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Dry eye treatment

cartoon of dry eye

Treatment for dry eye can make a significant difference in your comfort and quality of life if you suffer from chronic dry eyes.

Dry eye treatments include:

  • Artificial tears and lubricating eye drops

  • Prescription eye drops for dry eyes (Restasis; Xiidra)

  • Moisturizing inserts (Lacrisert)

  • Punctal plugs

  • Lipiflow dry eye treatment

  • Intense pulsed light (IPL) therapy

  • Nutritional supplements

 Often, multiple treatments for dry eye are recommended. Though there may not always be a permanent cure for dry eyes, the following treatments often provide significant dry eye relief.

Artificial tears

Dry eye treatment usually begins with the use of artificial tears (also called lubricating eye drops and moisturizing eye drops).

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Artificial tears usually are the first step in dry eye treatment.

There are many brands of artificial tears that are available without a prescription. The challenge with using artificial tears is not lack of product availability — it's the confusing number of brands and formulations available to choose from.

Artificial tears and other over-the-counter (OTC) lubricating eye drops are available in a wide variety of ingredients and viscosity ("thickness").

Artificial tears with low viscosity are "thin" and watery. They often provide quick relief with little or no blurring of your vision when you apply them. But often their soothing effect is very short-lived, and sometimes you must use these drops very frequently to get adequate dry eye relief.

On the other hand, artificial tears that have a high viscosity are more gel-like and can provide longer-lasting lubrication. But typically these drops cause significant blurring of your vision for several minutes immediately after you apply them. For this reason, these drops often are not a good choice for use during your work day or when you need immediate clear vision for tasks such as driving. Sometimes high-viscosity artificial tears are recommended for bedtime use only.

Also, the ingredients in certain brands of artificial tears may determine which type of dry eye condition they are better suited for. For example, one brand might work better if you don't produce enough natural tears (aqueous-deficiency dry eye) while another brand may be more effective if your natural tears evaporate too quickly (evaporative dry eye).Ask your eye doctor for advice regarding which brand of artificial tears is best for your type of dry eyes, and use only that product. 

Generic brands of artificial tears can often be less effective than brand-name products, so avoid substitutions without consulting your eye doctor.

READ MORE about eye drops for dry eyes

Restasis eye drops

Restasis (“reh-STAY-sis”) is a prescription eye drop for dry eye treatment.

Restasis reduces inflammation associated with dry eye syndrome and helps your body produce more natural tears to keep your eyes moist, comfortable and healthy.

The recommended dosage for Restasis is two applications in each eye per day, approximately 12 hours apart.

The therapeutic effect of Restasis (cyclosporine ophthalmic emulsion) is not immediate. You must use the drops daily for a minimum of 90 days to experience the full benefits of this dry eye treatment.

Some people who try Restasis will experience burning eyes early during the first few weeks of treatment.

Restasis eye drops are available by prescription from your eye doctor and are marketed by Allergan/Abbvie.

Xiidra eye drops

Xiidra (“ZYE-drah”) is another prescription eye drop for dry eye treatment.

Xiidra, like Restasis, is designed to reduce inflammation and improve tear production in people with dry eye syndrome.

In clinical studies, participants experienced a significant decrease in dry eye symptoms after six to 12 weeks of Xiidra use.

The most commonly reported side effects of Xiidra (lifitegrast ophthalmic solution) were eye irritation, altered taste sensation and reduced visual acuity, which occurred in 5% to 25% of participants.

The recommended dosage for Xiidra, like Restasis, is two applications in each eye per day, approximately 12 hours apart.

Xiidra eye drops are marketed by Novartis Pharmaceuticals.

Steroid eye drops

Steroid eye drops generally are used short-term to quickly manage dry eye symptoms caused by inflammation. They often are used in conjunction with artificial tears and Restasis or Xiidra, as a complement to these more long-term dry eye treatment strategies.

Steroid eye drops (especially if used for relatively long periods) have the potential of causing side effects. So, it's important to make your eye doctor aware of your full medical history before starting steroid eye drops.

