How are dry eyes treated?
You should discuss treatment options with an ophthalmologist (eye doctor). In some cases, dry eye is caused by another disease or condition, like rheumatoid arthritis or systemic lupus erythematosus. If this is the case, the systemic disease should also be treated in order to relieve the dry eyes.
Here are some common treatments for dry eyes:
Topical cyclosporine A eye drops (Restasis)
These are given 2 to 4 times a day in each eye to treat the underlying inflammation in the tear glands so they produce more tears and better quality tears. It typically takes 1 to 4 months before the cyclosporine A drops reduce symptoms and signs of dry eye. These drops have been found to be safe; the main side effect is stinging upon application, which usually gets better with continued treatment. Sometimes the ophthalmologist will also treat with corticosteroid drops for two weeks just before the cyclosporine A to speed up the treatment and reduce stinging caused by the cyclosporine A. The corticosteroids cannot be taken long-term due to the risk that they will induce cataracts and glaucoma.
Artificial teardrops and ointments
The use of artificial teardrops is a palliative (soothing) treatment that helps symptoms for a few minutes but does not treat the underlying cause of the dry eye disease. Artificial teardrops are available over the counter. No one drop works for everyone, so you might have to experiment to find the drop that works for you. If you have chronic (long-lasting) dry eye, it is important to use the drops even when your eyes feel fine, to keep them lubricated. If your eyes dry out while you sleep, you can use a thicker lubricant, such as an ointment, at night. If you have ocular rosacea associated with dry eye, then newer artificial tears contain lipid to help prevent tear evaporation. If you take artificial tears 4 or more times a day, you should use non-preserved artificial tears, since preservatives will likely worsen your condition.
Temporary punctal occlusion
Sometimes it is necessary to close the ducts that drain tears off the eye. This is done via a painless procedure where a plug is inserted into the tear drain of the lower eyelid. The plug will dissolve quickly. This is a temporary procedure, done to determine whether permanent plugs will help reduce symptoms and signs.
Permanent punctal occlusion
If temporary plugging of the tear drains works well or plugging is thought to be important for the health of the eye, then silicone plugs may be used. (Some physicians will go directly to silicone plugs without using temporary punctual occlusion.) The permanent plugs will hold tears around the eyes as long as they are in place. They can be removed. Rarely, the plugs may come out on their own or move down the tear drain. Many patients find that the plugs improve comfort and reduce the need for artificial tears.
If needed, the ducts that drain tears into the nose can be permanently closed to allow more tears to remain around the eye. This is done with local anesthetic on an outpatient basis. Cyclosporine A drops should always be tried for at least 6 months before permanent punctal occlusion to insure the patient doesn’t have tears running down the face (epiphora) when the dry eye inflammation is treated and the glands produce more tears.
Autologous serum drops
In severe cases of dry eye, artificial tears made from the patient’s own serum can be prepared and given 6 to 8 times a day in both eyes. This treatment, although often effective, is expensive ($300 to $400 every 3 months) and is not covered by Medicare or insurance.
On your own, you can take these steps:
- Humidify the bedroom to at least 40% humidity when you are sleeping (when tear production is lowest). This can be measured with a humidity meter (hygrometer) on the nightstand. Humidity may be very low (less than 25%) during the winter when the heater is on, and this worsens the dry eye condition.
- You can take alpha omega fatty acids or fish oil or flaxseed oil orally (by mouth) to improve dry eye.
- Take frequent breaks when you are doing something that requires close concentration (such as using a computer or reading), and blink frequently.
- Take artificial tears frequently.
- Wear sunglasses when you are outside to protect your eyes from wind and sun.
Symptoms can be greatly improved by these treatment options.