Ocular inserts are usually small clear tubes that look like grains of rice. They are often used to treat dry eyes when treatment with artificial tears is not successful.
Also Known As
- Eye inserts
- Ocular inserts
Lacrisert (Hydroxypropyl cellulose ophthalmic) inserts are the commonly used inserts. Each insert has 5mg of hydroxypropyl cellulose and a diameter of 1.27mm, and a length of 3.5mm. The inserts are odorless, tasteless, and physiologically inert.
The inserts' functions are to stabilize, thicken, and prolong the break uptime of the tear film. They also lubricate the eye, protecting it from injury and infection. Additionally, they reduce dry eye symptoms such as itching, burning, and the sensation of something in the eye.
Its typical use is for patients who require multiple doses of artificial tears or those with dry eyes that persist even after treatment with artificial tears. Eye inserts may also be used for patients with inflammatory dry eye or meibomian gland dysfunction as a supplement therapy.
Lacrisert inserts may be placed by the patient or by a clinician. Before application, the hands should be clean to avoid contaminating the insert, which should also not touch any other surface. An applicator that comes packed with the inserts is used for picking up the inserts. The patient or clinician should ensure the applicator is clean by rinsing it with hot running water and shaking off any water droplets that are visible.
S/he should then take hold of the lower eyelid’s outer corner and gently pull using the index finger and thumb. This creates a “pocket” where the insert is gently brushed. The lower eyelid is then pulled up and over the insert. After that, the patient or clinician should rinse the applicator again with hot running water and store it safely.
The insert should be positioned in a manner that ensures it does not touch the white part of the eye. It should not be visible if correctly placed, and the patient should feel comfortable. The insert may be expelled from the eye, particularly more often in patients with shallow conjunctival fornices. Patients should thus avoid rubbing eyes as the insert may get out.
One insert a day usually is sufficient to relieve dry eye symptoms, but some patients may require two in a day. The inserts may be placed at night or in the morning, but most doctors recommend using it at night, especially if it causes blurring or foreign objects' sensation. Some patients may have to use the inserts for several weeks before they observe any improvements in symptoms. The doctor may direct a patient to use the insert together with artificial tears. It is, therefore, crucial for a patient to use the inserts as prescribed by the doctor.
Complications with the use of lacrisert inserts are very rare. However, the inserts have been shown to cause blurred vision that is transitory due to an increase in tear volume. For this reason, patients should not drive when in this condition. Incorrect placement of the insert may also lead to corneal abrasion.
Hydroxypropyl cellulose may contain inactive ingredients that may cause allergic reactions in some patients. Patients who are hypersensitive to hydroxypropyl cellulose should find alternative treatments. The patient needs to give a detailed clinical history to avoid the adverse effects of an allergic reaction.
It is not clear whether the medication passes into breast milk or not, and so during pregnancy, it should only be used when completely necessary. Other side effects that have been reported include:
- Ocular discomfort
- Stickiness of eyelashes
- Eyelid edema
Serious side effects are infrequent, and the patient should immediately contact his/her doctor or remove the insert if these symptoms occur:
- Itching or swelling on the tongue, face, or throat
- Difficulty or trouble in breathing
- Severe dizziness.