Nasal Spray Provides a Novel Approach to Treatment of Dry Eyes

For over 20 years, 61-year-old Annette Sandoval struggled with dry eyes, a condition many Coloradans experience given the state’s arid climate. Allergies can also trigger dry eyes, as well as frequent computer use, medication side effects, and numerous health conditions. In many cases, the condition can significantly affect quality of life, as it did for Sandoval.

After catching COVID-19 in January, Sandoval’s dry eye disease became unbearable. Her eyes were constantly burning and had a thick, white discharge that she found herself dabbing with cotton swabs throughout the day.

“I thought I was going to lose my mind. That’s how bad it was,” she says. “I couldn’t go outside. I couldn’t be around people.”

"My eyes have improved so much," says Annette Sandoval, who used the nasal spray Tyrvaya to treat her dry eye disease.

When over-the-counter eye drops failed to relieve her symptoms, she visited multiple doctors and tried prescription eye drops. An ear, nose, and throat specialist arranged for an MRI of her tear ducts to look for blockages but found nothing unusual. Nothing seemed to be helping.

“That’s when I took matters into my own hands and called UCHealth,” she says. “When the appointment finally came, I was in tears.”

Tears of joy

Sandoval was referred to dry eye specialist Scott Hauswirth, OD, director of the CU Department of Ophthalmology’s Ocular Surface Clinic.

Hauswirth measured her tear production and confirmed she had extensive dryness of the cornea and the mucous membrane surrounding her eye and the inside of her eyelids.

“We see dry eyes worsen – usually, temporarily – following routine viral infections like a cold,” says Hauswirth, who is also an assistant professor of ophthalmology at the CU School of Medicine. “Given her timeline and knowing COVID-19 has an effect on the structures that support the nerves, it seemed logical that it played a role in decreasing her tear production.”

He put her on a treatment regimen that included serum eye drops made from her own blood to facilitate growth of healthy corneal tissue, and he recommended a new dry eye treatment, the nasal spray Tyrvaya, to improve tear production.

“When I started Tyrvaya, that’s when I really started to feel a difference,” Sandoval says. “I told Dr. Hauswirth, ‘I don’t know what this stuff is, but it’s really helped.’”

A game changer in dry eye treatment

When the Food and Drug Administration approved Tyrvaya as the first-ever nasal spray treatment of dry eye disease in October 2021, eye care providers at CU Anschutz Medical Campus were receptive to have another treatment to offer.

“Dry eye is an incredibly difficult condition to treat,” says Kaleb Abbott, OD, MS, ophthalmology instructor at the Sue Anschutz-Rodgers Eye Center. “So many options are out there, but at the same time, we feel like we don’t have enough. Another treatment was necessary.”

The new treatment is applied twice daily in the nostrils, alleviating patients of touching their eyes directly. The active ingredient – varenicline tartrate, the same ingredient used in smoking cessation drug Chantix – stimulates nerves in the nose that are connected to the nerves that stimulate tear production.

“As someone who was initially skeptical, I’ve become a fan,” says Darren Gregory, MD, associate professor of ophthalmology at the CU School of Medicine and dry eye specialist who practices alongside Hauswirth and Abbott. He estimates about three of four of patients he’s prescribed it to have seen beneficial effects.

Patients may see improvement in as little as two weeks, compared to one to three months typically for prescription eye drops. People who cannot put eye drops in their eyes, such as patients with a tremor or severe rheumatoid arthritis, find it easier to use. While many drops, such as artificial tears, mask the symptoms of dryness, Tyrvaya helps treat one of the root causes of dryness, which is insufficient tear production. However, depending on insurance coverage, it can be costly, and there is not a generic available.

“I tend to use it in severe patients who have tried everything else,” Gregory says. “It’s not for everyone. You have to spray it sideways in the nostril, you try not to inhale. Everybody sneezes a few times. It’s a little like spraying pepper spray in your nose.”

But for people like Annette Sandoval, the benefits are worth it.

“My eyes have improved so much,” she says. “I feel like I got my life back.”