Autologous serum eye drops
What are serum tears?
Autologous serum tears are eye drops made from a patient’s own blood. The drops can help patients with ocular surface diseases that have not improved with conservative treatments. But they are not FDA-approved or covered by insurance, which can prevent patients from using serum tears for treatment.
Serum eye drops have been used for over 40 years. The first time they were reported was in 1975 to treat ocular burns. They have been used to treat many different ocular surface diseases — especially dry eye syndrome — ever since.
Studies have shown that autologous serum eye drops can aid in healing by improving tear production, improving tear flow stability, and treating and preventing postoperative dry eye.
Uses and benefits of serum tears
Serum tears may be recommended for people with dry eye issues that have not shown signs of improvement after trying more conventional treatments.
The surface of the eye can become dry and inflamed as a result of various diseases and conditions that affect the ocular surface. Serum tears have been used to treat many of these conditions, including (but not limited to) the following:
Dry eye syndrome
Dry eye disease is a condition in which your eyes do not make enough tears or they do not make the right type of tears. This causes your eyes to become dry and inflamed. Symptoms include eye redness, feeling like something is in your eye, watery eyes and blurry vision.
Eye herpes is a disease caused by type 1 herpes simplex virus. It can result in eye redness, eye pain, rashes around the eye, and ulcers and scarring of the cornea. Ocular herpes is the leading cause of corneal blindness in the United States. It can also cause dry eye symptoms such as watery eyes and feeling like something is in your eye.
Sjogren’s syndrome is an autoimmune disorder that affects the glands of the body — mainly those of the eyes and mouth. It can cause dry eyes and damage to the corneal epithelium (the surface of the cornea).
This is a disease in which transplanted cells attack the recipient’s cells. This is sometimes seen in stem cell transplants. If it affects the surface of the eye, it can lead to dry eye.
Stevens-Johnson syndrome/toxic epidermal necrosis (SJS/TEN)
These potentially fatal conditions cause rashes and blisters on the skin and mucous membranes. This can lead to extreme peeling of the skin and serious problems for the eyes.
Ocular cicatricial pemphigoid
This autoimmune disease presents as chronic conjunctivitis in both eyes. Early symptoms are similar to dry eye and include eye redness, tearing and burning. It can cause conjunctival scarring and lead to vision loss.
Complications from refractive surgery procedures such as LASIK and PRK
Photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) surgeries are laser procedures that can improve your vision. Side effects of both procedures may include eye pain and light sensitivity. There can also be delayed healing. Serum tears may help with these side effects.
These procedures also increase the likelihood of developing dry eye, especially a subtype called neuropathic dry eye. This subtype is caused by the brain amplifying the dry eye pain signal, which results in an extreme sensation of discomfort in patients that have only very mild clinical signs. Neuropathic dry eye is especially hard to treat and the application of serum tears is one of the few successful therapies available.
Recurrent or persistent corneal erosions
In this condition, the surface of the cornea becomes loose from the layer underneath. If your eye becomes dry when you sleep, your eyelid could stick to your cornea. Symptoms of corneal erosion are worse when you wake up and include eye pain, blurry vision and light sensitivity.
This degenerative disease reduces sensitivity of the cornea and can cause the surface of the cornea to come loose. Because of their reduced sensitivity, patients often do not have any symptoms, though they can sometimes have eye redness and blurry vision. Healing is usually impaired and can lead to corneal infections.
Superior limbic keratoconjunctivitis
This is an inflammatory disease that affects the superior bulbar conjunctiva, the limbus and the upper cornea. Symptoms include eye pain, light sensitivity, burning and feeling like something is in your eye.
Your eyes can also become damaged and dry from:
Dry eyes can be treated in many ways, including warm compresses, massaging your eyelids, using eyelid cleaners, and using artificial tears or prescription eye drops. The benefit of serum eye drops over these conventional treatments is that the drops can help promote the healing of the surface of the eye.
Because serum tears are derived from blood, they contain platelets, proteins, vitamins A and C, antioxidants, electrolytes and other growth factors. These components aid in cell growth that can help to heal the ocular surface. Other treatments often only treat symptoms.
Some patients are able to discontinue serum tears once their eyes have healed. Others with chronic conditions may have to use the drops for a long period of time. Some need serum tears for the rest of their life.
