How to treat dry eyes

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How to treat dry eyes

Choosing the right over-the-counter eye drops usually depends on the type of eye problem that you have. Some eye drops are specifically designed to treat dry eyes, while others are designed to treat red or itchy eyes. In the case of most eye infections, however, over-the-counter eye drops may not be enough. For these types of conditions, your doctor may give you a prescription for eye drops.

Dry eyes are a common problem. This condition is usually temporary, and can be caused by a number of things, such as lack of sleep or staring at small print for an extended period of time. Lubricating eye drops are considered to be the best type of over-the-counter eye drops for dry eye sufferers. These contain artificial tears, which are similar to the natural tears that keep eyes moist. Although they may provide temporary dry eye relief, eye drops that are designed for red eyes should be avoided as they can make the problem worse.

Decongestant eye drops are a type of eye drop formulated for clearing up red eyes. These over-the-counter eye drops contain an ingredient that shrinks the blood vessels on the surface of the eye, making them less apparent. Prolonged use of these types of drops is not typically recommended, since the eye can become dependent on them. This may result in a person constantly needing to use the drops to get rid of red eyes.

Allergies during the spring and fall are quite common, and many people suffer from itchy eyes during this time. If you suffer from itchy eyes due to seasonal allergies, you may benefit from antihistamine eye drops. These types of over-the-counter eye drops work by blocking the release of certain chemicals in the body that cause allergic itching.

Conjunctivitis occurs when the mucous membrane that covers the eyeball becomes inflamed. Symptoms of this condition can include redness, itching, burning, and swelling of the eye, along with a discharge. Bacterial conjunctivitis usually does not benefit from over-the-counter eye drops and may require prescription eye drops.

When using any kind of eye drops, you should always make sure that the tip of the dropper never comes in contact with your eye. This can possibly contaminate the dropper and reinfect you or others with bacterial or viral eye diseases. To use over-the-counter eye drops, tilt your head back, and pull your lower eyelid down. Drip one or two drops into your eye and blink a few times to distribute them.

Last Updated: June 3, 2021 References

This article was medically reviewed by Rajesh Khanna, MD. Dr. Rajesh Khanna is a board certified Ophthalmologist and the Founder of Khanna Vision Institute in Los Angeles, California. Dr. Khanna specializes in Lasik, cataract, and refractive eye surgery as well as treatments for presbyopia and keratoconus. Dr. Khanna completed his first Ophthalmology Residency in Mumbai and his second Ophthalmology Residency at SUNY Downstate in New York City. He went on to complete a fellowship training in corneal and refractive surgery from the University of Cincinnati in Ohio and a Neurophthalmology fellowship from Kingsbrook Jewish Hospital in New York City. Dr. Khanna is also a voluntary member of the UCLA faculty and is an Internationally recognized top Lasik, presbyopic implants in the eye (PIE), and Refractive vision care specialist. He is board certified by the American Board of Ophthalmology and is a certified Master of Surgery by the University of Bombay.

There are 9 references cited in this article, which can be found at the bottom of the page.

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If you find yourself blinking a lot, you might have dry eyes. This condition occurs when you don’t produce enough tears to properly lubricate your eyes—and it can be quite uncomfortable! Fortunately, you can easily treat dry eyes with eye drops and a few other simple techniques. If you’re prone to dry eyes, there are also a few things you can do to keep them from bothering you as much.

A primary symptom of Sjögren’s, more than thirty million Americans have symptoms of dry eye disease, however only 16 million are diagnosed.

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For Sjögren’s patients, inflammation of tear-secreting glands reduces tear production, resulting in chronic dry eye. In addition, changes in the composition of tears contribute to dry eye. In people with dry eye, thin spots in the tear film may appear and the tears no longer adequately protect and support the health of ocular surface tissues.

In Sjögren’s, a patient’s white blood cells mistakenly invade tear and saliva producing glands, causing inflammation and reducing secretion. The age of onset for Sjögren’s is typically in the 40s, although many patients are being diagnosed at a younger age as education about Sjögren’s increases.

In a recent survey of Sjögren’s patients, dry eye was a symptom for 92% of respondents.

About Tears

Normal healthy tears contain a complex mixture of proteins and other components that are essential for ocular health and comfort. Tears are important because they:

  • Provide nutrients and support the health of cells in the cornea.
  • Lubricate the ocular surface.
  • Protect the exposed surface of the eye from infections. Clear vision depends on even distribution of tears over the ocular surface.

Treatments for Dry Eye Disease

Treatment for dry eye depend on its causes and severity, so it is important to be examined by an eye care professional who is trained to diagnose and treat ocular disease. The doctor may use tests to assess tear production, tear stability, and tear distribution to determine its’ severity.

