Dry Eye Syndrome : Drug Summary

Eye Corticosteroids*

Drug	Available Strength	Dosage	Remarks
Betamethasone	0.1% ophthalmic drops	Adjusted based on the severity of symptoms. Should be tapered appropriately.	Adverse Reactions Ocular effects (conjunctival hyperemia, conjunctivitis, corneal ulcers, delayed wound healing, glaucoma, increased intraocular pressure [IOP], keratitis, loss of accommodation, optic nerve damage, mydriasis, posterior subcapsular cataract formation, ptosis, secondary ocular infection) Special Instructions Avoid use in patients with viral diseases of the cornea and conjunctiva (eg acute superficial herpes simplex keratitis), mycobacterial or fungal infections of the eye Monitor IOP of patients receiving treatment for ≥10 days Withdraw therapy with gradual dose tapering
Dexamethasone	0.5 mg/1 mL ophthalmic drops; 0.1% ophthalmic gel; 0.1% ophthalmic suspension/drops/ointment
Fluorometholone	0.02% ophthalmic suspension; 0.1% ophthalmic suspension/drops
Loteprednol etabonate	0.2% ophthalmic suspension; 5 mg/1 mL ophthalmic solution
Prednisolone	0.5% ophthalmic drops; 1% ophthalmic drops
Rimexolone	1% ophthalmic drops

*Combination with various antibiotics are available. Please see the latest MIMS for specific formulations.

Ophthalmic Anti-Inflammatories

Drug

Available Strength

Dosage

Remarks

Ciclosporin (Cyclosporine)

0.05% ophthalmic solution;
0.1% ophthalmic emulsion

Instill 1 drop 12 hourly in each eye

Adverse Reactions

Ocular effects (ocular burning, conjunctival hyperemia, discharge, epiphora, eye pain, photophobia, foreign body sensation, visual disturbance)

Special Instructions

Avoid use in patients with ocular infection or known hypersensitivity to any components
Avoid eyedropper tip to come in contact with the eyes
Avoid use while wearing contact lenses
- Lenses may be reinserted after 15 minutes
May give concomitantly with artificial tears with 15-minutes interval

Lifitegrast

5% ophthalmic solution

Instill 1 drop 12 hourly in each eye

Adverse Reactions

GI effect (dysgeusia); Ocular effects (blurred vision, conjunctival hyperemia, irritation, discharge, pruritus, increased lacrimation); Other effects: (headache, sinusitis)

Special Instructions

Avoid use while wearing contact lenses
- Lenses may be reinserted after 15 minutes
Avoid the eyedropper tip to come in contact with the eyes

