The first two parts of our series on dry eye disease discussed the many causes and symptoms of the condition. In the third and final installment, we discuss available treatment options.

For the most part, people suffering from dry eye disease are unable to find a complete cure for their symptoms (Bustos and Patel 2014). However, if you can find the right treatment regimen and follow it regularly, you can usually experience greatly improved comfort, a decrease in symptoms, and sometimes, even an improvement in vision (Adler 2016).

Prior to treatment, a doctor will often have you fill out a self-report survey of the symptoms you’re experiencing in order to establish a pre-treatment baseline. After a certain period, the doctor may have you fill out the survey again to assess the efficacy of the treatment plan (Adler 2016).

Regardless of the severity or cause of the symptoms, diligence is key. It is essential that a patient follow their doctor’s recommendations regarding the consistency and frequency of treatments for a successful outcome.

Clinical Treatments for Dry Eye

There are a variety of treatments available to address the myriad causes of dry eye symptoms. Depending on the diagnosis, a doctor may recommend one or several of these treatments (Adler 2016).

Artificial tears

For patients with dry eye, artificial tears or other lubricating eye drops are often the first line of defense (Adler 2016). There was a time when this treatment was the only one available, and many of the formulations contained a preservative that was later found to be damaging to ocular health (Koch 2016).

These days, however, the number of available products can be overwhelming. There are numerous formulations, both over-the-counter and prescription, aimed at addressing different variations in dry eye symptoms and severity.

Eye drops range in viscosity, from a light and watery substance to a thicker, more gel-like consistency. The lighter formulations can offer quick relief without blurring the vision, but they tend to dissipate quickly, so their soothing effect is brief. It is often necessary to instill this type of drop frequently (Adler 2016).

Artificial tears with higher viscosity tend to provide longer lasting relief, but they often cause blurred vision for several minutes after they are applied. This makes them unfit for use immediately before driving or during the work day. It is generally recommended that high-viscosity tears are used only at nighttime (Adler 2016).

Another consideration in choosing an artificial tear is whether or not it contains preservatives. For patients with mild dry eye and an otherwise healthy ocular surface, it may be fine to use a version containing preservatives. If a patient is using artificial tears more than four times a day, though, it is generally recommended that they use a preservative-free formulation (“Preferred Practice Pattern” 2013).

Punctal Occlusion

Another popular method for treating dry eye is called punctal occlusion, which refers to the process of blocking one or both of the punctum, the ducts in the upper and lower eyelids that collect tears from the lacrimal glands. Provided that inflammation is not present on the ocular surface, this treatment is usually considered when eye drops have failed to produce significant results (Ervin, Wojciechowski, and Schein 2010).

During the process, an eye doctor will (non-surgically) insert the punctum plugs during an office visit. The punctum plugs will dam the drainage of tears, preserving the eye’s tear film and maintaining moisture on the eye’s surface (Haddrill 2015).

Plugs generally come in two forms (Haddrill 2015):

• Semipermanent – usually made of silicone or another long-lasting material, also referred to as non-absorbable
• Temporary – dissolvable and made of a material the body can easily absorb, such as collagen, also referred to as absorbable

The temporary plugs are designed to last anywhere from a few days up to several months. Semipermanent plugs can last indefinitely but can also be removed if necessary (Haddrill 2015).

Lid Hygiene

One of the most significant causes of evaporative dry eye is a dysfunction of the meibomian gland, which, when healthy, secretes the oil that comprises the outermost layer of the tear film (Adler 2016).

Addressing this issue can sometimes be as simple as properly caring for the eyelids and ensuring the gland openings are kept clean and healthy. A doctor might recommend meibomian gland expression, which involves forcing out the dried oil (meibum) or other debris that may be clogging the gland openings (Adler 2016).

This treatment should be recommended by an eye care professional and may or may not involve a warm compress being applied to the eyes prior to treatment to help soften the blockage. Warm compresses may also be recommended for home care along with other hygiene steps (Adler 2016).

