written by Dr. William McSwain
WHAT IS DRY EYE?
Dry eye occurs when not enough tears are produced or when the tears that are produced are of poor quality and do not function normally. The tear film is what makes the surface of the eye smooth allowing your vision to be clear and your eyes to feel comfortable. Any disruption to the tear film will not only cause irritation, but may also cause blurry vision. Other symptoms include burning, itching, a scratchy or gritty sensation, foreign body sensation, and tearing.
WHAT CAUSES DRY EYE?
Common causes of dry eye include aging, blepharitis (inflammation of the eyelids), menopause, smoking, oral medications such as anti-histamines or beta-blockers, dry or windy weather, contact lens wear, autoimmune diseases, refractive surgery, and traumatic or surgical damage to the eyelid anatomy. You may notice your symptoms are more common at the end of the day or when reading, watching TV, or using the computer because you do not blink as often when performing these tasks.
WHAT CAN BE DONE TO HELP WITH DRY EYE?
Lubricating drops are the first-line treatment. I recommend using Systane, Refresh, or Thera Tears drops up to 4 x daily, but there are many different brands and varieties that you can try and may prefer. DO NOT USE VISINE OR ANY DROP THAT SAYS “GET THE RED OUT.”
Some patients, especially if you are already on eye drops for other conditions such as glaucoma, may prefer preservative-free artificial tears. Preservative-free artificial tears come in a box of individual single-use vials and can be used as often as you like without having to worry about the buildup of preservative in your eyes that may cause irritation or an allergic reaction.
Lubricating ointment can be used at bedtime to keep your eyes from drying out while you sleep. I recommend Refresh PM, Systane Nighttime, or Retaine PM. Some patients do not like using ointment because it can make your vision cloudy if you wake up in the middle of the night. The cloudiness can be relieved by rinsing the ointment out with eyewash solution or a damp washcloth.
Punctal plugs are used to block the tear ducts that drain tears out of your eyes into your nose and the back of your throat. This keeps the tears in your eyes and prevents dryness. They can be inserted in the office in a pain-free, very low risk procedure that only takes about 1-2 minutes and is covered by most insurance companies. They are not visible and are well tolerated.
Omega-3 fatty acids can improve tear production. Consider taking a fish oil or flax seed supplement.
Treatment of blepharitis with warm compresses and lid scrubs can improve the quality of the tear film (see separate handout for more details on the treatment of blepharitis).
Steroid eye drops may increase tear production and heal the surface of your eyes if there is a significant inflammatory component to your dry eye. These require a prescription and are usually not used long-term because they can cause other problems in the eyes such as glaucoma or cataracts.
Restasis is a prescription medication that may increase your tear production. It may take several months to see any effect but in general, the longer you use Restasis, the better the benefit. Alternatively, a similar medication called Xiidra may be used.
Autologous Serum Tears are eye drops made from the serum or fluid component of your blood. Your blood’s serum contains all kinds of growth factors, antioxidants, and anti-inflammatories. These drops heal the surface of eyes damaged from chronic dryness leading to the production of increased quantity and quality of healthy tears. They may be expensive and are usually not covered by insurance but are extremely effective in treating chronic severe dry eye.
Prokera is a biologic corneal bandage containing amniotic membrane that is similar to a contact lens. The lens is usually placed on a Monday and removed on a Friday. It may be uncomfortable and causes blurry vision in while the lens is in place. The amniotic membrane in Prokera heals the surface of eyes that have been damaged by severe dry eye to reduce pain and improve tear production.