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Long-Term Use of Hydroxypropyl Cellulose Ophthalmic Insert to Relieve Symptoms of Dry Eye in a Contact Lens Wearer: Case-Based Experience

Wander, Arden H M.D.

doi: 10.1097/ICL.0b013e3181f84f92
Case Report

Objectives: To report a case in which hydroxypropyl cellulose ophthalmic inserts were successfully used for the treatment of dry eye disease in a contact lens (CLs) wearer for more than 25 years.

Methods: Review of clinical findings in a female CL wearer with dry eye spanning more than 30 years. The patient was diagnosed with the Sjögren syndrome and demonstrated inadequate lacrimation as assessed by Schirmer testing. Slitlamp examination demonstrated bilateral corneal stippling with fluorescein and signs of superior limbic keratoconjunctivitis.

Results: Initially, the patient's symptoms improved with infrequent use of artificial tears. As the signs and symptoms of dry eye disease worsened, the patient initiated therapy with once-daily hydroxypropyl cellulose ophthalmic inserts. Punctal plugs and updating to increasingly oxygen-permeable soft CLs, in combination with continued use of the inserts, largely controlled the signs and symptoms of dry eye disease during a 25-year period. Simultaneous use of the hydroxypropyl cellulose ophthalmic inserts and CLs was well tolerated without any significant side effects or changes in visual acuity.

Conclusions: Dry eye is a chronic disease often requiring long-term management. In this case, daily use of hydroxypropyl cellulose ophthalmic inserts effectively treated autoimmune dry eye, providing symptomatic relief, and resulted in improved objective measures of disease severity across several decades. Such an experience is consistent with the available evidence-based data for hydroxypropyl cellulose ophthalmic inserts and supports their use in clinical practice for the treatment of moderate-to-severe dry eye disease.

From the Department of Ophthalmology, University of Cincinnati College of Medicine and Academic Health Center, Cincinnati, OH.

Dr. Wander serves as an advisor to Aton Pharma, Inc.

Editorial assistance was provided by InterQuest Medical and Scientific Communications, L.L.C., Parsippany, NJ, and Donald S. Nelinson, Ph.D., New York, NY.

Address correspondence and reprints requests to Arden H. Wander, M.D., UC Physicians Medical Arts Building, 222 Piedmont Avenue, Suite 1700, Cincinnati, OH 45219; e-mail:

Accepted August 19, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.