For Dry Eye, Transnasal Neurostimulator Activates Real Tears

Christopher J. Rapuano, MD; Beeran B. Meghpara, MD


July 26, 2018

Editorial Collaboration

Medscape &

Christopher J. Rapuano, MD: Hi. I am Dr Christopher Rapuano, chief of the cornea service at Wills Eye Hospital, coming to you from the Wills Eye Alumni Society Newsroom at Wills Eye Hospital in Philadelphia. I'm here with Dr Beeran Meghpara, also from the cornea service. We are coming to you in partnership with Medscape.

Today we want to talk about a new treatment for dry eye. Can you tell us about it, Beeran?

Beeran B. Meghpara, MD: Happy to. The new treatment is called TrueTear® (Allergan; Madison, New Jersey). It is a device that performs transnasal neurostimulation, which means that it stimulates your own body and your own lacrimal system to produce tears. Thus, it is a unique treatment for dry eye in that it does not require external drops or medications. It helps your body produce its own tears.

Rapuano: It's a homeopathic treatment that your own body is working itself.

Meghpara: Exactly.

Rapuano: What type of patient will benefit from this treatment?

Meghpara: That is a good question. This is a relatively new device, so we are still trying to figure it out. Is it good for patients with mild dry eye who are using artificial tears and we want to eliminate some drops and use this device to help them produce their own tears? Or is it for patients with more advanced disease, after we have tried other treatments that don't work, and this could be a potential avenue for them to get symptom relief?

Rapuano: I assume that it could be used in conjunction with other treatments for dry eyes.

Meghpara: Definitely.

Rapuano: Are there any patients who should not use this treatment?

Meghpara: There are a handful of patients who should not. Because it is an electrical device and sending an electrical signal, patients with pacemakers, defibrillators, or cochlear implants should not use it. It is a device that is placed into the nose, so patients who have issues with nosebleeds or bleeding disorders should not be using it. There is about a 5% risk for nosebleeds with this device. Generally, the nosebleeds are minor, but if there is an issue, [those patients] should not be using it.

Rapuano: This device is approved by the US Food and Drug Administration (FDA). I understand that in the study that the FDA reviewed for its approval,[1] patients used this device numerous times a day at the beginning, but then toward the end of the study, months later, they did not need it quite as many times a day. They thought it was even more effective toward the end of the study, which is great.

Exactly how is it used? Can you show us?

Meghpara: Essentially, you place the device inside your nose and tilt it a little bit forward toward the roof of your nose. Then you push the "on" button. It sends an electrical signal for about 60 seconds. You feel this pulsation. Almost immediately, patients will tell you that they feel tears in their eyes. Initially we recommend using this twice a day, but it can be used more frequently than that if needed. As you said, as time goes on, patients do seem to need this less and less.

Rapuano: Is it just watery tears that are created, or are they normal, healthy, full-blown natural tears?

Meghpara: Any time you get something up your nose or stick something up your nose, theoretically, you are going to get teary. This device creates natural, healthy tears. Tears are made up of water, oil, and mucus. This device has been shown to increase not only the water content, but also the oil content and the mucus content in the tears. We are still trying to figure out exactly how it does that, but the thought process is that the device heats up the oil glands in the eyelids to allow more oil to be produced and secreted onto the surface of the eye. It is truly mimicking natural tears.

Rapuano: That is great. It not only increases tear production, but they are healthy tears with all of the components of tears. We have certain patients for whom dry eye is really a major problem in life, and it affects almost every waking moment. Anything that helps us to treat these patients is wonderful.

Meghpara: It is another tool in our toolbox. It is something else we can offer patients.

Rapuano: As you said, we are just beginning to roll this out. If patients wanted to try this device, how do they go about doing that?

Meghpara: It is distributed directly through the doctor's office. Patients can visit their eye doctor, and the eye doctor can prescribe and provide it.

Rapuano: They sell it through their offices. The disposable nasal units are good for a day or two and then you replace it with a new one. You can get a monthly supply for that.

Meghpara: Exactly.

Rapuano: That is wonderful. Thank you for explaining this very exciting new development for the treatment for dry eyes. We will see how this plays out during the next 6-12 months.

This is Chris Rapuano with Beeran Meghpara from the cornea service at Wills Eye Hospital in partnership with Medscape. Thank you very much.