Training module-2013-tears again

Tears Again Training Module2013

What are tears ? What is dry eye syndrome ? What are the symptoms ? What are the treatment options ? How does Tears Again work ? What are the benefits of using Tears Again ? PBS vs OTC. Related conditions. Tears Again test questions.

Tears Again Training Module

Tears clean and lubricate the eyes. Tears consist of 3 layers, each secreted from

different glands around the eyes.

What are tears made of?

Mucus layer :- Secreted by conjunctival goblet cells. Facilitates an even distribution of tears across the cornea.

Aqueous layer :- Secreted by lacrimal glands. Primarily water.

Lipid layer :- Secreted by meibomian glands (found on eyelid margins). Reduces aqueous evaporation and provides lubrication

between eyelid and eyeball.

Layers of the tear film

Also known as keratoconjunctivitis sicca. Occurs when one or more layers of the tear

film malfunction. May affect up to 14% of over 40s (according

to US survey). Research has shown that 79% of dry eye

patients have “evaporative dry eye” due to a malfunctioning lipid layer.

What is Dry Eye Syndrome ?

Triggers can include :- Aging. Other conditions, such as Sjorgren’s syndrome and

blepharitis (see later). Arthritis. Some medications, including antihistamines, beta

blockers and contraceptive pills. Wearing contact lens. Eye surgery. Environmental conditions, such as air conditioning.

What are the triggers of dry eye ?

Symptoms can include :- Itchy, gritty eyes. Redness. Pain. Blurred vision. Watery eyes.

What are the symptoms of dry eye ?

Multiple SKUs and brands. Leading brands sell up to 500,000 units per

annum. Leaders include Systane and Poly Tears.

How big is the market in Australia ?

Dry eye treatments come in 3 broad categories :-

1. Containing preservatives.2. Preservative-free.3. Ointments (for overnight use).

Preservatives in dry eye treatments

Usually a multi-dose bottle. Can use for up to 30 days after opening. Will contain a preservative such as

benzalkonium chloride, which may irritate eyes if used frequently or over a long period.

Not recommended for long-term use. Brands include : Visine; Poly Tears; Optive.

Preservative-Containing Drops

Sold in individual, single-use vials. Suitable for long-term use. Brands include Systane; Cellufresh, Refresh. Usually available either OTC or on PBS.

Preservative-Free Eye Drops

1. Measure tear volume using Schirmer test :- Filter paper place on lower eyelids for 5

minutes. Filter paper is removed and amount of

moisture is measured.

How is dry eye measured / diagnosed?

2. Measuring tear break-up time (BUT) :- Tear film is stained. Physician observes how long it takes tear to

break-up when eye is left open (ie no blinking). Any time less than 10 seconds is an indication of

dry eye. The lipid layer is the main determinant of BUT.

Unstable lipid layer = shorter BUT.

79% of dry eye patients lack a stable lipid layer, leading to evaporative dry eye.

Tears Again is the only dry eye treatment that works to stabilise the lipid layer.

A stable lipid layer means :- Reduced evaporation. Extended break-up time (BUT). Improved tear volume (as measured by Schirmer Test). Reduced eyelid inflammation due to improved

lubrication between the eyelid and eyeball.

The Principles Behind Tears Again

Contains phospho-lipid liposomes. These are the same type of lipids that make up

the lipid layer of the tear film. Liposomes are microscopic balls of oil, with an

aqueous core. The lipids in Tears Again supplement the

natural lipids secreted from meibomian glands. Since its action is purely physical, Tears Again is

classified as a medical device, not a medicine.

What is in Tears Again?

Spray onto a closed eyelid from 10-15cm. Eyes can be opened immediately after

spraying. Use as often as required (since the action is

purely physical). Applying 3 times per day is normal.

How is Tears Again Used ?

When sprayed onto a closed eyelid, a small percentage of the spray forms on the eyelid margins.

This is where meibomian glands are located and the natural lipids are secreted.

Tears Again supplements the natural lipids and is then blinked across the eye.

The outcome for patients: stable lipid layer means extended BUT, improved tear volume and reduced inflammation.

How does Tears Again work through a Closed Eyelid ?

Study by Lee, Daush, Meierhofer and Dausch (2004) compared Tears Again to placebo.

Tears Again showed significant improvement in BUT, tear volume and inflammation.

95% of patients preferred the spray to previous drop application.

Other studies exist showing effective use in cases of contact lens wear and surgery-induced dry eye.

How Well Does Tears Again Work?

How can Tears Again work when sprayed onto a closed eye ?Tears Again is designed to mimic meibomian secretions. These lipids are secreted onto the eyelid margins. When Tears Again is sprayed onto a closed eye, a small percentage forms on the eyelid margins. Here, it supplements the natural meibomian secretions and is blinked across the eye.

What happens if Tears Again is sprayed onto an open eye ?Tears Again works equally well on an open or closed eye. However, spraying onto an open eye is almost impossible due to the blink reflex.

Will Tears Again ruin make-up ?No, just let the residue on the face dry naturally (approx. 30 seconds).

Can I use Tears Again if I wear contact lens ?Contact lens can physically disrupt the lipid layer and cause dry eye. All types of lens can be left in when using Tears Again.

FAQs

How often should I use Tears Again ?As often as you feel the need. Since its action is purely physical there are no adverse effects from frequent use.

Can I use Tears Again and eye drops ?Yes, but use the drop first and Tears Again afterwards.

Does Tears Again contain a preservative ?Tears Again contains phenoxyethanol. This preserves Tears Again in the bottle. Being an ethanol-based preservative, it is volatile and quickly evaporates when sprayed. As such, Tears Again is designed for long-term use like a preservative-free eye drop.

What is the shelf-life of Tears Again ?Tears Again can be used for up to 3 years (expiry date) even after opening.

Why are watery eyes a common symptom of dry eye?As eyes dry out (usually due to excessive evaporation), they become irritated. This results in the lacrimal glands to produce a greater volume of tears – more than the eye can readily drain. The result is watery eyes in patients who still suffer the symptoms of dry eye.

FAQs continued

Tears Again is available either OTC or with a prescription on the PBS.

For concession card holders there is a very considerable saving with a PBS prescription.

Each PBS prescription is for 2 bottles, with a maximum of 5 repeats.

Approximately 50% of Tears Again sales are via PBS.

OTC vs PBS

Some Related Condition Information

Pronounced “shoh-grinz”. Autoimmune disease in which immune cells attack

and destroy the glands which produce tears and saliva.

90% of sufferers are female, mostly post-menopause.

Affects up to 250,000 Australians. Symptoms include severe dry mouth and dry eye. Tears Again can be used effectively to relieve the

dry eye associated with Sjorgren’s syndrome.

Sjorgren’s Syndrome

This is an inflammation of the eyelid and is usually a chronic condition.

Symptoms include red eyes and eyelids, crusting on lid margin (especially upon waking), gritty sensation in eyes.

Blepharitis cam lead to interrupted flow of lipids from meibomian glands.

This, in turn, can lead to dry eye. Tears Again is an ideal treatment for the dry eye

associated with blepharitis.

Blepharitis

What are the 3 layers of the tear film? How does Tears Again work when sprayed

onto a closed eyelid? Does Tears Again contain a preservative? What is BUT? Why do dry eye patients often have watery

eyes ? What is a liposome?

Test QuestionsAll answers are included in previous pages.

If you don’t know an answer, go back and re-read.