The Sjögren’s Foundation also developed Dry Eye and Sjögren’s clinical practice guidelines that give a treating eye care provider a roadmap for how to treat the various levels of severity in Sjögren’s dry eye. Some of the treatment options are:

Artificial tears, gels and ointments are available over the counter. They can provide temporary relief from dry eye symptoms. Artificial tears contain water, salts, and polymers but lack the proteins found in natural tears. Those who frequently use drops or ointments should choose a brand without preservatives or one with special non-irritating preservatives. Artificial tears are used to treat mild forms of dry eye or to supplement other treatments. It is important to avoid over-the-counter redness reliever eye drops as they may exacerbate dry eyes and redness with chronic use. Ointments usually are reserved for night use since they tend to blur one’s vision.

Punctal occlusion blocks the small openings in the eyelid that normally drain tears away from the eye. Usually this is done by inserting plugs made of silicone or other materials into the openings. This simple in office procedure helps to retain the patient’s tears on the ocular surface for a longer time. It can improve symptoms and increase comfort for some patients.

There are also prescription products available to help treat dry eye

Restasis ® (cyclosporine ophthalmic emulsion) 0.05% treats an underlying cause of chronic dry eye by suppressing the inflammation that disrupts tear secretion.

Xiidra® (lifitegrast ophthalmic solution) 5% was approved by the FDA for both the signs and symptoms of dry eye disease.

CEQUA™ (cyclosporine A, ophthalmic solution) 0.09%CEQUA is a calcineurin inhibitor immunosuppressant indicated to increase tear production in patients with dry eye.

Corticosteroids (cortisone), topically applied, are occasionally prescribed to treat acute episodes of inflammation in dry eye. The use of these medications should be limited in frequency and duration to avoid potential complications of elevated intraocular pressure and glaucoma, cataract and increased risk of infections.

For more treatment options, please visit our Treatment page. Additionally, Foundation members have access to the Sjögren’s Foundation Product Directory in the Member Community.

Other Options & Considerations

Blepharitis or Meibomian Eyelid Gland Dysfunction (MGD)

Because excess evaporation of the tear film can occur when there is irritation of the eyelids, conditions known as blepharitis or meibomian eyelid gland dysfunction (MGD), it is often helpful to maintain eyelid hygiene. In addition to traditional management strategies for meibomian gland dysfunction or blepharitis include warm compresses, eyelid massage and eyelid scrubs, there are many promising in-office manual and mechanical treatments that may provide the potential of symptomatic relief for patients with meibomian gland dysfunction. In addition, t opical azithromycin may be prescribed for those with MGD.

Additionally, ocular allergies and certain skin disorders, such as rosacea, also can aggravate dry eye and should be treated appropriately.

Scleral Lenses

A scleral lens is a large-diameter contact lens that vaults across the entire corneal surface and rests on the white part of the eye, known as the sclera. Liquid fills the space between your eye and the back surface of the scleral lens. This liquid bandage protects the cornea from the ongoing mechanical shearing effect of the eyelids that occurs when you blink. It also continuously bathes your sensitive corneal tissue. If you have Sjögren’s and also require vision correction, the scleral lens is additionally helpful because other contact lens options may be limited by the compromised state of your ocular surface.

Omegas

There is accumulating evidence to suggest that taking essential fatty acid supplements (Omegas) by mouth may improve dry eye symptoms and signs. Although research is not conclusive on this, many believe that Omegas may still be beneficial. Essential fatty acids are also available in food, flaxseed oil, blackcurrant seed oil, fish oil supplements and in some over-the-counter products.

How to treat dry eyes

Sponsored by Natural Ophthalmics, Inc.

By Elise Brisco, OD, FAAO, FCOVD, CCH

How do your eyes feel at the end of the day? If you are like the majority who are literally staring at a computer or cell phone for much of the day, or part of the growing aging population, you’d probably answer, “My eyes are often tired and dry.”

Chronic dry eyes affect as high as 87.5% (Fenga et al) of computer users and 73.5% (Uchini et al) of the elderly population. It is the number one vision problem that optometrists and ophthalmologists treat. Dry Eye Syndrome (DES) is becoming an epidemic because our work, play and socialization has shifted from working with our bodies, to working with our eyes.

Symptoms of DES include fluctuating vision, tired eyes, redness, burning, foreign body sensation, excessive tearing, itching and recurring eye infections. Causes include heavy digital use, stress, age, sleep deprivation, menopause, allergies, medication (i.e. antihistamines, diuretics, antidepressants, birth control pills, beta-blockers and hormone replacement therapy), low humidity environments, lid disease and contact lens wear.

Staring at a computer or digital device decreases your blink rate by 60% so oily tears are not spread over the eyes to lubricate and nourish them. Combine this with stress or inadequate sleep which compromises the immune system. These tears end up coagulating in the meibomian glands with the unchecked bacteria flora.

Traditional treatment for dry eyes has been: artificial tears, punctal plugs, prescription eye drops: Restasis and Xiidra, steroid drops, antibiotic drops, autologous serum drops (preparing eye drops from your own plasma) and managing prescription drugs that cause dry eyes.

