Clinical Decision-Making in DED: Evaluating Tear Film Stability With Varenicline Nasal Spray Solution

EP: 1.Dry Eye Disease: Pathophysiology, Impact, and Standard of Care

EP: 2.The COAT Trial: Evaluating Ocular Surface Health in DED

EP: 3.Crossover Study: Nanomicellar Cyclosporine 0.09% vs Emulsion Cyclosporine 0.05%

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EP: 4.Clinical Decision-Making in DED: Evaluating Tear Film Stability With Varenicline Nasal Spray Solution

A prospective study was conducted over 28 days with 50 participants who used a nasal spray twice daily compared with a vehicle control. The primary outcomes measured were the surface regularity index (SRI) and surface asymmetry index (SAI), which reflect the quality and stability of the tear film. Secondary outcomes included corneal fluorescein staining, tear breakup time (TBUT), eye dryness scores, and dry eye questionnaire responses. Results showed significant improvements in SRI and SAI as early as day 1, just 15 minutes after treatment administration. Additionally, statistically significant improvements were observed in corneal staining, eye dryness, and questionnaire scores over the course of the study. Although TBUT did not demonstrate statistically significant changes, patient-reported improvements in TBUT were noted.

The clinical relevance of SRI and SAI lies in their direct impact on visual quality. An unstable or insufficient tear film can cause fluctuations in vision and reduce overall visual clarity, which are common complaints among individuals with dry eye disease. Enhancing tear volume leads to better surface regularity and symmetry, which in turn helps stabilize the tear film and improve the quality of vision. These improvements contribute meaningfully to symptom relief and help patients manage the discomfort and visual disturbances caused by dry eye conditions.

Despite the lack of significant improvement in TBUT, this does not deter the use of the nasal spray in clinical practice. The treatment is especially useful for patients with aqueous-deficient dry eye, where TBUT may not be the primary issue, as this spray does not target meibomian gland function, which more directly influences TBUT. By increasing tear volume, the nasal spray effectively improves symptoms and ocular surface health, offering patients a valuable option to better control their dry eye disease and improve daily comfort.