Autologous serum eye drops for severe dry eye

On this page

1. What autologous serum eye drops are
2. How they differ from ordinary drops
3. Who the drops may suit, and who they may not
4. Questions worth clarifying before you start
5. How the process works, step by step
6. What it feels like, and how to use the drops
7. Possible side effects and risks
8. What is important to know in advance
9. How the drops fit with other treatments
10. Cost

This page is for people with severe dry eye that does not improve enough with lubricating drops, anti-inflammatory drops and other treatments. Here you will find what autologous serum eye drops are, who they may suit, how they are prepared and stored, and what their limitations are.

What autologous serum eye drops are

Autologous serum eye drops are eye drops prepared from the patient's own blood. Blood is taken, the serum (the liquid part of the blood, without the blood cells) is separated from it, and it is diluted and made into drops under sterile conditions. Serum contains substances that are also found in natural tears, such as growth factors, vitamin A and proteins that help the cells of the cornea (the clear layer at the front of the eye) renew themselves. Unlike most off-the-shelf drops, they contain no preservative.

How they differ from ordinary drops

Ordinary lubricating drops add fluid to the eye surface and ease the sensation, but they do not contain the biological substances found in natural tears. In severe dry eye, when the eye produces almost no tears, the eye surface also loses the substances that nourish and renew it. Autologous serum eye drops try to restore some of these substances. This also explains why they require a more complex process of preparation and storage.

Who the drops may suit, and who they may not

Autologous serum eye drops are usually reserved for severe conditions, such as:

• Severe dry eye in Sjögren's syndrome.
• Graft-versus-host disease (GVHD) of the eyes, after a bone marrow transplant.
• A wound in the surface layer of the cornea (the epithelium) that does not heal (a persistent epithelial defect), or that keeps reopening.
• Damage to the corneal nerves that slows healing, and other severe conditions of the eye surface.
• Severe dryness that does not respond to standard treatment.

The drops may not be suitable, or may require further assessment, when there is a blood-borne infection, certain blood disorders, anaemia, difficulty having blood taken, or a medical condition in which repeated blood draws are undesirable. That is why blood tests and a conversation about your general health are done before preparation.

Questions worth clarifying before you start

• Which blood tests are needed, and whether some of them can be done as part of tests you are having anyway.
• How long it takes from the blood draw to receiving the drops, and how long the supply will last.
• How to transport and store the bottles at home, and what to do if freezing is interrupted.
• Which other drops you continue, and in what order to put them in.

How the process works, step by step

1. Assessment at the clinic. The severity of the dryness and the condition of the eye surface are examined, and together we decide whether the drops are suitable.
2. Blood tests. Tests to rule out blood-borne infections are usually needed, as well as general tests.
3. Blood draw. Blood is taken from a vein, similar to an ordinary blood test, but in a larger amount.
4. Preparation in the laboratory. The blood is separated, and the serum is diluted and divided into small bottles under sterile conditions. Who prepares the drops and how long it takes will be explained to you at the appointment.
5. Storage. The bottles are kept frozen. One bottle at a time is thawed, kept in the fridge and used for a limited time.
6. Use and follow-up. You put in drops several times a day as instructed, and come back for follow-up visits to see whether there is improvement and whether to continue. When the supply runs out, the process is repeated.

What it feels like, and how to use the drops

The blood draw feels like an ordinary blood test. The drops themselves are usually pleasant, and many describe them as gentler than other drops. Improvement, if it comes, is usually gradual, over weeks.

To reduce the risk of infection:

• Wash your hands before each use.
• Do not touch the tip of the bottle, and do not let it touch your eye or eyelashes.
• Keep an opened bottle in the fridge, and throw it away at the set time, even if there is fluid left in it.
• Do not thaw and refreeze the same bottle.

Possible side effects and risks

• Infection: the serum contains no preservative, so a contaminated bottle may cause an eye infection. This is the most important risk.
• Irritation or mild discomfort when putting in the drops.
• Effects of the blood draw: a small bruise at the needle site, and sometimes dizziness.
• The effort involved: the process requires tests, repeated blood draws, careful refrigerated and frozen storage, and patience.

A Cochrane review (Pan 2017) found that the drops may improve symptoms in the short term in some patients, but the evidence is limited and the studies are small. That is why this is a treatment for selected conditions and not a first-line treatment.

What is important to know in advance

Autologous serum eye drops are not a medicine that cures the disease causing the dryness. They may support the eye surface and ease symptoms for as long as they are used, so for many patients this is a long-term treatment. It is important to weigh the benefit against the effort together, and to check at follow-up visits whether the treatment is really helping you.

How the drops fit with other treatments

Autologous serum eye drops are usually added to existing treatment and do not replace it. They can be combined with punctal plugs, which keep the drops on the eye for longer, and with anti-inflammatory drops that the eye doctor may prescribe. When there is a corneal wound that does not heal, they are sometimes combined with a bandage contact lens. In conditions such as Sjögren's and GVHD, treatment is coordinated with the other treating doctors.

Cost

The cost is set and discussed at the consultation, according to the treatment that suits you.

Want a basic explanation first?For basic information on dry eye treatment options: the guide on the Mitzmutz site

Frequently asked questions

Why from my own blood?

Serum, the liquid part of the blood, contains substances similar to those in natural tears, including growth factors and vitamins that help the cells of the eye surface. When it comes from your own blood, the risk of an immune reaction is low.

How long does it take to get the drops?

Preparation involves blood tests, a blood draw and preparation in a laboratory under sterile conditions, so it takes some time. The exact timeline will be explained to you at the appointment.

How are the drops stored?

You usually receive several frozen bottles. They are kept in the freezer, and one bottle at a time is thawed and kept in the fridge, according to the instructions you receive. An opened bottle is used for a limited time and then thrown away.

Are the drops safe?

They are considered safe when prepared and stored correctly. The main risk is contamination of the bottle, so it is very important to follow the instructions.

Sources

1. Pan Q, Angelina A, Marrone M, Stark WJ, Akpek EK. Autologous serum eye drops for dry eye. Cochrane Database Syst Rev. 2017;2:CD009327.
2. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628.
3. Foulks GN, Forstot SL, Donshik PC, et al. Clinical guidelines for management of dry eye associated with Sjögren disease. Ocul Surf. 2015;13(2):118-132.
4. Ogawa Y, Kim SK, Dana R, et al. International Chronic Ocular Graft-vs-Host-Disease (GVHD) Consensus Group: proposed diagnostic criteria for chronic GVHD (Part I). Sci Rep. 2013;3:3419.

The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.