGD can use Systane Balance to restore their lipid layer, re-establish their natural tear film, and maintain their tear film stability," said Sabri Markabi, MD, who also is the company's senior vice president of research and development.

Dr. May urged practitioners to be selective in their use of Systane Balance only for patients with MGD, because it would not deliver prolonged relief in patients who do not have lipid-layer deficiencies. Although further studies are necessary, current drop research could lead to relief for as long as 6 hours, he said.

"Five or 6 years ago, if we had an artificial tear that could make a patient feel good for about an hour, we were happy with that," Dr. May said. "The emulsion technology in Systane Balance is able to do much better and stretch that out for more than 2 hours."