BOTULINUM TOXIN FOR EPIPHORA

 

Lacrimal gland injections can be a good option for patients who experience excessive tearing. In this study it was found that Schirmer test scores decreased at three months as well as having decreased at six months. Adverse event overall incidence was 22%, with the most common being ptosis and diplopia. 

Other than the objective measurement of Schirmer scores, subjective patient-reported outcomes also displayed significant improvement, reflective of high patient-reported satisfaction.

Therapeutically, the effect of Botox is achieved via inhibition of acetylcholine at the neuromuscular junction within the lacrimal gland.

In general they believe botulinum toxin injection “stands as a promising option for select patients, offering a balance of efficacy, reversibility and low invasiveness in managing chronic epiphora.”

Adding IPL to LLLT Improves Symptom Frequency and Severity in Meibomian Gland Disease and Dry Eye.

 

Two emerging treatments for dry eye disease (DED) associated with meibomian gland dysfunction (MGD) are intense pulsed light therapy (IPL)—thought to lead to the breakdown of aberrant or telangiectatic blood vessels and decrease inflammation—and low-level light therapy (LLLT)—a more recent development intended to aid tissue repair and neural recovery. When performed alone, the latter procedure has been shown to alleviate clinical signs and symptoms better than IPL, prompting the authors of a new study to investigate whether LLLT is more effective for MGD-related DED on its own or in combination with IPL. Their findings revealed that while both approaches improved symptom frequency and severity, combined therapy held an advantage in boosting cellular energy levels.

The results revealed significant improvements in symptomatology across both treatment modalities. 

Furthermore, meibum expressibility saw improvements in both groups after treatment.  The study did not report any adverse effects throughout its duration, a testament to the safety and tolerability of both treatment modalities.

The researchers note that “LLLT alone could be considered in clinical settings as an adjunctive therapy for MGD if IPL is contraindicated for improving meibum expressibility and symptom frequency.”

Higher Copper Intake Associated with Reduced Risk of Late AMD

Copper, found in foods typical of the Mediterranean diet, plays a critical role in various biological processes, including antioxidant defense and extracellular matrix biosynthesis. In a recent study, researchers investigated the relationship between the intake of copper, as well as iron, zinc, selenium in diet and late AMD, and found that out of all of these elements, increased copper consumption is associated with a reduced risk of late AMD, especially in those between the ages of 70 and 85.

The Age-Related Eye Disease Study (AREDS) 1 and AREDS 2 study demonstrated similar results, indicating that copper consumption was linked to reduced late-stage AMD risk.

The authors suggest that more research into the mechanism linking copper and late AMD development is warranted.

Tryptyr - New Dry Eye Medication from Alcon

Tryptyr (pronounced trip-tir), released by Alcon activates trigeminal nerve signaling, leading to increased basal tear production. The recommended dosing of Tryptyr is twice per day. 

Roughly half of subjects receiving the test drug met the primary outcome of at least a 10mm increase in Schirmer score at day 14, up to a fourfold increase over controls treated with the vehicle only, 

The Alcon press release also states that some subjects treated with Tryptyr demonstrated statistically significant natural tear production as early as day 1. The company anticipates a US launch in the third quarter of 2025. Tryptyr will be supplied in preservative-free, single-use vials.

 

ASTEROID HYALOSIS

This patient below has 20/20 vision in the right eye and 20/25 in the left. He does report seeing some "spots and lines", but they don't bother him. 

 

BERGMEISTER'S PAPILLAE

 

Bergmeister's Papillae is a fetal remnant of the hyaloid artery that extends from the optic nerve head to the developing lens of the eye.  Generally this vessel disintegrates entirely before birth, but in some cases, remnants remain.