For example, steroid eye drops can increase the risk of developing high eye pressure or even cataracts if used for extended periods of time. But these risks are low when the drops are used only on a short-term basis for dry eye treatment.

Lacrisert

Lacrisert is a sterile, slow-release lubricant that’s placed under the lower eyelid for dry eye treatment.

It is a solid insert composed of a preservative-free lubricating agent (hydroxypropyl cellulose) that slowly liquefies over time, providing an all-day moistening effect.

For most people with dry eyes, a single Lacrisert insert is applied once a day. The device has been proven to relieve dryness, burning, watery eyes, foreign body sensation, itching, light sensitivity and blurred vision, according to Bausch + Lomb, which markets the product.

Lacrisert typically is recommended for patients with moderate to severe dry eye symptoms, especially if dry eye treatment with artificial tears alone proves unsuccessful.

If placed under the eyelid improperly, it's possible Lacrisert can cause a corneal abrasion. Also, Lacrisert may cause temporary blurred vision, eye discomfort or irritation, matting or stickiness of eyelashes, red eyes and sensitivity to light.

Punctal plugs

Punctal plugs are another common dry eye treatment.

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This drawing shows a punctal plug inserted in the tear duct of the lower eyelid to keep the eye’s tear film from draining away too quickly. Image: Oasis Medical, Inc.

A punctal plug is a small, sterile device that is inserted into one of the small openings (puncta) of tear drainage ducts that are located in the inner corner of the upper and lower eyelids.

After these openings have been plugged, tears can no longer drain away from the eye through these ducts. This results in the tear film remaining intact longer on the surface of the eye, relieving dry eye symptoms.

So where do the tears go? Usually they will simply evaporate from the eye surface without symptoms. But if insertion of punctal plugs causes watery eyes, one or more of the plugs can be removed.

Meibomian gland expression

A very significant percentage of dry eye cases are caused by inadequate oil (meibum) being secreted from meibomian glands located along the margin of the eyelids.

The openings of these glands are near the base of the eyelashes. If these openings get clogged, the oil that's critical to keeping the tear film from evaporating too quickly cannot do its job. This is called meibomian gland dysfunction (MGD), which is a significant cause of evaporative dry eye symptoms.

To treat MGD and evaporative dry eye, your eye doctor may perform an in-office procedure called meibomian gland expression. In this procedure, warm compresses may or may not first be applied to your eyelids; then a forceps-type device is used to squeeze the clogged contents (hardened meibum and possibly other substances) from the meibomian glands.

To fully express the contents of the meibomian glands and get them functioning properly, significant pressure must be applied to the eyelids, which can be uncomfortable. But the results usually make any short-term discomfort from the procedure worth it.

Warm compresses

An alternative way to help open clogged meibomian glands to treat dry eyes is to apply warm compresses to the closed eyelids to soften the hardened meibum.

Unfortunately, for warm compresses to work well, some researchers say you have to use a compress that can maintain a temperature of 108 degrees Fahrenheit for more than 10 minutes, and the compresses have to be applied for this length of time at least twice a day.

Most people are unable or unwilling to perform this type of dry eye treatment correctly, and shorter and less frequent use of variable-temperature warm compresses typically is ineffective.

LipiFlow

The LipiFlow Thermal Pulsation System (Johnson & Johnson Vision) is an automated, in-office dry eye treatment that combines the best features of warm compress therapy and meibomian gland expression.

Watch a video about how LipiFlow works.

The patented device fits over the eyelids and applies precisely-controlled heat to the lids to soften hardened meibum trapped in the meibomian glands. At the same time, the LipiFlow system applies pulsed pressure to the eyelids to open and express the clogged glands, thereby restoring the correct balance of oils in the tear film to relieve dry eye syndrome.

Lipiflow treatment takes approximately 12 minutes per eye. In a clinical study of the effectiveness of the procedure, 76% of patients reported improvement of their dry eye symptoms within two weeks of treatment. Most patients also showed improvement in the quality and quantity of meibomian gland secretions and the duration of time their tear film remained on the eye before evaporating.

