The following case study is the third in a series of cases that highlight treatment intervention with LACRIFILL Canalicular Gel (Nordic Pharma). Here, a patient presented with cloudy, blurry vision in her right eye following refractive cataract surgery in both eyes with implantation of multifocal IOLs.
Presentation
In January 2025, a 72-year-old woman presented to me with “very cloudy and blurry vision” in her right eye only. She had undergone refractive cataract surgery in both eyes, with implantation of multifocal IOLs 1 month prior.
The patient had recently completed her surgical drops (prednisolone, moxifloxacin, and bromfenac) and as her symptoms were suspected to be due to dry eye, she was prescribed HYLO artificial tears (Optase), warm compresses, clobetasol propionate ophthalmic suspension 0.05% (Eyenovia) drops BID, and Pataday® eye drops (Alcon) to help improve the ocular surface. Her vision was blurry due to the ocular surface dryness and poor tear film, and cloudiness/blurriness was observed from the cornea and the ocular surface. The patient did not have a diagnosis of dry eye disease prior to undergoing cataract surgery.
The patient’s UCDVA OD measured 20/40-2, (pinhole 20/25-2) and UCNVA was J3, and her manifest refraction measured -1.00 +0.75 x 095. Her UCVA OS measured 20/20, near J1+. An external exam revealed that the right eye had scattered 1+ superficial punctate keratitis (SPK) and a tear break-up time (TBUT) of 5 seconds; OS, the exam showed no SPK and a TBUT of 8 seconds (Figure 1).
Figure 1. Wavefront imaging of the patient’s right eye 1 month after cataract surgery showed irregularity due to scattered 1+ superficial punctate keratitis.
Treatment
Following her presentation, I placed the patient on clobetasol steroid drops twice daily, HYLO artificial tears four times daily, and warm compresses as described above. Two weeks later, the patient still complained of very cloudy and blurry vision OD. Upon follow-up, there was a second examination from the initial treatment initiation of topical clobetasol steroid drops, HYLO artificial tears, and warm compresses; however, the vision remained unchanged, with UCVA 20/40. A decision was then made to place LACRIFILL Canalicular Gel OU. I made this decision due to the limited improvement with medical treatment and her persistent poor vision complaints. I wanted to use Lacrifill Canalicular Gel to help raise the tear layer and hopefully stabilize the tear film and improve the patient’s vision.
Outcomes
When the patient returned 2 weeks later for her next follow-up following LACRIFILL Canalicular Gel placement, she reported immediate relief of her previous symptoms (within the hour per her report). An exam completed at this appointment demonstrated her UCVA OD measured 20/20 and near J1+, and the manifest refraction was -0.25 +0.25 x 34. Her UCVA OS was 20/20 and near J1+. A corneal examination OU showed two clear corneas with no SPK and a TBUT of 9 seconds in both eyes (Figure 2).
Figure 2. After LACRIFILL Canalicular Gel intervention, the patient reported that her symptoms had resolved. The right eye achieved 20/20 UCVA, an absence of SPK, and a TBUT of 9 seconds.
Conclusion
Both the patient and I were extremely pleased with her results. This case underscores the importance of controlling the ocular surface, especially after surgery. I believed that LACRIFILL Canalicular Gel was the next appropriate choice in the patient’s treatment plan as I wanted to improve her tear volume and tear quality. I initially started with topical treatment using steroid drops to help reduce any ocular inflammation. Upon her return with minimal improvement in vision, the next step was to place LACRIFILL Canalicular Gel.
After her improvement in UCVA and improved visual quality, I discontinued her topical steroid drops (clobetasol) but did advise her to continue her daily routine with artificial tears and warm compresses. We discussed the importance of continued dry eye management to maintain good quality vision and comfort. I also recommended that she return in 6 months to reassess how she was doing with LACRIFILL Canalicular Gel, and to irrigate out the gel and then likely reapply it.
