How can I relieve dry eyes?

Alan J. Margolis, MD
The first step in treating dry eye syndrome is to determine the cause of dry eye in an individual to the best extent possible. Dry eye is a description of a condition which has a variety of causes and, therefore, a variety of treatments. For example, abnormalities involving the secretion of material from the meibomian glands of the eyelid can be associated with symptoms such as burning of the eyes, and is typically worse in the mornings than the later part of the day. This condition may be called meibomianitis and suggest treatment to the abnormally secreting meibomian glands. Alternatively, some individuals do not produce enough fluid from the lacrimal glands. These individuals often benefit from other treatments, which either replace missing tears, or help promote production of tears from the person's abnormally functioning lacrimal glands.  

The range of treatments is numerous and our goal is to direct therapy to the underlying cause whenever possible. Once the dry eye condition has been characterized and the level of severity determined, treatment is often undertaken. Treatments range from lubricating eye drops to wrap around eye glasses, which create increased humidity on the ocular surface and decrease the evaporation of fluid from the ocular surface, Omega-3 fatty acids, topical steroid eye drops used for short periods of time, Restasis, serum tears and oral Pilocarpine can all be employed in the treatment of this condition. The key to effective treatment is the appropriate diagnosis of the subset of dry eye which the individual has. For this reason, people who feel they have dry eye syndrome should be seen by an ophthalmologist and the underlying causes should be diagnosed whenever possible in order to guide the most appropriate treatment regimen.
While few experts would say dry eye can be cured, they certainly believe it can be managed effectively. Topical treatments such as eye drops (both over-the-counter and prescription) provide relief for some people, as do ointments meant for use during sleep, but they rarely get to the root of the problem and can even make things worse if people develop sensitivities to preservatives in the products. Some anti-inflammatory drops (e.g., Restasis, a prescription cyclosporin) can control inflammation that contributes to dry eye. A procedure to place punctal plugs is another approach. Plugs are placed into the punctum (drainage ducts) and act like "stoppers," damming up the tears and keeping them on the ocular surface longer.
There are many different kinds of dry eyes, and many different treatments are available. Some people have dry eyes from systemic diseases or medicines. Others have dry eyes related to their age. And many times, we do not know the cause. Treatments include artificial tears, prescription drops such as Restasis, or placing small plugs to close the tear drains. A complete exam with your ophthalmologist can determine what treatment plan is best for you.
Laura C. Fine, MD
Treatment for eye dry syndrome (a decline of tear production) usually involves some type of topical medication, with most preparations available over the counter. If the problem is caused by a reduction in natural tear production, artificial tears may provide some relief. For blepharitis (an inflammation of the inner eyelid that is common in people with allergies), oil-based emulsion drops are helpful, or the prescription medication cyclosporine (Restasis) is an option. Although dry eye may be sporadic, longtime sufferers often need to use these drugs repeatedly.

To minimize evaporation of tears, avoid exposure to dust, pollen, cigarette smoke, and other pollutants and stay out of the wind and away from hair dryers and air conditioner currents. Humidifiers may help by adding moisture to indoor air. If you have blepharitis, your ophthalmologist may advise you to apply warm compresses to your eyelids and massage them periodically to free oil from the glands.

In severe cases, an ophthalmologist may need to insert plugs into the tear drainage ducts. The plugs help natural and artificial tears stay on the eye longer by preventing them from draining out of the opening in the inner corner of the eyelid. Alternatively, your doctor may prescribe special soft contact lenses that help hold in moisture. You may also be advised to wear goggles at night to retain moisture, especially if the eye does not fully close in sleep.
Treatment options for dry eyes depend on the cause and range from over-the-counter lubricating drops to surgery. In most cases, the application of artificial tears can solve the problem. If these drops are not effective, surgery to seal the ducts that drain tears from the eyes may be considered.
Adding Tears 
Eyedrops called artificial tears are similar to your own. They lubricate eyes and help maintain moisture. Artificial tears are available without a prescription. There are many brands, so you may want to try several to find the one you like best.

Preservative-free eyedrops are available for people sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands may be better for you.

