Dry Eye Treatment in Denver: When Xiidra and Restasis don’t work


Dry Eye Treatment in Denver: When Xiidra and Restasis don’t work


In a recent advertising campaign Xiidra and Restasis have done extensive advertising especially in Colorado to drive patients to dry eye disease treatment. These ads are targeted towards older women who have the highest rates of dry eye disease. Often dry eye patients are managed with artificial tear drops. Some patients use Xiidra and Restasis which are prescription drops to treat dry eyes. What are the treatments for patients however when dry eye medication fails? What options do patients have? Dry eye treatment in Denver past drops goes into several categories:

  1. Punctal Plugs

  2. Laser to oil gland

  3. Permanent Closure of Tear Ducts

  4. Closure of corner of eyelids

  5. Raising lower eyelids

Punctal Plugs

Punctal plugs are small stoppers that are placed on the eye tear duct entrance hole. These keeps more water on the eye surface to reduce dryness of the eyes. It takes about 5 minutes to place plugs in the tear duct. They can last from 3 months to 12 months before they fall out. The procedure is done in the office with numbing drops. Often this can help many patients and is the common second step for dry eyes after failed drops.

Laser to oil gland

IPL (Intensed Pulse light) may help to open oil glands in patients. It is in early testing but has shown success in some patients up to 90%. The principle is that the laser increases blood flow to the oil gland and works like super strong warm compresses. Laser or IPL to the eyelids is not a permanent treatment and often multiple treatments are necessary. It has not had overwhelming support in the ophthalmology community.

Permanent Closure of the Tear Duct

If a patient is getting punctual plugs often and they are relieved with them, often the doctor will recommend permanently closing the tear duct entrance. This is done in the operating room or office to close off the tear duct hole. First it is critical to have punctual plugs to make sure that the patient can tolerate closing the tear duct without having too much water in the eye and resulting in tearing. This procedure takes 15 minutes and there can be swelling and bruising afterwards. Often most patients have one set of their tear ducts closed before closing all of them.

Closure of the Corner of the eyelid

Small stitches can be placed in the corner of the eyelids to close the eyelids a small amount to reduce the size of the eye to reduce the evaporation of water from the eye. If small enough it will not significantly change the size of the eyes. It can be closed from a tiny amount to the entire eyelid if need be. This procedure is often done in the operating room under IV sedation. Recovery is 1 week.

Raising lower eyelids

Raising the lower eyelids can also serve to reduce the evaporative surface of the eyelid. This can be done in a multitude of ways depending on how the lower eyelid is drooping. This can be via tightening the lower eyelid or even placing material in the inside of the lower eyelid to lift it up. It works to raise the lower eyelid and improve dry eyes.

As can be seen there are many ways to surgically improve dry eyes if drops such as Xiidra and Restasis are not working. Most patients will not need these options but if you do seek out a specialist who performs these procedures often.


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