2. Tears Again Training Module
What are tears ?
What is dry eye syndrome ?
What are the symptoms ?
What are the treatment options ?
How does Tears Again work ?
What are the benefits of using Tears Again ?
PBS vs OTC.
Tears Again test questions.
3. What are tears made of?
Tears clean and lubricate the eyes.
Tears consist of 3 layers, each secreted from different
glands around the eyes.
4. Layers of the tear film
Mucus layer : Secreted by conjunctival goblet cells.
Facilitates an even distribution of tears across the cornea.
Aqueous layer : Secreted by lacrimal glands.
Lipid layer : Secreted by meibomian glands (found on eyelid margins).
Reduces aqueous evaporation and provides lubrication
between eyelid and eyeball.
5. What is Dry Eye Syndrome ?
Also known as keratoconjunctivitis sicca.
Occurs when one or more layers of the tear film
May affect up to 14% of over 40s (according to US
Research has shown that 79% of dry eye patients have
“evaporative dry eye” due to a malfunctioning lipid
6. What are the triggers of dry eye ?
Triggers can include : Aging.
Other conditions, such as Sjorgren’s syndrome and blepharitis
Some medications, including antihistamines, beta blockers
and contraceptive pills.
Wearing contact lens.
Environmental conditions, such as air conditioning.
7. What are the symptoms of dry eye ?
Symptoms can include :
Itchy, gritty eyes.
8. How big is the market in Australia ?
Multiple SKUs and brands.
Leading brands sell up to 500,000 units per annum.
Leaders include Systane and Poly Tears.
9. Preservatives in dry eye treatments
Dry eye treatments come in 3 broad
categories :1. Containing preservatives.
3. Ointments (for overnight use).
10. Preservative-Containing Drops
Usually a multi-dose bottle.
Can use for up to 30 days after opening.
Will contain a preservative such as benzalkonium
chloride, which may irritate eyes if used frequently or
over a long period.
Not recommended for long-term use.
Brands include : Visine; Poly Tears; Optive.
11. Preservative-Free Eye Drops
Sold in individual, single-use vials.
Suitable for long-term use.
Brands include Systane; Cellufresh, Refresh.
Usually available either OTC or on PBS.
12. How is dry eye measured /
Measure tear volume using Schirmer test :
Filter paper place on lower eyelids for 5 minutes.
Filter paper is removed and amount of moisture is
13. 2. Measuring tear break-up time (BUT) : Tear film is stained.
Physician observes how long it takes tear to break-up when eye is
left open (ie no blinking).
Any time less than 10 seconds is an indication of dry eye.
The lipid layer is the main determinant of BUT.
Unstable lipid layer = shorter BUT.
14. The Principles Behind Tears Again
79% of dry eye patients lack a stable lipid layer, leading to
evaporative dry eye.
Tears Again is the only dry eye treatment that works to
stabilise the lipid layer.
A stable lipid layer means :
Extended break-up time (BUT).
Improved tear volume (as measured by Schirmer Test).
Reduced eyelid inflammation due to improved lubrication
between the eyelid and eyeball.
15. What is in Tears Again?
Contains phospho-lipid liposomes.
These are the same type of lipids that make up the
lipid layer of the tear film.
Liposomes are microscopic balls of oil, with an
The lipids in Tears Again supplement the natural lipids
secreted from meibomian glands.
Since its action is purely physical, Tears Again is
classified as a medical device, not a medicine.
16. How is Tears Again Used ?
Spray onto a closed eyelid from 10-15cm.
Eyes can be opened immediately after spraying.
Use as often as required (since the action is purely
Applying 3 times per day is normal.
17. How does Tears Again work through
a Closed Eyelid ?
When sprayed onto a closed eyelid, a small
percentage of the spray forms on the eyelid margins.
This is where meibomian glands are located and the
natural lipids are secreted.
Tears Again supplements the natural lipids and is then
blinked across the eye.
The outcome for patients: stable lipid layer means
extended BUT, improved tear volume and reduced
18. How Well Does Tears Again Work?
Study by Lee, Daush, Meierhofer and Dausch (2004)
compared Tears Again to placebo.
Tears Again showed significant improvement in BUT,
tear volume and inflammation.
95% of patients preferred the spray to previous drop
Other studies exist showing effective use in cases of
contact lens wear and surgery-induced dry eye.
How can Tears Again work when sprayed onto a closed eye ?
Tears Again is designed to mimic meibomian secretions. These lipids are secreted onto the
eyelid margins. When Tears Again is sprayed onto a closed eye, a small percentage forms
on the eyelid margins. Here, it supplements the natural meibomian secretions and is
blinked across the eye.
What happens if Tears Again is sprayed onto an open eye ?
Tears Again works equally well on an open or closed eye. However, spraying onto an open
eye is almost impossible due to the blink reflex.
Will Tears Again ruin make-up ?
No, just let the residue on the face dry naturally (approx. 30 seconds).
Can I use Tears Again if I wear contact lens ?
Contact lens can physically disrupt the lipid layer and cause dry eye. All types of lens can be
left in when using Tears Again.
20. FAQs continued
How often should I use Tears Again ?
As often as you feel the need. Since its action is purely physical there are no adverse effects from
Can I use Tears Again and eye drops ?
Yes, but use the drop first and Tears Again afterwards.
Does Tears Again contain a preservative ?
Tears Again contains phenoxyethanol. This preserves Tears Again in the bottle. Being an
ethanol-based preservative, it is volatile and quickly evaporates when sprayed. As such,
Tears Again is designed for long-term use like a preservative-free eye drop.
What is the shelf-life of Tears Again ?
Tears Again can be used for up to 3 years (expiry date) even after opening.
Why are watery eyes a common symptom of dry eye?
As eyes dry out (usually due to excessive evaporation), they become irritated. This results in
the lacrimal glands to produce a greater volume of tears – more than the eye can readily
drain. The result is watery eyes in patients who still suffer the symptoms of dry eye.
21. OTC vs PBS
Tears Again is available either OTC or with a
prescription on the PBS.
For concession card holders there is a very
considerable saving with a PBS prescription.
Each PBS prescription is for 2 bottles, with a maximum
of 5 repeats.
Approximately 50% of Tears Again sales are via PBS.
22. Some Related Condition
23. Sjorgren’s Syndrome
Autoimmune disease in which immune cells attack
and destroy the glands which produce tears and
90% of sufferers are female, mostly post-menopause.
Affects up to 250,000 Australians.
Symptoms include severe dry mouth and dry eye.
Tears Again can be used effectively to relieve the dry
eye associated with Sjorgren’s syndrome.
This is an inflammation of the eyelid and is usually a chronic
Symptoms include red eyes and eyelids, crusting on lid
margin (especially upon waking), gritty sensation in eyes.
Blepharitis cam lead to interrupted flow of lipids from
This, in turn, can lead to dry eye.
Tears Again is an ideal treatment for the dry eye associated
25. Test Questions
All answers are included in previous pages.
If you don’t know an answer, go back and re-read.
What are the 3 layers of the tear film?
How does Tears Again work when sprayed onto a
Does Tears Again contain a preservative?
What is BUT?
Why do dry eye patients often have watery eyes ?
What is a liposome?