You can use artificial tears once or twice a day or as often as several times an hour. Other treatment options may include ointments, gels and inserts.

Conserving your Tears 
Conserving your eyes’ tears is another approach to keep them moist. Tears drain out of the eye through a small channel into the nose (which is why your nose runs when you cry). Your ophthalmologist may close these channels either temporarily or permanently. The closure conserves your tears and makes artificial tears last longer.

Other Methods 
Tears evaporate like any other liquid. You can take steps to prevent evaporation. In winter, when indoor heating is in use, a humidifier or pan of water on the radiator adds moisture to dry air. Wrap-around glasses may reduce the drying effect of the wind.

A person with dry eye should avoid anything that may cause dryness, such as an overly warm room, hair dryers or wind. Smoking is especially bothersome.

Some people with dry eye complain of “scratchy eyes” when they wake up. This symptom can be treated using an artificial tear ointment or thick eyedrops at bedtime.

Some may find relief by supplementing their diets with omega-3 fatty acids, which are found naturally in foods like oily fish (salmon, sardines, anchovies) and flax seeds. Ask your ophthalmologist if you should incorporate oral supplements of omega-3 fatty acids into your dry eye treatment regimen, and if so in what form and dosage.
If other methods don't give you relief from dry eye, your ophthalmologist may suggest that you use a prescription medication. One such medication, cyclosporine, works to resolve your symptoms by stimulating tear production. Steroid eyedrops may also be used, but are generally not recommended for long-term treatment.

Dry eye due to lack of vitamin A is rare in the United States but is more common in poorer countries, especially among children. Ointments containing vitamin A can help dry eye if it is caused by conditions such as Stevens-Johnson syndrome or pemphigoid. Vitamin A supplements don't seem to help people with ordinary dry eye.
Are your eyes itchy, scratchy, burning, or dry? As you age, normal tear production tends to decrease, which can lead to dry eyes. To prevent dry eyes, eat more foods with vitamin A (e.g., cantaloupe, carrots, and mangoes), use a humidifier to moisten dry air, and be sure to wear sunglasses to protect your eyes on bright or windy days. Some prescription and over-the-counter meds, such as antihistamines and pain relievers, can reduce your eyes' ability to create natural tears.

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Dr. Michael Roizen, MD
Internal Medicine
Ease your dry-eye discomfort with a humidifier (aim for humidity over 30% indoors), over-the-counter saline eye drops or artificial tears, or prescription eye drops. Also, eat more omega-3 fats -- from salmon, walnuts, avocados, docosahexaenoic acid (DHA) supplements, and omega-3 eggs -- to decrease inflammation in your tear glands, which relieves dryness.
There is no best treatment for dry eyes. There are many treatments for dry eye but no single treatment that works for everyone. I like to think of the treatments in stages. For mild dry eye, most ophthalmologists recommend supplemental tear drops to be used as needed, along with the avoidance of activities that cause increased evaporation from the eyes, such as ceiling fans, motorcycles, and other wind-driven activities. Dietary supplements with dietary oils, like flaxseed, can also be helpful.  Moderately severe dry eye is better treated with punctum plugs, which can be used to greatly diminish the rate in which tears exit the surface of the eye and drain from the eye into the back of the nose. These plugs are simple to insert, are done in the office without pain, and can easily be removed if needed. I save the use of Restasis eye drops for the most severe cases of dry eye because of its expense and the fact that it must be used forever. Your ophthalmologist (eye doctor) will know how to evaluate your degree of dry eye and work with you to achieve greater comfort with your eyes.
When over-the-counter tear replacements do not give comfort, your doctor might prescribe drops used for chronic dry eyes. They include cyclosporin (Restasis) and dilute loteprednol (Alrex). If you have not tried these drops, ask your opthalmologist or optomotrist about them. There are also hydroxypropyl cellulose inserts (Lacriserts) which are placed behind the lower eyelids once daily; these inserts then slowly melt away and help keep the eyes moist all day.  In addition, small plugs can be placed in the tiny openings on the edge of the eyelid through which tears drain away, or those openings can be closed by cautery in a simple office procedure. Surgery is seldom done for dry eye unless there is an abnormal position of the eyelids against the eye.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.