Explaining Dry Eye Treatment Options

With Dry Eye treatment, like other conditions, we tend to try the easiest and cheapest treatments first.

Artificial Tears

• First line dry eye treatment almost always uses a good quality artificial tear, put in the eyes four (4) times per day.
• It has to be four times per day. If you wait until your eyes feel dry, the damage is already done and it will be a day or so before the cornea heals itself.
• The object of artificial tears is to prevent the feeling of dryness or irritation from occurring at all.

• Unfortunately about 75% of the artificial tears on the market use a preservative that is toxic to the eye. Sounds weird, doesn't it?
• The preservative is benzalkonium chloride (BAK) and some closely-related chemicals.
• BAK has been shown in numerous studies to harm both the cornea and the conjunctiva, making DES worse.
• BAK is cheap, so it's used in nearly all the "generic" artificial tears made by the big-box stores. Unfortunately many of the brand-name makers use it too.
• Examine all eye drops you buy and if possible avoid BAK.

Two of the non-BAK artificial tears I recommend are Optive and Systane.

Ointments and Gels

Though it seems unlikely, many patients have eyes that are drier in the morning than later in the day. Many of these patients have a condition called lagophthalmus.

Lagophthalmus patients sleep with their eyes open. This produces a very dried-out cornea where the lids didn't cover the eye.

These patients wake up with scratchy, red, irritated eyes. Sometimes they also have vision that seems blurred or hazy for a few hours.

The condition tends to improve in a few hours after getting up unless a very dry eye also exists.

Treatment of Lagophthalmus

We can't stop patients from sleeping with their eyes open without interfering with their sleep. Consequently we need to use a gel or an ointment in the eyes at bedtime to protect them from drying out.

• Ointments are more protective but blur the vision more and are harder to remove from the lids in the morning.
• Gels provide fairly good protection and are easier to remove in the morning.
• Artificial tears don't provide good protection at night.
• Don't try to squirt the ointment or gel directly into the eye. You have a good chance of scraping the eye.
• Instead, wash your hands, put a glob on your finger, pull down the lower lid and gently wipe the glob on the inside of the lid. When you let go the gel or ointment will cover the eye.
• Don't do this until you're ready to go to bed, since your vision will be very blurred.

Omega-3 Oils

Numerous studies have shown the benefits of adding docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA) to the diet to improve the functioning of the meibomian glands, a very important type of gland in the tear production system.

Click here to go to the Omega-3 page, for more information about DHA and sources of omega-3 oils.

Using DHA and EPA as a dry eye treatment can take four to six weeks to start to help, so be patient and keep taking it.

In Search of a Good Cry...

Often the use of artificial tears and omega-3 fatty acids fails to provide sufficient relief and we need to add additional therapy.

• Such therapy needs to be guided by the type of DES the patient has.
• In nearly all of the following examples the basics of artificial tears and omega-3 fatty acids should still be followed.
• Aqueous Tear Deficiency is a form of DES in which a reduced amount of tear is formed by the eye.
• This form of DES is often treated with a prescription eye drop called Restasis.
• If Restasis is insufficient, punctual plugs are sometimes inserted in the puncta, or drains of the tears. This keeps your natural tears in the eye longer.
• DES has a strong inflammatory component. This means that there is inflammation in the lids and in the glands that secrete the tears.
• Restasis acts to reduce inflammation without a steroid and improve the secretion of tears.
• Using Restasis prior to the insertion of punctual plugs has improved our overall ability to successfully treat this type of DES.
• Evaporative Dry Eye is a form of DES in which one type of tear gland, the meibomian gland, is not working well. This is called meibomian gland dysfunction (MGD).
• Meibomian glands secrete the oily, outer layer of the tear film.
• This layer prevents evaporation of the inner, watery layer. Without a good-quality oily layer your tears evaporate within a couple of seconds, producing dry eye symptoms.
• DHA and EPA (see above) is effective at improving meibomian gland dysfunction (MGD).
• When DHA and EPA are insufficient as a dry eye treatment, we often use a type of tetracycline called doxycycline or minocycline.
• Doxycycline and minocycline are not used for their antibiotic properties, but because they reduce inflammation and increases functioning of the meibomian glands.
• Meibomian glands in the lids and sebaceous glands in the skin are both improved.
• Rosacea, a skin disease of sebaceous glands that can cause DES-type symptoms and red eyes, also responds well to these drugs. Steroid eye drops may be required initially to get the condition under control.

Related Pages

For more detailed information about Dry Eye Syndrome and Dry Eye Treatment, also visit these pages:

• Dry Eye Syndrome
• Severe Dry Eyes
• Lasik Dry Eye