Is Lacrisert Good for Dry Eye?

March 11, 2009

A Lacrisert rep came to the office today. He stated that the Lacrisert gets great results- much more dry eye relief than taking drops four or five times a day. And many of my patients complain bitterly of taking drops so often, and many of them simply don’t respond to Retsasis. I am not sure if my patients will like the idea of inserting this thing into their conjunctival fornix, but I am willing to try. I wonder what others have found?

 

 



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76 Responses to “Is Lacrisert Good for Dry Eye?”

  • MHG

    Miriam,
    I use a small pair of scissors (inexpensive sewing-type scissors) that you can manage close to the Lacrisert. If you’re concerned about sterility, you can wipe the ends with an alcohol rub first, and let it dry, or rinse in hot water and dry with a clean dry cloth before you cut. (I don’t use alcohol wipes but do rinse in hot water after each use and store the scissors in a container in my bathroom cabt).

    Then I open the wrapper on my counter, slowly, so the Lacrisert stays near or in the center of the wrapper, and snip it in half, keeping the scissor tips close to the wrapper so the Lacrisert doesn’t ‘pop’ off the wrapper after it’s cut. You can also use the index finger of your free hand to place over the scissor tip to keep the Lacrisert from moving while you’re cutting it.

    Usually I apply each half without the applicator and use the tip of my index finger to ‘drop’ it into my lower/outer lid; I moisten it with a drop of water first so the Lacrisert sticks and I don’t ‘lose it’ from my fingertip. This has become my preference since I don’t always have the applicator with me and I’ve just found it a little easier – really, a personal preference of mine and not in the Lacrisert Rx instructions.

    When at home, I also use a lighted magnifying mirror (the type on a stand with two sides) and this helps the entire process of applying the Lacrisert. Overall, after you get into a routine, it takes less than a minute to cut the Lacrisert in half and apply to both eyes. I hope this helps!

  • Miriam

    I appreciate your notes very much (and everyone else’s!). I am still curious, however, as to exactly HOW you cut the insert in half. What do you use?

  • MHG

    Please read my 3/16/09 post re long-term use: In my personal situation, 20 years of daily use has been only a positive experience. My eyes produce no tears – absolutely a very severe case of dry eye disease. Annual exams do not show evidence of internal eye damage as a result of Lacrisert, and in fact, initial corneal damage (resulting from no tear production) was halted. My vision was saved.

    Many years ago, to minimize the AM and afternoon ‘gunk’, I began cutting the insert in half. This helps in many ways to control the ‘melting’ residue. When your eyes begin to feel dry again, simply remove the old insert from your lower outer lid area and replace with another half-insert. (Wash your eye area at the same time with a gentle scrub and re-apply eye make-up 😉 . I have noticed the weather and humidity level effects how often I need to replace Lacrisert during the day. In summer (I live in a warm-weather climate), my daily routine is to add one half before bedtime (or early evening if necessary), remove in the AM and replace with a new half for the day. In winter and on higher-humdity days, the half-insert can last most of the day.

    I have also found that I can use, with success, Lacrisert with Clear Eyes drops to remove the associated redness if necessary; and it can also be used (with good results) at bedtime with a product called ‘Clear Eyes PM Tears Ointment’ an over-the-counter eye ointment. The combination works well for me on very dry nights and eliminates waking up with eye pain.

    For the occassional eye infection that can result from airborne micro-materials that cannot be washed out of your eye b/c of the thickness of melting Lacrisert, I have used Rx Erythromycin Opthalmic Ointment with success. Applied to your outer eyelids, it also helps with redness that can be associated with the melting Lacrisert residue and irritation. On average, I use this once per week on outer lids and once per month to eliminate an eye infection.

    Re residue: a moist cotton ball or moist Q-tip suggestions are all good. Carry them in your handbag to use during the day if necessary. Sometimes a little inconvenience but I never forget the alternative!

    These are my personal notes from two decades of Lacrisert ‘trial and error’ and finding the combination of therapy that works well in my situation. Everyone’s challenge is different but my hope is to provide you with ‘tried and true’ solutions and another combination of proven treatment.

  • Miriam

    I am interested in cutting them in half, too! The Lacrisert inserts are very comfortable UNTIL they swell up and I have to take them out–after about 8 hours. How would you cut them, and maintain sterility?

  • Janel

    I have been using Lacrisert inserts for about a year now through the recommendation of my opthamologists. I was in a car accident in 1996 and my eye lid does not close completely when I am asleep. I have used many different drops during the day and many different gels for the night for this condition. Nothing has worked like Lacrisert. They work like a charm and have eliminated the need for drops of any kind.

    My only problem, like so many above, is that they melt after so many hours the next day after inserting them. I can not see and gunk is all over my eyelid. I have used a q tip and/or kleenex to move the melted insert out of my eye. I will try the suggestion of inserting another lacrisert in the eye after the old one has melted after about 10 hours. Thanks!!