Ophthalmic Lubricants*

Drug	Available Strength	Dosage	Remarks
Carbomer (Polyacrylic acid)	0.3% ophthalmic gel	Instill 1 drop 8-12 hourly as needed	Adverse Reactions Temporary visual disturbances, allergic reactions Special Instructions Use with caution when driving or operating machines Avoid use while wearing contact lenses
	2 mg/g ophthalmic gel	Instill 1 drop into the conjunctival sac 3-5x/day and 30 minutes prior to bedtime
	0.25% ophthalmic gel	Instill 1 drop into the lower conjunctival sac 6-24 hourly
Carmellose (Carboxymethylcellulose sodium)	0.5%, 1% ophthalmic drops; 0.5%, 1% preservative-free ophthalmic drops	Instill 1-2 drops as needed	Adverse Reactions Eye irritation and allergic reactions have been reported occasionally Special Instructions Avoid the eyedropper tip to come in contact with the eyes Discontinue if symptoms persist or worsen >72 hours
Diquafosol Na	3% ophthalmic solution	Instill 1 drop 4 hourly	Adverse Reactions Ocular effects (blepharitis, irritation, conjunctival injection, discharge, pruritus, ocular discomfort, foreign body sensation in the eyes) Special Instructions Avoid the eyedropper tip to come in contact with the eyes
Glycerin/Polysorbate 80	Glycerin 1%/Polysorbate 80 1% ophthalmic drops	Instill 1-2 drops as needed	Adverse Reactions Eye irritation and allergic reactions have been reported occasionally Special Instructions Avoid the eyedropper tip to come in contact with the eyes Discontinue if symptoms persist or worsen >72 hours
Hypromellose (Hydroxypropyl methylcellulose)	0.3%, 0.5% ophthalmic drops	Instill 1-2 drops 6-8 hourly or as needed	Adverse Reactions Temporary burning or stinging sensation, allergic reactions, redness of eyes Special Instructions Use with caution when driving or operating machines Avoid the eyedropper tip to come in contact with the eyes Discontinue if symptoms persist or worsen
Naphazoline	0.012% ophthalmic drops	Instill 1 drop up to 6 hourly	Adverse Reactions Ocular effects (temporary visual disturbances, pupil enlargement, eye redness, irritation, eye pain) Special Instructions Avoid use while wearing contact lenses
Perfluorohexyloctane	1.338 g/mL ophthalmic drops	Instill 1 drop 6 hourly	Adverse Reactions Ocular effects (blurred vision, conjunctival erythema) Special Instructions Avoid use while wearing contact lenses
Polyethylene glycol	0.25% ophthalmic drops	Instill 1 drop as needed	Special Instructions Avoid eyedropper tip to come in contact with the eyes Blink several times after administration
Polyvinyl alcohol	1.4% ophthalmic drops	Instill 1 drop as needed	Adverse Reactions Eye irritation and allergic reactions have been reported occasionally Special Instructions Avoid eyedropper tip to come in contact with the eyes Avoid use while wearing contact lenses Discontinue if symptoms persist or worsen >72 hours
Propylene glycol	0.6% ophthalmic drops	Instill 1-2 drops as needed	Special Instructions Avoid eyedropper tip to come in contact with the eyes Discontinue if symptoms persist or worsen

*Various combination products are available. Please see the latest MIMS for specific formulations.

Other Eye Preparations*

Drug	Available Preparation	Dosage	Remarks
Sodium chloride	0.9% ophthalmic drops	Instill 1 drop as needed	Special Instructions Avoid eyedropper tip to come in contact with the eyes Avoid use while wearing soft contact lenses
Sodium hyaluronate	0.1% ophthalmic solution	Instill 1 drop 5-6x/day	Adverse Reactions Ocular effects (blepharitis, eyelid dermatitis, itching, irritation, conjunctivitis, conjunctival injection, corneal lesions eg keratitis, superficialis diffusa, eye discharge) Special Instructions Use 0.3% ophthalmic solution if 0.1% ophthalmic solution is ineffective Avoid the eyedropper tip to come in contact with the eyes Avoid use while wearing soft contact lenses
	0.3% ophthalmic solution	Instill 1 drop 5-6x/day
	0.18% , 0.2% ophthalmic drops, 0.18% preservative-free ophthalmic drops	Instill 1-2 drops as needed
	0.3% preservative-free ophthalmic gel	Instill 1-2 drops as needed

*Various combination products are available. Please see the latest MIMS for specific formulations.

Other Parasympathomimetic

Drug	Dosage	Remarks
Secretagogue
Pilocarpine	Initial dose: 5 mg PO 8 hourly Maintenance dose: 15-30 mg/day Max dose: 10 mg/dose	Adverse Reactions Systemic cholinergic effects (sweating, nausea, intestinal cramping) Special Instructions Avoid use in patients with hypersensitivity to Pilocarpine or any component of the formulation Use with caution in patients with cognitive or psychiatric disorders, renal impairment, biliary tract disorders Titrate dose according to response and tolerability
Varenicline	1 spray each nostril 12 hourly	Adverse Reactions Respiratory effects (cough, sneezing, throat irritation); Other effect (local site irritation) Special Instructions Avoid shaking the bottle and spraying directly at nasal septum

Dry Eye Syndrome Drug Summary

Eye Corticosteroids*

Ophthalmic Anti-Inflammatories

Ophthalmic Lubricants*

Other Eye Preparations*

Other Parasympathomimetic

Related MIMS Drugs