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Case Reports
. 2025 Feb 5;17(2):e78554.
doi: 10.7759/cureus.78554. eCollection 2025 Feb.

Recalcitrant Dry Eye Disease in a 31-Year-Old Female: Favorable Outcomes Following Complete Ocular Lavage Facilitated by an Irrigating Eyelid Retractor

Sathi Maiti  1 , Srinivas Sai A Kondapalli  2 , Laura M Periman  1
Affiliations
Case Reports

Recalcitrant Dry Eye Disease in a 31-Year-Old Female: Favorable Outcomes Following Complete Ocular Lavage Facilitated by an Irrigating Eyelid Retractor

Sathi Maiti et al. Cureus. .

Abstract

This report explores the management of an otherwise healthy 31-year-old Caucasian female with chronic, refractory dry eye disease (DED) unresponsive to extensive conventional therapies. The initial treatment included artificial tears, cyclosporine, hypochlorous acid spray, and thermal eyelid pulsation, which provided limited relief. Progressive therapeutic interventions, such as intense pulsed light, varenicline nasal spray, perfluorohexyloctane drops, platelet-rich plasma, and topical antibiotics, resulted in only modest improvement over 15 months. Persistent symptoms and corneal staining prompted the implementation of a novel treatment: high-pressure ocular surface lavage using an irrigating eyelid retractor (Rinsada®) with preservative-free saline. Post-lavage, the patient experienced immediate and significant symptomatic relief, with marked improvement in corneal staining noted on slit lamp examination. Continued improvement was observed over two weeks following the procedure. This report underscores the potential of high-pressure saline irrigation for addressing inflammatory mediators and biofilm on the ocular surface. The irrigating eyelid retractor enabled precise and effective lavage of the palpebral conjunctiva and fornices, reducing the inflammatory load and resetting the ocular surface. This technique represents a promising adjunctive therapy for recalcitrant DED, offering rapid symptom relief and improved clinical outcomes. Further studies are warranted to validate these findings and optimize patient care.

Keywords: dry eye disease; meibomian gland dysfunction; novel therapies; ocular surface disease; ocular surface inflammation.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Srinivas Sai A. Kondapalli declare(s) a patent from Rinsada. Dr. Kondapalli holds a US Patient for the irrigating eyelid retractor . Intellectual property info: Dr. Kondapalli has a US Patient for the irrigating eyelid retractor. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Corneal staining on presentation
First visit - February 2023. The patient’s right eye (A) and left eye (B) illustrate significant superficial punctate keratitis of the lower one-third of the cornea and limbus
Figure 2
Figure 2. Corneal staining with active pharmaceutical intervention
A: The image shows the right eye of the patient with persistent inferonasal superficial punctate keratitis on active pharmaceutical management. 2B: The image illustrates the left eye of the patient with persistent inferonasal superficial punctate keratitis and irregular staining pattern on active pharmaceutical management
Figure 3
Figure 3. Corneal staining one day post complete ocular lavage
The right eye (A) and left eye (B) of the patient with reduced superficial keratitis and improved staining pattern one day after complete ocular lavage with irrigating eyelid retractor
Figure 4
Figure 4. Corneal staining approxiamately two weeks post complete ocular lavage
The right eye (A) and the left eye (B) of the patient with nearly resolved superficial keratitis and improved staining pattern 13 days after complete ocular lavage with the irrigating eyelid retractor
Figure 5
Figure 5. Irrigating eyelid retractor
View of the irrigating eyelid retractor with the distal port that aims fluid at the fornix
See this image and copyright information in PMC

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