Raccomandazioni terapeutiche

L'algoritmo di trattamento consente di dividere le terapie iniziali in tre categorie di gocce basate sull'ingrediente attivo basato su

- CMC (carbossimetilcellulosa) - HPMC (idrossipropilmetilcellulosa) - Acido ialuronico

In una recente revisione completa dei principi attivi contenuti nelle lacrime artificiali, gli ingredienti sopra elencati hanno dimostrato di essere i più vantaggiosi nel migliorare i livelli di comfort del paziente. Per ognuna di queste categorie, sono state raccomandate le marche di lacrime artificiali più studiate. Inoltre, Systane® e Refresh Tears® sono stati ben studiati e sono stati utili nel trattamento della sindrome dell'occhio secco lieve (vedere tabella 2 e 4). Systane® Ultra e Soothe® sono stati entrambi mostrati nella ricerca clinica per superare le formulazioni CMC/HPMC/acido ialuronico elencate sopra (vedere le Tabelle 4 e 7). Nel caso in cui la terapia iniziale non riesca a controllare adeguatamente i sintomi di DTS, una di queste due gocce dovrebbe essere considerata come la prossima terapia.

Nel caso in cui le lacrime artificiali standard non riescano a ridurre adeguatamente i sintomi del paziente e/o in caso di grave DTS, cheratopatia da esposizione, è indicata

l'implementazione di ulteriori terapie come gel, unguenti, spray liposomiali (tabella 5). Queste terapie potrebbero essere implementate prima in base alla gravità della malattia. A dispetto del maggior costo e della minore convenienza di applicazione rispetto ai farmaci multidose, l’acido ialuronico offre nell’opinione degli autori superiori vantaggi terapeutici e clinici: la frequenza di applicazione consigliata si aggira intorno alle 2-3 volte al giorno, mentre la media per gli altri farmaci è di 4-6. Si consiglia però l’uso delle lacrime artificiali tre o quattro volte al giorno per un periodo di 2 mesi prima di passare alla fase successiva. Se l'uso di lacrime artificiali si estende oltre 4-6 volte al giorno, si dovrebbe usare una

formulazione priva di conservanti.

Le pomate oftalmiche sono usate quando i sintomi del DTS persistono (ointments, tabella 5) ma hanno lo svantaggio che gli agenti lubrificanti usati nella formulazione consistono nella

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difficoltà visiva dopo applicazione, dovuta alla densità della pomata sulla superficie oculare e nell’accumulo di materiale residuo sulle palpebre.

Start

CMC: Refresh Optive®, Refresh Liquigel® HPMC: GenTeal® Moderato a grave, Lacril®

Acido ialuronico: Blink® Tears, Hylo- Comod®

Unguenti: Refresh Lacrilube® Spray liposomiali: Tears again®

Inserto prescritto: Lacrisert®

Sintomi persistenti

2014 Moshirfar et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution. Clin Ophthalmol. 2014; 8: 1419–1433.

CONCLUSIONI: In base a tutto queste raccomandazioni, la selezione di lacrime artificiali dovrebbe essere personalizzata in base alle esigenze specifiche del paziente.

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