  • Luci

    When my eyes are very dry some problems with Lacrisert not dissolving and creating a very red air on inner lower eye lid. Thoughts? Thanks to all.

  • Lynne

    Due to scarring on my cornea as a result of a shingles episode last summer, my right eye has had a dry, burning sensation that eye drops helped only on a very short term basis. I have tiny tear ducts, so plugs would not stay, and my ophthomologiest asked if I would try Lacrisert as a rep had brought in some samples. I did, and after a couple of attempts, was able to effectively insert the Lacrisert. I do NOT feel it when it is properly inserted, and it keeps my eye moist all day. My only issue is with the residue after it melts. I cannot find it in my eye and I have had to flush my eye out using Theratears. I will try the moistened QTip as that seems like a good idea. This morning, the excess was gunked up in my upper lashes. I’ll keep you posted.

  • Luci

    Angela, I brought Walgreens “Soothing eye wash” it cups with a tiny cup. If I have leftover gunk in the morning I fill the cup no more than 1/4 fill and rise my eye. I then apply Systane and wait a few miniutes. My doctor added Genteal gel which is wonderful. If my eyes are too dry the Lacrisert pellet will not dissolve. First, I put a drop of Genteal gel in my eye and then insert the Lacrisert.

    I am still having trouble crying and losing the lacrisert in that way. Also, if I inadvertently touch my eye I lose them. This would not be a problem but for the fact that our insurance now has a copyay of 20% of drug price. I did find coupons for up to $60.00 of 20.00 for each script.

    I continue to appreciate all ideas. Has anyone cut them in 1/2. I did not understand the last answer. Thanks to all.

    Luci

    Sincerely,

    Luci

  • Angela

    I have been using Lacrisert for the past 6 months. I use them at night and have no problem sleeping with them. Unfortunatley i do have to remove them in the morning. because as they melt they break up in my eye and cause blurry vision and my eye lids stick together.
    There are times that I have trouble removing them.
    It would be great if the company made Lacrisert in an 8 hour size to eliminate the need to remove them in the AM.

    I am concerned about long tem use. Are there any known long term effects to be concerned about?

  • Luci

    Hi, Some further questions about Lacrisert. I am having trouble sleeping with them especially if one falls out mid-day there does not seem to be enough eye moisture to dissolve the disc. When asleep they appear to migrate into other areas of my eye and in the morning I usually have a dry eye without a disc or one that is gunky with Lacriset.
    Now I am just using them during the day and using Systane P.M. lubricant at night. Have others experienced this problem? How do you prevent them from falling out when you cry? Also, how are people supplementing the Lacrisert for me it is not lasting through the night even if it does not migrate. I have been using an eye rinse with cup to clear the eye and then add Lubricant before bed. All of this is expensive and does not alwalys work are there other ideas? Thanks so much, Luci

  • ellen

    as a followup to my comment above, I have found that the insert becomes transparent in the eye pocket after several hours, which is why I could not see it to remove it when it was causing blurriness/photosensiitvity. This morning I followed the package insert instructions for how to remove the insert (what a novel idea) and found that it worked fine. After 10 hours in my eyes, The insert had become 5+ times its original size, was very soft and completely transparent, and came out easily with pressure on the lower lid pocket. And even after removal, my eyes stayed more moist than before. So life is good. I highly recommend a trial of these inserts to anyone having unrelieved dry eye problems.

  • ellen

    I have been using Lacrisert for the past three days and am thrilled with the change in my eyes- they finally have lubrication again, for the first time in years. As background, Restasis and eye lid scrubs/compresses were controlling my dry eye during most daytimes but I was waking 4-6 times a night to have to insert eyedrops and “pry open” my eyelids from my dry eyes, which caused constant discomfort, actual pain, jaw clenching and sleep disruption. So I tried Lacrisert as a last resort and it has cured the night-time dry eye problem. I can now sleep all the way through the night with no eye drops, for the first time in years – yeahhh!. I found Lacrisert relatively easy to insert, although it can stick to the applicator and refuse to come loose in eye when I am ready for it to do that. One of my doctors didn’t want to prescribe it for me, saying it was like “putting rocks in your eyes,” but I have completely the opposite experience. Even with sensitive eyes, I have had no pain or discomfort with the pellet in place. My only side effect so far has been blurry vision and photosensitivity during the day (when I have inserted Lacrisert the night before). I can’t find the pellet anymore when I wake (8+ hours after insertion) and assume it is largely melted away at that point, but I would like to get the residue out of my eyes to prevent the blurring and photosensitivity. I will try the moist q-tip idea above, and flushing water into my eyes, to see if I can get the residue out in the morning. If there are any other good ways to address those side effects for those of us who use Lacrisert only for nighttime, i would love to hear more. I totally agree with the top comment above, that doctors would not be serving their patients well if they fail to mention this option to people with dry eyes for whom other remedies are not working.

