How are dry eyes treated?
You should discuss treatment options with an ophthalmologist or optometrist (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 twice a day in each eye to treat the underlying inflammation in the tear glands so they produce more 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 doctor will also treat with corticosteroid drops for 2 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 they can cause cataracts and glaucoma.
- Lifitegrast (Xiidra®): These drops are also done twice a day in each eye, to treat the underlying inflammation in the tear glands. The Food and Drug Administration (FDA) has approved Xiidra to treat both the signs and symptoms of dry eye diseases with an onset of action in as little as 2 weeks. It is the first approved drug in a new class of medication called lymphocyte function-associated antigen 1 (LFA-1) antagonists.
- 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 tears 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.
- Surgery: 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.
Symptoms can be greatly improved by these treatment options.