To evaluate the therapeutic effects of topical heparin (Hylo-Parin®, Ursapharm Saarbr cken, Germany) and spray type phospholipids (Tears Again®, Optima Pharmazeutische GmbH. Freising, Germany) in severe dry eye syndrome resistant to conventional therapy.

Twenty eyes of ten patients with refractory severe dry eye were treated with Hylo-Parin® (two times a day) and Tears Again® (three times a day) for three months. Before and one and three months after treatment, a symptom questionnaire was administered to the patients. The ocular surface disease index (OSDI), tear film break-up time, Schirmer test, conjunctival fluorescein staining examinations and filamentary keratitis were evaluated.

After using Tears Again® and Hylo-Parin®, the OSDI score improved from 64.13 ± 15.12 to 43.80 ± 15.87 ( p <0.01). Tear film break-up time significantly increased from 1.0 ± 0.65 to 2.3 ± 0.73 seconds ( p <0.01) and conjunctival staining score (Oxford scale) significantly decreased from 3.85 ± 0.75 to 3.25 ± 0.97 ( p <0.01). Filamentary keratitis in the slit-lamp examination showed significant improvement ( p <0.01).

Tears Again® and Hylo-Parin® are considered as new treatment modalities for severe dry eye syndrome and filamentary keratitis in patients with chronic ocular surface disease resistant to conventional therapy. These treatments require additional research.