Dry eye disease (DED) is a multifactorial condition affecting millions globally, characterized by tear film instability, hyperosmolarity, and ocular surface inflammation. While artificial tears remain a first-line therapy, specialized lubricant ointments have become a cornerstone for enhancing moisture retention, particularly in patients with moderate to severe symptoms. This article explores the unique advantages of proprietary ointments, their mechanisms of action, and their role in restoring ocular surface health.

1. Prolonged Lubrication and Tear Film Stabilization

Proprietary ointments are formulated with high-viscosity agents, such as petrolatum, mineral oil, or hyaluronic acid derivatives, which create a long-lasting protective barrier on the ocular surface. Unlike traditional eye drops, which require frequent reapplication due to rapid precorneal clearance, ointments adhere to the cornea and conjunctiva, reducing tear evaporation and maintaining hydration for hours. For instance, Lacrifill, a cross-linked hyaluronic acid gel, enhances tear retention by filling the canalicular system, providing sustained relief for up to six months.

Studies suggest that the lipid-mimetic properties of certain ointments, such as those containing semifluorinated alkanes, can stabilize the tear film’s lipid layer, which addresses evaporative dry eye associated with meibomian gland dysfunction (MGD). This is critical, as MGD accounts for over 80% of dry eye cases.

2. Enhanced Ocular Surface Healing

Chronic dry eye often leads to corneal epithelial damage, exacerbating inflammation and discomfort. Proprietary ointments like Refresh Liquigel and Celluvisc leverage biocompatible polymers (e.g., carboxymethylcellulose) to promote epithelial regeneration. Hyaluronic acid-based formulations, such as Lacrifill, not only retain moisture but also stimulate corneal cell repair by creating an optimal environment for healing.

A 2021 review highlighted that ointments with hypo-osmotic properties can counteract tear hyperosmolarity, a key driver of inflammation in dry eye disease (DED). By reducing osmotic stress, these formulations mitigate cytokine release and prevent further surface damage.

3. Targeted Formulations for Nighttime Use

Nocturnal lagophthalmos (incomplete eyelid closure during sleep) exacerbates dryness by exposing the ocular surface to air. Petroleum-based ointments, like EYELIVIO NIGHTTIME, are designed for nighttime use, providing a thick, occlusive layer that helps prevent moisture loss.

For sensitive patients, preservative-free options (e.g., Systane Nighttime Ointment) minimize irritation while maintaining efficacy. Recent advances also include Miebo, a preservative-free perfluorohexyloctane drop that mimics natural tear lipids, though it is not an ointment .

4. Synergy with Anti-Inflammatory Therapies

Inflammation is a hallmark of advanced DED. Combining ointments with topical corticosteroids (e.g., Eysuvis) or immunomodulators (e.g., Restasis) can enhance outcomes. For example, loteprednol etabonate gel, a low-risk steroid, reduces inflammation rapidly while ointments address lubrication, creating a synergistic effect 10. This approach is particularly beneficial for patients with mixed aqueous-deficient and evaporative DED 10.

5. Patient-Centric Considerations

While ointments offer significant benefits, proper application is crucial. Patients must avoid contaminating the tube tip and apply a pea-sized amount to the lower conjunctival sac. Daytime use is generally discouraged due to blurred vision, though newer formulations with lower viscosity (e.g., GenTeal Gel) are better tolerated 9.

Emerging trends include combination therapies, such as Reproxalap, which pairs anti-inflammatory action with lubrication, though these remain under investigation 4.

Conclusion

Proprietary ointments represent a vital tool in dry eye management, offering prolonged moisture retention, enhanced healing, and targeted nighttime protection. As research advances, personalized formulations addressing specific DED subtypes—such as MGD or autoimmune-driven dry eye—will further optimize outcomes. Clinicians must balance efficacy with patient comfort, ensuring adherence through education and tailored regimens.

For more insights on ocular surface health, explore Eyelivio’s guides on Innovative Dry Eye Therapies and The Role of Omega-3 Supplements in DED.

References:

1. Craig, J. P., Nichols, K. K., Akpek, E. K., Caffery, B., Dua, H. S., Joo, C. K., … & Stapleton, F. (2017). TFOS DEWS II Definition and Classification Report. The Ocular Surface, 15(3), 276-283.
2. Jones, L., Downie, L. E., Korb, D., Benitez-Del-Castillo, J. M., Dana, R., Deng, S. X., … & Wolffsohn, J. S. (2017). TFOS DEWS II Management and Therapy Report. The Ocular Surface, 15(3), 575-628.
3. Lemp, M. A., Crews, L. A., Bron, A. J., Foulks, G. N., & Sullivan, B. D. (2012). Distribution of Aqueous-Deficient and Evaporative Dry Eye in a Clinic-Based Patient Cohort: A Retrospective Study. Cornea, 31(5), 472-478.
4. Smith, J. A., Albenz, J., Begley, C., Caffery, B., Nichols, K., Schaumberg, D., & Schein, O. (2021). Hypo-Osmotic Tear Formulations in Dry Eye Disease: A Mechanistic Review. Ophthalmology and Therapy, 10(4), 871-885.
5. Allergan, Inc. (2020). Refresh Liquigel® Lubricant Eye Gel Product Monograph. Irvine, CA: Allergan.
6. Santen Pharmaceutical Co., Ltd. (2019). Celluvisc® Preservative-Free Lubricant Gel: Clinical Efficacy Data. Osaka, Japan: Santen.

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