The problem is that many of these treatments do not adequately address the underlying causes of dry eyes: inadequate production or poor quality tears, stress and clogged oily tear glands (meibomian glands). Also, many of these eye drops contain preservatives that further irritate the eyes.

Addressing the underlying cause of dry eyes improves the likelihood of making your patients more comfortable, while also treating the problem. Here is an integrative approach that you can use to help your patients with DES.

  1. Use homeopathic tear stimulation drops instead of artificial tears or prescription eye drops, which may feel good when you apply the drops, but do not have a long-lasting benefit. Homeopathic tear stimulation drops trigger release of all three layers of your own tears: mucous, oily and aqueous. I have had wonderful success with both the Tear Stimulation Forte Drops and Women’s Tear Stimulation Drops by Natural Ophthalmics. It has helped patients with everything from Dry Eye Syndrome to Sjogren’s Syndrome. The women’s formula has two added ingredients which address dry eyes due to hormonal changes from aging. 1 Homeopathic medications are all FDA approved, and are cited in at least two Materia Medicas with provings of their efficacy.
  2. Unclog plugged meibomian glands that become clogged over time with the oily tears and bacteria. I use both an in-office and home heated eye massage to open the meibomian glands to get the tears flowing, and bacteria out. In the office I use the Mibo Thermaflow which is a therapeutic medical device that effectively liquifies the clogged oily tear ducts and evacuates bacteria by heating the lid safely and comfortably to 110 degrees Fahrenheit. For home treatment, I give patients an infrared heated mask which not only heats, but also promotes healing with the infrared heat. To treat the bacteria that is expressed with the heated massage, I prescribe Zocular foam, which is an okra-based product to decrease the bacteria and moisturize the eye lids.
  3. Improve tear quality and quantity from the inside out with omega 3’s. Only 2 formulas have been clinically proven to do this: HydroEye by Science Based Health, and Ultra Dry TG by OcuSci, Inc. 2,3
  4. Treat co-existing allergies with Allergy Desensitization Drops by Natural Ophthalmics which decreases the over-reaction to pollens the same as taking allergy shots. The two main ingredients in Natural Ophthalmics’ Allergy Desensitization Drops, Apis mellifica and Sabadilla, have been clinically shown to increase stability of basophils by decreasing their degranulation. 4,5 Allergic conjunctivitis aggravates dry eyes by irritating tear production glands to diminish tear production. In turn, insufficient production and release of tears decreases the eye’s ability to flush away airborne allergens such as pollen and dander, which exacerbate the allergic conjunctivitis.

Summary: DES is the number one eye problem that patients present with in an eye care practitioner’s office. The first step in treating dry eyes is to ask patients how their eyes feel at the end of the day, then connecting the symptoms to DES. After that, the problem can be diagnosed using several tests including meibography (infrared imaging of meibomian oily tear glands using the Meibox), tear break up test, meibomian gland manual expression, and Phenol Red Thread Test or Schirmer’s Test. Once the diagnosis is made, the key is to treat the underlying cause rather than simply using artificial tears which don’t get to the root of the problem.

About the Author

How to treat dry eyes

Elise Brisco, OD, FAAO, FCOVD, CCH is the Chief Medical Advisor for Natural Ophthalmics in Dillon, Colorado. She is also the co-founder of the Rehabilitative Vision Clinic at the Cedars Sinai Medical Center in the Department of Physical Medicine and Rehabilitation, and the Director of the Integrated Wellness Clinic. Dr. Brisco is in private practice focusing on integrative optometry with an emphasis on rehabilitation and children’s vision at the Hollywood Vision Center Optometry and Homeopathy, Inc.

References

  1. A Follow-Up Study on the Efficacy of the Homeopathic Remedy Arsenicum album in Volunteers Living in High Risk Arsenic Contaminated Areas. Evidence-Based Complementary and Alternative Medicine. 2011, 9 pages. doi:10.1093/ecam/nep122
  2. Sheppard JD, Singh R, McClellan AJ et al, Long-term Supplementation With n-6 and n-3 PUFAs Improves Moderate-to-Severe Keratoconjunctivitis Sicca: A Randomized Double-Blind Clinical Trial, Cornea 2013; 32:1297-1304
  3. Moeller et al., Assoc Between Age-Related…, Arch. Ophthalmology, 2008
  4. Poitevin, B, Davenas, E, and Benveniste, J, “In vitro immunological degranulation of human basophils is modulated by lung histamine and Apis mellifica,” British Journal of Clinical Pharmacology, 1988, 25: 439-44.
  5. Abelson, Mark B, George, Michelle A., Garofalo, Christopher, and Weintraub, Dana. An Effective Treatment for Allergy Sufferers. Contact Lens Spectrum. December 1995: 28-32