  • ari weitzner

    pataday is a good anti-itching drop.
    i have no good advise about removing left over lacrisert except to moisten a qtip with some saline, pull down the lid, and sweep the area while looking in a mirror.

  • Luci

    I suffer from profound dry eye which had a temporal relationship to lasik, Within a month of Lasik surgery and prior to Restasis coming on the market I have suffered with a number of health issues. It is very important to wet the product prior to insertion. The product is easily dropped and I would suggest it eventually be dyed with an inert material as it is difficult to see. Finally, I would suggest a paper towel be placed below the area where the patient inserts the product since it is easy to drop. I find the product absolutely wonderful but would love to see improvements in having the insert actually stay in my eye. I cry not infrequently and find I am losing inserts. Also, noting some itching in my eyes.
    Overall, this product can change the quality of one’s life. Sometimes my eyes actually shine again. Finally, if you use it twice a day be sure to put it in well before bedtime. I am a disabled R.N. and would be happy to discuss this product with you if interested. The cost is $503.00 per month on a BID usage. I thank-you and hope this helps. I would like to know what can be safely used for itching and to remove leftover inserts in the eye which sometimes cloud vision.
    My Best,
    Luci

    Sincerely,

    Luci

  • BENAMARA

    BONJOUR,

    Le lacrisert a également sauvé le confort de ma vie quotidienne. Simplement, il coûte désormais très cher : 169,00€ !

  • Naaz

    Hi MHG,

    Can you please tell me what do you use to cut the lacrisert in half??
    I would like to try that.

    Thanks in advance.

  • Dr. Weitzner

    thanks so much for your input. i will surely pass it along to my patient!

  • MHG

    Dear Dr. Weitzner,

    It may be helpful to your patient if she carefully reviews the Lacrisert instructions with insert diagram, and gives it another try. If the Lacrisert insert is placed into the deepest section of outer/lower lid, it is secure and will not float and shouldn’t be seen or felt. If I may offer another suggestions to a new user: Be patient and allow your eye to adjust to Lacrisert, in the same way an eye adjusts to a contact lens or eyeglasses.

    Also, since I have extensive experience with Lacrisert, I have learned on certain types of weather-days, i.e. higher humidity vs lower humidity, I cut one insert in half prior to placing it in my eye, using a half-dose. This half-dose of Lacrisert is more effective on a humid day and blurry vision symptoms are lessened. To maintain effectiveness, I simply replace the insert with a new one, halfway through the day. Also, I have learned to adjust for wind conditions, and for hours of time spent on the computer. Again from my experience, a half-insert works best in these scenarios, replaced halfway throught the day. And on the days when my eyes are feeling especially dry or at night, a full-size insert relieves the dryness completely. And finally, I use eye drops to relieve redness when necessary, without evidence of degrading the effectiveness of either product.

    Thank you for initiating this discussion; it is very much appreciated.

    Best regards, MHG

  • Dr. Weitzner

    that is certainly a compelling endorsement and will motivate me to offer it to my severe dry eye sufferers. incidentally, a patient called me several times yesterday to whom i gave a lacrisert sample, and she was distraught as the lacrisert didnt quite stay deep in her eye and she could see it in the mirror and it was bothering her/blurring her. oh well- not for everyone, but i will keep trying!

  • MHG

    Dear Doctor,

    I am a patient who can answer your question and relieve your concerns.

    Lacrisert has saved my vision and quality of life. Diagnosed with “mucous-maker” eyes as a teen, I eventually found an exceptional Board Certified Eye Surgeon when my disease evolved to severe dry eye syndrome. Simply, I have no tear production. Having tried every imaginable therapy available at the time, my doctor prescribed Lacrisert as a last option; I believe it was a fairly new drug at the time. There is not a day that goes by when I do not mentally thank this physician for having the awareness to consider new options and the compassion to share a relatively unknown drug and offer a possible solution.

    This drug therapy has been part of my life for almost 20 years and without it, I could not imagine life as it once was…a daily challenge with scratchy, grainy, painful infected eyes. I have often wondered why Lacrisert is not a common household name for those who suffer from dry eye syndrome and severe dry eyes, as in my situation. In my opinion, to NOT recommend this therapeutic option to a patient is not an option. Your rep has presented you with a medical solution that will change lives.

    There is no pain inserting Lacrisert (it takes seconds), and the only discomfort is mild blurry vision that occurs late into the ‘melting’ process, usually after 10 hours. The solution to that mild discomfort is to replace the old Lacrisert insert with a new one. Other than that, I am not aware Lacrisert is in my eyes. But I am VERY aware of life without this drug and encourage you to provide this same resolution to your patients, colleagues, and the medical community that often searches for solutions to diseases, without success. In this case, success is held in the hands of your pharmaceutical rep. Please give that person a call today, and give your patients the ‘gift’ and quality of life they deserve.

    Best Regards, MHG

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