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

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.