In some cases, however, it can take a few months for improvements from the LipiFlow procedure to become apparent.

Typically, the beneficial effects of the LipiFlow procedure last one to three years or longer.

Potential side effects from LipiFlow dry eye treatment include corneal abrasion, eye pain, swollen eyelids, eyelid irritation or inflammation, chalazion, transient blurred vision, itching, and red eyes.

Intense pulsed light

Another in-office dry eye treatment is intense pulsed light (IPL) therapy.

Ocular rosacea is characterized by dilated blood vessels coursing along the eyelash margin in patients suffering from blepharitis that often contributes to dry eye symptoms.

In IPL treatment, a hand-held device flashes bright light onto the skin of the eyelids. The light is filtered to allow only wavelengths that can be absorbed by the dilated blood vessels. The effect of this treatment may be the resolution of the dilated vessels and associated inflammation that contributes to dry eye symptoms.

Many patients experience relief from their dry eye symptoms after IPL and become less dependent on artificial tears and other routine measures to keep their eyes comfortable. For this reason, IPL treatment may be well-suited for people with dry eyes who don't want to be troubled by the inconvenience of frequent use of eye drops.

Four to six monthly IPL treatments usually are required for optimum effects. Typically, the treatments are well-tolerated and are not associated with any downtime. However, it's important to discuss with your doctor how much time you spend in the sun, as the treatments will make your eyelids more light-sensitive.

IPL treatment generally is not covered by health insurance or vision insurance and it may not be appropriate for patients with certain skin pigmentations.

Nutritional supplements

Doctors sometimes recommend nutritional supplements as part of a holistic dry eye treatment plan.

Studies have found that supplements containing omega-3 fatty acids can decrease dry eye symptoms. Good sources of omega-3s include cold-water fish such as salmon, sardines, herring and cod. For a vegetarian source of omega-3s, some eye doctors recommend flaxseed oil to relieve dry eye.

Also, simply drinking more water might help relieve dry eye symptoms. Mild dehydration often makes dry eye problems worse. This is especially true during hot, dry and windy weather.

SEE RELATED: Home remedies for dry eyes

Other considerations

In addition to the dry eye treatments listed above, your eye doctor may recommend one or more of the following supplemental measures if any of the conditions below apply to you:

Medication adjustment

Many medicines — including antihistamines, antidepressants, birth control pills, certain blood pressure medications and more — can cause or worsen dry eye symptoms. Even over-the-counter (nonprescription) medications for allergies and other conditions can cause dry eyes.

Be sure to discuss all medications you are taking with your eye doctor if you are experiencing dry eye problems. In some cases, adjusting the type and number of medications you are taking may help reduce dry eye symptoms without causing adverse health effects.

However, never discontinue a prescription medication without first discussing the matter with your physician. If your eye doctor feels an adjustment to one of your medications may help relieve dry eye symptoms, he or she can discuss it with your physician (or have you discuss it with your doctor) to see if such a change is possible.

Treating eyelid conditions

If you have blepharitis, meibomian gland dysfunction or other eyelid conditions, these often are associated with dry eye disease and should be addressed as part of your overall dry eye treatment regimen. For example, if you have blepharitis, your eye doctor may recommend use of an antibiotic and/or steroid ointment or eye drop in addition to daily eyelid cleansing with a non-irritating shampoo.

Discontinuing or reducing contact lens wear

If you wear contact lenses, it can be difficult to tell if an underlying dry eye condition is causing contact lens discomfort or if your contact lenses are causing dry eye symptoms. If you wear contacts, it's often best to discontinue wearing them (or perhaps switch to daily disposable contact lenses) while your dry eye treatment is in progress.

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Gary Heiting, OD

Gary Heiting, OD, is a former senior editor of AllAboutVision.com. Dr. Heiting has more than 30 years of experience as an eye care provider, health educator and consultant to the eyewear ... Read more