Neuro-Stimulation for Dry Eye Disease

Neurostimulation is a relatively novel and innovative treatment option for patients with Dry Eye Disease (DED). It involves the use of vibrational or chemical impulses to stimulate the nerves that control tear production. The goal of neurostimulation for dry eye is to increase tear production and improve the overall health of the ocular surface.

There are currently two safe and effective treatment options available: 1) iTear100 (extranasal stimulation) and 2) Tyrvaya nasal spray (intranasal stimulation). Both modalities work in different ways and have different mechanisms of action.

iTear100 (Olympic Ophthalmics) is a non-invasive, easy-to-use handheld at-home device. Through a drop-less, preservative-free approach, the iTear100 delivers tiny vibrations to each side of the nostril. When the device is applied externally to each nostril (for 30 second per side), it targets and activates the external nasal nerve, which a branch of the trigeminal nerve. This method stimulates the nerve endings that control tear production, which can help increase tears and reduce symptoms of dry eye. It is commonly prescribed for twice daily use. Initial study results suggest an increase in basal tear secretion as quickly as 14 days. 

Tyrvaya nasal spray (Oyster Point) is FDA approved for signs and symptoms of DED. It is a preservative-free medication that contains Varenicline.  When Varenicline nasal spray is administered, it is absorbed through the nasal mucosa and increases the production of mucin, aqueous, and meibum, which improves dry eye symptoms. Before administering Tyrvaya, prime the bottle (by spraying into the open air 5 times). When you're ready, insert the tip gently into the nostril and point it toward the same ear. During instillation, hold your breath, press the pump then exhale the excess product. Once the mist hits the nasal mucosa, the trigeminal nerve innervation process has begun. Initial studies showed increased Schirmer and reduced symptoms within 4 weeks. 

In terms of effectiveness, both iTear100 and Tyrvaya nasal spray have shown promising results in clinical studies. However, it is important to note that the effectiveness of these treatments may vary depending on the individual and the severity of their dry eye.

It is also important to consider potential side effects before using these treatments. iTear100 is generally considered safe and well-tolerated, but caution is advised for patients with pre-existing and severe migraines; the device may cause dizziness or lightheadedness (in about 2-3% of patients in clinical studies). Tyrvaya nasal spray, on the other hand, may cause nasal irritation, sneezing, coughing, throat, and nose irritation (in about 10-15% of patients).