Dry Eyes FAQ
Q: My wife has rheumatoid arthritis, and from this very dry eyes. What are the best eye drops to use? K.M., Canada
A: There are a variety of over-the-counter artificial tears. There are proprietary brand names and generic brand names. Try them one brand at a time and see which works for her. After a while, if one stops working, switch to a new one.
An artificial tear preparation that works for one person doesn't necessarily work for the next. Trial and error is the best way to go. Dr. Slonim
Q: I have dry eyes. I want to know if insurance will pay to have the implants put in the tear ducts? I am 22 years old. R.W., Tennessee
A: It depends on your insurance. Usually yes, as implantation of punctal plugs in the tear drainage ducts of the eyelids is a medical procedure to correct a medical condition. Usually works great, also! Dr. Dubow
Q: What can I do for excessively dry eyelids? They are cracking open. Also, I am experiencing puffiness under my eyes. J.W., Georgia
A: Cracking eyelids can be a sign of a staphylococcal blepharitis (inflammation of the eyelids), especially when the cracking occurs at the outer corners of the eyelids. If the cracking is really scaling, this could represent a type of psoriasis of the skin of the eyelids. If it is just dryness, try an eyelid moisturizing cream found at a makeup counter. See your eye doctor for a definitive diagnosis and treatment. Dr. Slonim
Q: I have been diagnosed with dry eyes but would still like to continue wearing contacts from time to time. Is it true that a lens lower in water content is better for me? J.S., New York
A: Some contact lens practitioners find that, in fact, lenses with lower water content can sometimes be better for people who have dry eyes. But some patients actually do better with high-water content lenses. It has long been felt by some practitioners that the thicker the lens, the better, as well.
To increase your comfort with contact lenses (regardless of the type of lenses your eye doctor recommends) first have your dry eye condition evaluated and treated. Ask your doctor about the possibility of lacrimal or punctal occlusion, which plugs up the tear drainage system to keep more moisture on your eyes. Dr. Dubow
Q: I wore contact lenses about four years ago. I have dry eyes from prescription Premarin, which I must take for the rest of my life. Have there been any updates since that time to ensure a longer contact lens wearing period? J.A.
This drawing shows the lacrimal glands and tear ducts. A lacrimal plug (or punctal plug) has been inserted into the lower tear duct to keep the eye's moisture from draining away too quickly. Image: Oasis Medical, Inc.
A: You bet! There are several dry eye contact lenses on the market. Ask your eye care practitioner about CooperVision's Proclear lenses. These are the only contacts approved by the FDA for the claim, "may provide improved comfort for contact lens wearers who experience mild discomfort or symptoms relating to dryness during lens wear," according to the company. There are other contact lenses that your eye doctor might recommend for people with dry eyes as well.
I highly recommend you also use non-preserved contact lens care products. Ask your practitioner about hydrogen peroxide-based contact lens care systems or the chemical-free Purilens Plus system.
There also is a procedure called lacrimal occlusion or punctal occlusion whereby your eye doctor can block some of your tear drainage, keeping more tears on your eyes. This is a simple procedure taking only a few minutes and done right in your doctor's office. It can work wonders for folks with dry eyes. Dr. Dubow
Q: I've worn soft contact lenses on and off for 15 years, and I chronically have red, bloodshot eyes. I've gone for periods of weeks and months wearing only my glasses and avoiding contacts, but honestly my eyes seem less bloodshot when I wear my contacts. What can I do to clear up my red eyes? And does the fact they are chronically bloodshot indicate any eye health problems or disease? M.A., Georgia
A: The known causes of red eyes take up volumes in the ophthalmic literature. It sounds like you need to obtain a diagnosis for your condition so that the appropriate treatment can be prescribed.
Eye allergies and dry eye syndrome are probably the two most common causes of red eyes. Wearing contact lenses on top of an already inflamed eye can only lead to further problems. See your eye doctor to determine the cause of your red eyes and the best treatment. Dr. Slonim
Q: Why do some contact lenses feel more dry than others? Is it better to go with lower water content or higher? R.D., Georgia
A: This is a very technical question. Contact lenses are made from different plastics and silicones that have different characteristics. Some have more water content than others.
