Treatment of severe dry eye following acoustic neuroma surgery with eyelid androgen gel application

Purpose: To report a case of recalcitrant dry eye disease caused by acoustic neuroma and subsequent microsurgery. Observations: A 51-year-old female presented with refractory unilateral (right eye) severe dry eye disease (DED). The patient had a history of right acoustic neuroma with surgical excision 14 years prior. With normal eyelid closure, the patient reported persistent dry eye symptoms despite use of several tear substitutes and ointments. The patient was a subject in a clinical trial, and was found to be in the active treatment arm following unmasking. The patient had been dosed with a topical eyelid application of testosterone 4.5 % wt./wt. gel twice per day for 4 weeks and followed up to 8 weeks after discontinued drug application. Dry eye symptoms were significantly improved and brought to near normal range (Ocular Surface Disease Index (OSDI)