Perfluorohexyloctane ophthalmic solution: a review of a prescription treatment for dry eye disease that directly targets tear evaporation

Introduction: Perfluorohexyloctane (PFHO) ophthalmic solution (brand name, MIEBO) was recently approved by the United States Food and Drug Administration to treat the signs and symptoms of dry eye disease (DED). Unlike most DED treatments, PFHO addresses evaporative DED, which represents the vast majority of DED cases. PFHO may function as a surrogate for the tear film's lipid layer, inhibiting evaporation.Areas covered: This article summarizes data - found via PubMed and clinicaltrials.gov (May 30-1 September 20231 September 20231 September 2023) - surrounding PHFO and provides some considerations for its use. Preclinically, PFHO's unique molecular properties facilitate formation of a layer at the tear film's air-liquid interface and inhibit saline evaporation by 81%. These properties translate to improved clinical outcomes in DED: in phase 3 studies, 40% to 50% of PFHO-group patients had a >= 3-step total corneal fluorescein staining improvement at day 57, and approximately 60% of patients had >= 30% reduction in visual analog scale dryness scores, improvements that persisted to 52 weeks. Additionally, PFHO demonstrated a robust safety profile.Expert opinion: PFHO is the first prescription eye drop that directly addresses hyperevaporation in DED. PFHO is poised to help fill the large unmet need of patients with evaporative DED, potentially improving patient outcomes and quality of life.