Can you use TRYPTYR and Restasis together? Yes you can & here is why:

The goal of treatments for eye dryness, burning, tired eyes, redness, blurry vision, itching, reflex, tearing, foreign body sensation, grittiness, crusting, stringy discharge, inability to tolerate, putting in your contact lenses, recurrent styes (an acute blocked oil gland called the meibomian gland(s) or chalazia (an old stye), is to decrease surface inflammation. 

This inflammation can be viewed at it as a monster or mountain or fire of inflammation. Depending on your symptoms score, your doctor will try to throw everything they can to decrease the fire as quickly as possible. Some patients want to get rid of the symptoms as quickly as possible; some patients want to take it step-by-step to decrease the inflammation. Please tell your physician how quickly you want to have relief.

The treatments we used to help decrease inflammation are varied. Most of these can be used on top of each other because they work on different mechanisms of the inflammatory cascade.

TRYPTYR: is an neuromodulator: Instant cooling drop that activates a natural nerve (TRPM8) to boost natural tear production. Not an anti-inflammatory. No long term effects see to date other than allergy.

Cyclosporine (ie Restasis, Vevye, Cequa): Long-term anti-inflammatory that helps tear glands heal. Takes weeks to work. Restasis: takes about three months, Vevye: Takes about 28 days, Cequa: Takes about one month to work). No long term effects see to date other than allergy.

Lifitegrast (Xiidra): Anti-inflammatory that reduces burning and irritation by blocking LFA-1/ICAM-1. Not immediate. No long term effects see to date other than allergy.

Miebo: is a FAT drop—Lightweight oil-layer drop that helps stop tears from evaporating and stabilizes the tear film. It is not an anti-inflammatory. No long term effects see to date other than allergy.

Warm compresses: Melt thickened oils in the eyelid glands to improve tear stability. Risks: don’t make it too hot or too long to avoid hurting your skin. Some patients with ocular rosacea cannot use any heat as heat can make inflammation worse but heat is only way to open the meibomian glands’ orifice, liquify the oil, and give a chance for the oil glands to change out their oil (like a mini oil change for your delicate gland cells).

Blinking exercises: Retrain eyelids to squeeze oil out properly, especially for screen users. No long term effects see to date.

IPL: Light-based treatment that reduces eyelid inflammation and improves oil gland function. Biggest risk: does not help symptoms, stye formation—IPL will rev up meibomian gland oil but if orifice gets blocked a stye can form which is partly good —meaning we want proof of more oil formation —but we don’t want a stye as it can lead to a scarred gland. No other long term effects see to date other than rare skin sensitivity to light. Very rare risks roughly risk 1 in 1:1000 patients: uveitis in patients who did not have a metal shield placed during; concern for decrease under eyelid wrinkles but could also represent decrease fat pad under lid if too may IPLs which is <1 in 1000 risk to date.

Meibomian Gland Probing (MGP): Opens blocked oil glands to restore natural oil flow. No long term effects see to date other than allergy. Biggest risk: does not help symptoms, stye formation—MGP will rev up meibomian gland oil but if orifice gets blocked a stye can form which is partly good —meaning we want proof of more oil formation —but we don’t want a stye as it can lead to a scarred gland. There is no evidence MGP damages glands long term other than a chalazia formation.

LipiFlow/TearCare: Heat plus gentle pressure to clear and express meibomian glands. Biggest risk: does not help symptoms, stye formation—Lipiflow will rev up meibomian gland oil but if orifice gets blocked a stye can form which is partly good —meaning we want proof of more oil formation —but we don’t want a stye as it can lead to a scarred gland. 

PRP drops: Made from patient’s blood; contain healing components with anti-inflammatory, antibacterial, and antiviral properties. Biggest risk: does not help otherwise no long term effects see to date. No infections reported to date. 

Autologous serum (AS) drops: Blood-derived drops with natural growth factors to help the surface heal. Biggest risk: does not help otherwise no long term effects see to date. Rare case of infections reported to date.

Cord blood serum (CBS) drops: Rich in growth factors; used for stronger healing support. Biggest risk: does not help otherwise no long term effects see to date. No infections reported to date. 

Steroid eye drops/cream: Reduce inflammation quickly; used short-term due to risks like cataract formation (which if curable but could require cataract surgery) and increased eye pressure/glaucoma which can lead to blindness, if not treated quickly. Risk of vision loss is real with long term steroid use.

Testosterone therapy: Can improve oil gland function in select patients; monitored carefully. Biggest risk: does not help otherwise no long term effects see to date. No infections reported to date. 

Amniotic membrane: A powerful, non-controversial form of embryonic stem cells that heals tissue quickly, and significantly decreases inflammation in the majority of patients. It is very safe and often used for infections all over the body, including corneal infections. It is taken from a placenta of a newborn baby and is evaluated for a series of transmitted disease prior to use. Usually the placenta is thrown away after delivery. Biggest risk: does not help otherwise no long term effects see to date. No infections reported to date. 

Each therapy targets a different part of the inflammation cascade behind dry-eye symptoms in a step-ladder approach.