Reviewed by Richard Adler, MD
Dry eye syndrome is a chronic and typically progressive condition. Depending on its cause and severity, it may not be completely curable. But in most cases, dry eyes can be managed successfully, usually resulting in noticeably greater eye comfort, fewer dry eye symptoms, and sometimes sharper vision as well.
Because dry eye disease can have a number of causes, a variety of treatment approaches are used. The following is a list of dry eye treatments that are commonly used by eye doctors to reduce the signs and symptoms of dry eyes. Your eye doctor may recommend only one of these dry eye treatments or a combination of treatments, depending on the cause(s) and severity of your condition.
Also, some eye doctors will have you complete a questionnaire about your symptoms prior to initiating dry eye treatment. Your answers to this survey are then used as a baseline, and the questionnaire may be administered again after several weeks of treatment to evaluate the effectiveness of the chosen treatment approach.
Successful treatment of dry eyes requires that you are willing to follow your doctor’s recommendations and that you use the products he or she recommends consistently and as frequently as directed.
For mild cases of dry eyes caused by computer use, reading, schoolwork and other situational causes, the best dry eye treatment may simply be frequent use of artificial tears or other lubricating eye drops. 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 “light” 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. Instead, high-viscosity artificial tears are recommended only for bedtime use.
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 for aqueous-deficiency dry eyes, while another brand may be more effective for an evaporative dry eye condition.
If your eye doctor recommends that you use one or more brands or formulations of artificial tears, be sure to follow the directions he or she gives you concerning when and how often you use the drops. Also, do not substitute different brands from those your eye doctor recommends. Using a different brand or multiple brands of artificial tears will make it difficult to assess the success of the dry eye treatment your doctor recommended.
Instead of OTC artificial tears (or in addition to them), your eye doctor might recommend daily use of a prescription eye drop called Restasis (Allergan) for your dry eye treatment. Restasis does more than simply lubricate the surface of your eye. It includes an agent that reduces inflammation associated with dry eye syndrome and helps your body produce more natural tears to keep your eyes moist, comfortable and healthy. It’s important to know, however, that the therapeutic effect of Restasis 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. A significant percentage of people who try Restasis will experience burning eyes early during the first few weeks of treatment.
Steroid Eye Drops
Over the past several years, doctors have discovered the importance of inflammation as a cause of dry eyes. Inflammation frequently causes the redness and burning associated with dry eye disease; but in many cases, it may be present without any visible signs or symptoms at all.
Artificial tears usually do not adequately address these inflammatory changes, and your doctor may recommend steroid eye drops to better manage the underlying inflammation associated with dry eyes. Often there’s no “quick fix” for dry eyes. Follow your eye doctor’s instructions and be patient for results from dry eye treatment. Steroid eye drops are generally used short-term to quickly manage symptoms. They are often used in conjunction with artificial tears and Restasis, as a complement to these more long-term treatment strategies.
While a small amount of the steroid may get absorbed systemically, in the right candidate, the effects of steroid eye drops are generally not noticed beyond the eye. Still, it’s important to discuss your medical history with your eye doctor before starting steroid eye drops.
Many different types of steroid drops are available and differ in their potency. Most
doctors prefer to start with mild steroids that are quickly degraded inside the eye. In some cases, however, more potent drops are required to address more severe symptoms. 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.
Punctal plugs are sometimes used in dry eye treatment to help tears remain on the surface of the eye longer. 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. 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. In this way the tear film stays 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 the eyes to “water,” 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, and if these openings get clogged, the oil that is critical to keeping the tear film from evaporating too quickly cannot do its job. This is called meibomian gland dysfunction (MGD), which leads to a condition called evaporative dry eye.
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 are worth putting up with the short-term discomfort of the procedure.
An alternative (and potentially more comfortable) way to help open clogged meibomian glands to treat dry eyes is to simply 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.
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.
Drinking more water can help, too. Mild dehydration often makes dry eye problems worse. This is especially true during hot, dry and windy weather. Simply drinking more water sometimes reduces the symptoms of dry eye syndrome.
Home Remedies for Dry Eyes
If you have mild dry eye symptoms, there are several things you can try to get relief before going to the eye doctor:
Blink more frequently. When using a computer, smartphone or other digital device, we tend to blink our eyes less frequently than normal, which can cause or worsen dry eye symptoms. Make a conscious effort to be aware of this, and blink more often when using these devices. Also, perform full blinks, gently squeezing your eyelids together to wash your eyes fully with a fresh layer of tears.
Wraparound-style sunglasses and eyewear with side shields can protect your eyes from moisture-robbing wind and irritating debris.
Take frequent breaks during computer use. A good rule of thumb here is to look away from your screen at least every 20 minutes and look at something that is at least 20 feet from your eyes for at least 20 seconds. Some eye care practitioners call this the “20-20-20 rule,” and abiding by it can help relieve both dry eyes and computer eye strain.
Remove eye makeup thoroughly. Eyeliner and other eye makeup can clog the openings of the meibomian glands at the base of the eyelashes, leading to meibomian gland dysfunction and evaporative dry eye. At the end of the day, be diligent about remove all traces of makeup from your lids and lashes.
Clean your eyelids. When washing your face before bedtime, gently wash your eyelids to remove bacteria that can cause blepharitis and meibomian gland problems that lead to dry eye symptoms. Apply a warm, moist washcloth to your closed lids for a minute or two. Then gently scrub your lids and lashes with a mild cleanser, such as diluted baby shampoo or pre-moistened eyelid wipes sold in drugstores.
Wear quality sunglasses. When outdoors during the day, always wear sunglasses that block 100 percent of the sun’s UV rays. It’s best if they feature a wrap-style frame to protect your eyes from wind, dust and other irritants that can cause or worsen dry eye symptoms.