How autologous serum tears are made
In order to make autologous serum tears, the patient will need to have their blood drawn. This can be done in a doctor’s office, in a lab or at home by a mobile phlebotomist. The blood then gets sent to a compounding pharmacy that is set up to make this type of eye drop.
The serum is made by first allowing the blood to clot. Then a centrifuge separates the serum from the solids in the blood. The serum is diluted with a sterile and preservative-free saline solution.
The most common concentrations are 20% (a five-fold dilution of the serum) or 50% (a two-fold dilution). Concentrations that are over 50% may actually interfere with the healing of your eye(s) and are not recommended.
Once the drops are made, they must be stored in the freezer. Serum tears can last six months in the freezer. When the patient is ready to use the drops, they can be stored in the refrigerator. Serum tears last for one week in the refrigerator.
Autologous serum tears vs. conventional eye drops
There are many differences between autologous serum tears and conventional eye drops. The main difference is that many conventional eye drops contain preservatives that can irritate the eyes.
Also, conventional eye drops like artificial tears tend to only treat the symptoms of dry eye. They do not have the components to heal the ocular surface and reduce inflammation like serum drops.
They also differ from conventional eye drops in other ways, including that autologous serum tears:
Mimic natural tears.
Have antibacterial properties.
Are not artificial as they are made from the recipient’s blood.
Contain albumin, a protein that is synthesized by the liver and found in the bloodstream. It has antioxidant properties that can protect the surface of the eye.
Risks and side effects
Serum tears have very few side effects. One reason is that they do not contain preservatives. Another reason is that serum tears are made from the patient’s blood, and not from artificial ingredients.
Risks are also minimal. However, it is important to store the drops properly to avoid infection. The drops must be stored in the freezer upon receiving them and until ready to use. The drops can be moved to the refrigerator when using them.
Safety precautions should also be taken with patients who have blood or serum diseases to avoid disease transmission.
How to get serum tears
Serum tears can be prescribed by your doctor if they think you are a good candidate for the treatment. However, not all doctors are set up to prescribe serum tears and you may need to seek out or ask for a referral to a dry eye or cornea specialist. These specialists will often work with specific compounding pharmacies that have the ability to produce the drops.
Your doctor or the compounding pharmacy can set up an appointment to have your blood drawn and then shipped to the compounding pharmacy. You can usually have your drops delivered to you within 48 hours.
A challenge to obtaining autologous serum eye drops is that they are not approved by the FDA to treat ocular surface disorders. This means the drops are not covered by insurance and patients must pay out of pocket for them. The average cost can range from $250 to $500 for a three- to six-month supply of drops.
Further trials that test the efficacy of serum tears for treating ocular surface disorders may help in getting future FDA approval.
Autologous serum tears: An overlooked treatment for dry eye. Modern Optometry. July/August 2020.
Autologous and allogenic serum tears. American Academy of Ophthalmology. EyeWiki. June 2023.
Autologous serum-based eye drops for treatment of ocular surface disease. Ophthalmology. September 2019.
What is dry eye? Symptoms, causes and treatment. American Academy of Ophthalmology. July 2022.
Herpetic eye disease. Cleveland Clinic. April 2019.
What is uveitis? American Academy of Ophthalmology. December 2022.
Sjogren’s syndrome. National Institute of Arthritis and Musculoskeletal and Skin Diseases. January 2021.
Graft-versus-host disease. StatPearls. October 2022.
Stevens-Johnson syndrome. Cleveland Clinic. December 2020.
Ocular pemphigoid. StatPearls. March 2023.
Photorefractive keratectomy (PRK) eye surgery. Cleveland Clinic. June 2021.
LASIK — laser eye surgery. American Academy of Ophthalmology. July 2023.
Corneal abrasion and erosion. American Academy of Ophthalmology. March 2023.
Recurrent corneal erosion. American Academy of Ophthalmology. EyeWiki. May 2023.
Neurotrophic keratitis. StatPearls. April 2023.
Superior limbic keratoconjunctivitis. American Academy of Ophthalmology. EyeWiki. April 2022.
Myths and misconceptions about autologous serum for dry eye. Ophthalmology Times. June 2020.
Physiology, albumin. StatPearls. December 2022.
Page published on Thursday, August 3, 2023
Page updated on Tuesday, August 8, 2023
Medically reviewed on Friday, June 30, 2023