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I am a male, age 82 who has been suffering from DED for about 5 years. I have gone through the usual treatment stages - eye drops and gels of various viscosities, punctual plugs, and finally Restasis and Xiidra. I currently have punctual plugs inserted in the upper tear duct of both eyes and I am using both Restasis and Xiidra concurrently. I thought it might be helpful to the forum to read my comments on these various treatments as they applied to me and in the order we tried them:
1. Eye drops: Offered only temporary relief seldom lasting longer than about 15 - 20 minutes for even the most viscous formulations. Provided relief from the scratchy gravel-in-the-eyes feeling, but only for a short duration. I was using them so often my ophthalmologist told me to use preservative free drops to avoid a allergic reaction to the preservatives used in the traditional eye drops (he said I should not use drops containing preservatives more than 4X daily, but I could use unlimited preservative free drops (however, they are much more expensive). I was also awakened at night by the gritty feeling and had to use drops 3 - 4 times nightly.
2. Punctual plugs: As you know, we all have an upper and a lower tear duct in each eye. My ophthalmologist said the upper ducts drain about 10% of the tears, and the lower ducts about 90%. We decided to start by inserting punctual plugs in my lower tear ducts only. After a 3 week trial, there didn’t seem to be any improvement so he inserted plugs in the upper ducts also, so all tear ducts were plugged. I was suddenly awash in tears to the extent I was constantly wiping them away with Kleenex. Unfortunately this didn’t help with the DED. The tears, although abundant, seemed to be lacking the necessary lubricating oils. He removed the two upper plugs but retained the lowers.
3. Restasis: Still retaining my lower punctual plugs, he started me on Restasis, twice daily. After six months I seemed to improve slowly with less discomfort during the day but still had to use drops at night. I felt I had reached a plateau.
4. Xiidra: A month ago he wrote me a free one month prescription for Xiidra. He said to keep using the Restasis and use the Xiidra concurrently (I also still have the lower punctual plugs in place). After two weeks there was no noticeable difference. At three weeks things really improved and I no longer needed drops at night. After four weeks, I am much more comfortable during the day only using drops once or twice daily, usually after spending time reading, or on the computer. I no longer am awakened at night and my eyes feel normal upon awakening. Previously they felt “stuck shut” and gravelly when I awakened.
He wrote me a 90 day prescription for Xiidra with renewals and want’s me to continue using it along with my remaining Restasis (I still have several months supply). When the Restasis is gone, I will continue on Xiidra alone and see if everything remains constant.
BTW, my side-effect experience with Xiidra so far is that it seems to “sting” about the same as Restasis but, with both medications, this reaction is random and doesn’t occur every time (maybe there are other environmental factors involved?). This discomfort, when it occurs, passes within 5 - 10 minutes. Also, immediately after using Xiidra, I have more blurred vision than with Restasis. It lasts about 10-15 minutes and is not really a problem for normal vision (I have difficulty focusing on newspaper articles or other small print for a while, then it clears). Finally, I have not experienced the Xiidra dysgeusia (unusual taste) side effect.
Bottom line: Xiidra seems to be working for me. I’m very pleased both in terms of comfort and (I do believe) I have improved vision. In a few months, after I have been using Xiidra by itself for some time, I will report again on my progress.
1. Eye drops: Offered only temporary relief seldom lasting longer than about 15 - 20 minutes for even the most viscous formulations. Provided relief from the scratchy gravel-in-the-eyes feeling, but only for a short duration. I was using them so often my ophthalmologist told me to use preservative free drops to avoid a allergic reaction to the preservatives used in the traditional eye drops (he said I should not use drops containing preservatives more than 4X daily, but I could use unlimited preservative free drops (however, they are much more expensive). I was also awakened at night by the gritty feeling and had to use drops 3 - 4 times nightly.
2. Punctual plugs: As you know, we all have an upper and a lower tear duct in each eye. My ophthalmologist said the upper ducts drain about 10% of the tears, and the lower ducts about 90%. We decided to start by inserting punctual plugs in my lower tear ducts only. After a 3 week trial, there didn’t seem to be any improvement so he inserted plugs in the upper ducts also, so all tear ducts were plugged. I was suddenly awash in tears to the extent I was constantly wiping them away with Kleenex. Unfortunately this didn’t help with the DED. The tears, although abundant, seemed to be lacking the necessary lubricating oils. He removed the two upper plugs but retained the lowers.
3. Restasis: Still retaining my lower punctual plugs, he started me on Restasis, twice daily. After six months I seemed to improve slowly with less discomfort during the day but still had to use drops at night. I felt I had reached a plateau.
4. Xiidra: A month ago he wrote me a free one month prescription for Xiidra. He said to keep using the Restasis and use the Xiidra concurrently (I also still have the lower punctual plugs in place). After two weeks there was no noticeable difference. At three weeks things really improved and I no longer needed drops at night. After four weeks, I am much more comfortable during the day only using drops once or twice daily, usually after spending time reading, or on the computer. I no longer am awakened at night and my eyes feel normal upon awakening. Previously they felt “stuck shut” and gravelly when I awakened.
He wrote me a 90 day prescription for Xiidra with renewals and want’s me to continue using it along with my remaining Restasis (I still have several months supply). When the Restasis is gone, I will continue on Xiidra alone and see if everything remains constant.
BTW, my side-effect experience with Xiidra so far is that it seems to “sting” about the same as Restasis but, with both medications, this reaction is random and doesn’t occur every time (maybe there are other environmental factors involved?). This discomfort, when it occurs, passes within 5 - 10 minutes. Also, immediately after using Xiidra, I have more blurred vision than with Restasis. It lasts about 10-15 minutes and is not really a problem for normal vision (I have difficulty focusing on newspaper articles or other small print for a while, then it clears). Finally, I have not experienced the Xiidra dysgeusia (unusual taste) side effect.
Bottom line: Xiidra seems to be working for me. I’m very pleased both in terms of comfort and (I do believe) I have improved vision. In a few months, after I have been using Xiidra by itself for some time, I will report again on my progress.
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