All contact lenses are subject to evaporation while on the eye. In other words, the environment sucks the water out of the lenses. The rate of this happening depends on many factors: humidity, wind, temperature, your health, what medicines you are taking, how much you blink, the care system you use, how clean the lenses are, etc.
Some eye care practitioners believe that high water content lenses perform better for those with dry eye, while others believe just the opposite. A few lenses are specially made from plastics that resist dehydration and evaporation to increase comfort for wearers with dry eyes. Examples include Proclear (CooperVision) and Extreme H2O (X-Cel Specialty Contacts).
I also suggest trying silicone hydrogel contact lenses such as Air Optix (Alcon), PureVision (Bausch + Lomb) and Acuvue Oasys (Johnson & Johnson Vision Care). For a contact lens solution suitable for someone with dry eyes, I recommend Clear Care (Alcon).
An in-office procedure is also available that blocks some of the tears from draining away. Tiny punctal plugs are inserted into the tear drainage holes in the eyelids. This is called lacrimal occlusion. It is very safe and effective for those with clinically dry eyes and can really help with comfortable contact lens wear. Dr. Dubow
Q: Why do my eyes water all the time, especially my left eye? Susie, California
A: This is actually impossible to know without examining you. But you should consider two major things: your tear drainage system may be plugged, or you may have dry eyes. Although this seems contradictory, these two conditions are the most common for causing watery eyes.
If your eyes are constantly watery, with tears dripping onto your face, I would suspect a blockage in your drainage system. This can usually be alleviated by flushing out the tiny ducts in your eyelids that drain tears away from your eyes.
If your eyes water primarily when you are in wind or cold or when your eyes are irritated, I would suspect dry eyes as the cause. This can be helped by actually blocking the tear drainage system to keep more tears in your eyes.
I recommend you see an eye doctor who is familiar with lacrimology and can test you for these two problems, along with considering other factors such as your lids and how their shapes interact with your eyes. Dr. Dubow
Q: I have a tear duct that leaks on regular basis. My doctor recommends surgery. What does this entail? C.K.
A: Sounds like you might need a dacryocystorhinostomy (DCR). This is a tear drainage bypass surgery that treats blockage of the nasolacrimal duct (the duct that drains tears from the eyes into the nose). Obstruction of this duct causes abnormal tearing (epiphora) and watery eyes.
The DCR procedure creates a channel for tears to exit the tear drainage system (above the blockage) directly into the nose. The procedure can be performed under general or local anesthesia, and it commonly is performed endoscopically (the opening is made from inside the nose) so there is no visible scarring.
DCR has a high success rate (greater than 92 percent, according to one study). Rarely some post-op discomfort might occur. Seek out an oculoplastic surgeon with experience in performing this procedure. Dr. Slonim
Q: Lately I have been experiencing excessive tearing from both eyes, but with no eye allergy symptoms (no red, swollen, or itchy eyes). I am five months pregnant could excessive tearing be a symptom of pregnancy? What can I do to stop the tears? E.R., Virginia
A: Excessive tearing can be one of the many symptoms of pregnancy. You can't stop them, just wipe them. There could be a problem with the outflow mechanism (tear ducts) that drains the tears away from the eyes and into the nose.
As long as there is no infection or other symptoms that you mentioned, wait until after the delivery to see if the tearing goes away. If you are concerned, check with your eye care practitioner. Dr. Slonim
Page updated January 2018
More Dry Eye Articles
About Dry Eye Syndrome |
About Dry Eyes: FAQ
Answers From a Dry Eye Expert | Dry Eyes After Menopause
Meibomian Gland Dysfunction | Sjogren's Syndrome
Dry Eye Treatment: Overview | Dry Eye Treatment: Punctal Plugs
Dry Eye Prevention: Nutrition | Contact Lenses for Dry Eyes
LASIK and Dry Eyes