News Updates - more bad drops on the market and a new kind of “punctal plug” - Lacrifill!

First the bad news - FDA warnings about drops that could infect or injure you, continue:
”[1/31/2024] FDA is warning consumers not to purchase or use South Moon, Rebright or FivFivGo eye drops because of the potential risk of eye infection.

These are copycat eye drop products that consumers can easily mistake for Bausch + Lomb’s Lumify brand eye drops, an over-the-counter product approved for redness relief.” https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-consumers-contaminated-copycat-eye-drops?fbclid=IwAR085_VOsxm-9x0CtykAzUJF2Fb4Rn2nQzBFAd7HYsdwc6EBKu31z9hy_jI_aem_AfyHpReFyoRIaWRypfQKaucUi2WHDOhHkA7HxmLNfxqe1dwwFHXGJmlWgjMWkFb2a-A

I posted on Lumify (and other eye whiteners) - and the risks taken even with on-brand drops like these here: https://www.eyethera.com/blog/can-i-use-eye-whiteners-like-visine-or-lumify-when-my-eyes-get-red

Now the better news -

April 7, 2024, I attended the American Society of Cataract and Refractive Surgery annual meeting. While I no longer perform cataract or refractive surgery, I see patients who have cataracts, and who may be planning cataract surgery, nearly every day in my clinical dry eye practice. I’ve posted on cataracts and dry eyes here: https://www.eyethera.com/blog/dry-eye-cataract-and-glaucoma-segment Control of the ocular surface is critical to a good outcome with cataract surgery, so I am often involved in the pre (and post) operative care of these patients. During that meeting, a new punctal plugging product. was rolled out, called “Lacrifill.” It is basically a sugar gel like “Juvederm” or “Restylane” (a natural “hyaluronic acid” compound found in skin and eyes) that has long been used as a filler in cosmetic procedures and in cataract surgery. It will gradually dissolve into sugar and water, so needs replacement approximately every 6 months (& may last a bit longer - or less long, for some). If it works “too well” and results in chronic, unwanted tearing (down the cheeks), then a salt water solution can be used to rinse it down the “plumbing” into the nose. There is also an enzyme that can dissolve it in cases that a simple rinsing doesn’t work (expected to be rare). Insurance is expected to cover it, as a plugging procedure, but it’s possible that some may require a “prior authorization” approval process. Punctal plugging is not for everyone (I’ve blogged about this before: https://www.eyethera.com/blog/what-about-punctal-plugs-or-why-not-dam-up-those-damn-tears and https://www.eyethera.com/blog/when-tears-dont-drain-properly-you-get-toxic-soup-and-the-toxic-soup-syndrome

While these prior posts cover most of the potential “negatives” involved with blocking the normal flow of tears from the eye to the nose, it is true that there are numbers of patients who will significantly benefit from such tear duct closure. Keeping more tears (and any medicated products) on the surface of the eyes is hepful when the tears are “good tears” but just too little to do their job. A potential benefit of this unique use of sugar gel, is the “soft” and “sticky” quality of this natural filler. This means no “plastic” is exposed to the delicate membranes of the eye, and nothing to “fall out,” which is a common problem with the plastic plugs that are “wedged” into the tiny tear duct openings along the inner eyelid margins. Lacrifill can “hug” the passageways leading from the eyelid to the nose, blocking tears along the entire way.

A few key points - as a sugar gel, the reason it doesn’t instantly “dissolve” into sugar and water, is due to the “crosslinking” where the sugar molecules are bound strongly to each other. Natural enzymes break these links down over time and the more “links” in the chain, the harder it is to break down. Staying soft and “gel-like” means that excessive manipulation (squeezing, massaging, rubbing) may cause some gel to “burp out” of the tear duct (either into your tears, or down your nose), so avoidance of excess manipulation near the tear drainage area should generally be avoided with this product (especially in the first days of instillation, as most sugar gels tend to “set up” and become more locked in place as they mature in their position). If too much burps out and into your tears, this leaves a portion of the duct “empty” with a blockage in place closer to the nose. Typically, this can lead to a “stagnant pool” of tears where germs can thrive and potentially cause infections. If the area of the lids closer to the nose become infected, then sticky yellow-to-greenish discharge and/or redness, swelling, tenderness and warmth of that area can indicate an urgent need to see your eye doctor.

As usual, I recommend working with a dry eye specialist to get the best results for your dry eyes.

To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:

(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020

(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463