Dr. Giacomina Massaro Giordano, MD, of the Penn Dry Eye and Ocular Surface Center in Philadelphia, recommends applying a warm and moist compress to the eyelids for several minutes (moisture works better than a dry heat, she says). After that, she recommends you remove any makeup and scrub the eyelids and eyelashes using a gentle cleanser. Then, apply mild pressure toward the eyelash edges of the eyelids to force oil out of the adjacent openings (Karmel 2014).

Tips and Tricks for Treating Dry Eye Yourself

It’s important to consult an eye doctor in order to get the most comprehensive and efficient treatment for dry eye, but here are some tips on how to supplement that treatment and how to handle the everyday forces that aggravate symptoms.

Supplementing your diet

Many doctors recommend adding omega-3 fatty acids to your diet to improve dry eye symptoms. Depending on a patient’s exam results, Larry Patterson, MD, the Medical Director for Eye Centers of Tennessee, likes to begin treatment with an omega-3 triglyceride fish oil supplement. Consult your own doctor for advice before choosing a supplement, as Patterson warns that selecting the correct form and dosage is essential. Patterson also advises patients to avoid excessive processed foods and carbohydrates, as they can cause ocular inflammation and, instead, focus their diet on fruits, vegetables, and lean meats (Patterson 2016).

It may seem simple, but drinking more water might also reduce the severity of some dry eye symptoms, which can be worsened by dehydration (Adler 2016).

Modifying your behavior

Remember to blink! When reading, watching TV, or using a computer, people don’t blink as often as they should. Taking frequent breaks from eye strain to consciously blink and also focus on something in the distance can help moisturize and relax the eyes (Dang 2015).

Smoking can be doubly dangerous for dry eye, as it can not only cause health defects that lead to the condition, but can also exacerbate the symptoms when the smoke interacts with the eye’s surface (“Seven Tips” 2013).

Managing environmental causes

Sufferers may find relief from avoiding dry and windy climates, both indoors and out. Air conditioning and fans can increase the evaporation of tears and worsen symptoms.

When outside on a windy day, a pair of wrap-around sunglasses can protect your eyes from both the sun and the wind, as well as from other irritants (Adler 2016).

Remaining Hopeful

The above are some of the common treatments for dry eye. For more severe cases, your eye doctor will review other options to combat symptoms that don’t respond to the common methods, such as altering medications, discontinuing the use of contact lenses, or addressing an underlying condition. Cases of dry eye disease often require unique, individualized treatment plans. Regardless, a doctor will recommend the appropriate steps.

It’s important to remain patient and understand that results take time. While it can be frustrating to try multiple treatment plans that don’t significantly improve symptoms, don’t throw in the towel yet! New medications and treatments are being explored every day that may bring new hope to current and future sufferers of dry eye.

Citations:

• Bustos, Daniel E., MD, MS and Alpa S. Patel, MD. “Dry Eye Syndrome.” American Academy of Ophthalmology. 2014.
• Adler, Richard, MD. “Dry Eye Treatment: Getting Relief From Dry Eyes.” All About Vision. 2015.
• Koch, Paul S., MD. “3 steps to improve ocular health of dry eye patients.” Ophthalmology Times. 2016.
• American Academy of Ophthalmology Cornea/External Disease Panel. “Preferred Practice Pattern® Guidelines. Dry Eye Syndrome.” American Academy of Ophthalmology. 2013.
• Ervin, Ann-Margret, Robert Wojciechowski, and Oliver Schein. “Punctal Occlusion for Dry Eye Syndrome.” The Cochrane database of systematic reviews. 2010.
• Haddrill, Marilyn. “Punctal Plugs for Dry Eyes.” All About Vision. 2016.
• Karmel, Miriam. “A Quick Guide to Dry Eye.” American Academy of Ophthalmology. 2014.
• Boyd, Kierstan. “Dry Eye Treatment.” American Academy of Ophthalmology. 2014.
• Dang, Shirley. “Four Ways to Fight Dry Eye” American Academy of Ophthalmology. 2015.
• “Seven Tips for Battling Dry Eye.” American Academy of Ophthalmology. 2013.
• Patterson, Larry, MD. “Rethinking First-Line Treatment for Dry Eye Disease.” EyetubeOD. 2016.