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Living with chronically dry, irritated eyes can be a pain — literally. But even if first-line treatments haven’t worked, you still have options.
If you’re living with dry eye, you likely have your eyecare routine down to a science. You might limit your time on devices, apply warm compresses before bed, and use artificial tears a few times a day.
For some people, first-line treatments like these are enough to ease their symptoms. But others need more help.
“Dry eye syndrome can best be described as a condition that needs constant maintenance,” says Sandra Pinon, O.D., an optometrist at America’s Best Contacts & Eyeglasses in New Braunfels, Texas. “For some patients, eye drops alone may work. For other patients, eye drops plus in-office treatments plus other forms of therapy would need to be considered.”
Although you can’t cure chronic dry eye, you can work with your optometrist to treat its irritating symptoms. Here’s what you need to know about your options.
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First, a Quick Reminder About the Causes and Symptoms of Dry Eye
Even when you aren’t crying, a film of tears keeps your eyes moist. The lacrimal gland, also called the tear gland, secretes these tears. When you blink, the eyelids help spread tears across the surface of the eyes, creating a tear film.
It’s a simple enough process. But when it gets interrupted, dry eye can result. There are two main types of dry eye, and some people may have both types at once:
- Aqueous-deficient dry eye. This is when the lacrimal gland is unable to produce enough tears to keep your eye moist.
- Evaporative dry eye. This is when the tear film evaporates too quickly to keep your eye moist.
Maybe you only notice dry eye symptoms on windy days or when your car’s air-conditioning vent is pointed straight at your face. If that sounds like you, your symptoms are likely conditional and not caused by chronic dry eye syndrome, says Dr. Pinon. Still, it’s a good idea to discuss your symptoms with your optometrist to be sure.
But if you notice your eyes are dry and irritated more often, it may signal a chronic condition.
“If you constantly suffer from painful redness or fluctuation in your vision, this could be an indication of dry eye syndrome,” says Dr. Pinon. Rather than treating the problem yourself with over-the-counter (OTC) eye drops, visit your optometrist. They can diagnose your condition and work with you to create a plan to manage your symptoms.
First-Line Treatments for Dry Eye
Many patients with dry eye can manage their symptoms with artificial tear drops, gels, or ointments. These treatments help keep the eyes moist. Learn more about choosing the best dry eye drops for you here.[link to the Dry Eyes Drops story]
Other simple ways to treat dry eye include:
- Using warm compresses. Massaging the eyelids with warm compresses each night can help improve the quality of the tear film, the thin layer of fluid covering your eye.
- Taking omega-3 supplements. Based on research, Dr. Pinon recommends a supplement with 1,000 mg to 2,000 mg of omega-3 fatty acids. She also suggests ones with an EPA-to-DHA ratio of at least 2:1 or 3:1. (EPA and DHA are types of omega-3 acids often found in fish.) Supplements aren’t right for everyone, so it’s important to talk with your doctor before taking any new supplements.
- Taking more frequent breaks from screen time. Blinking helps keep our tear film intact. But we blink less often while using devices with screens, such as cellphones, computers, and TVs. Giving your eyes a screen break may help ease your symptoms.
- Wearing wraparound sunglasses outdoors. Big sunglasses are more than a fashion statement. They can help protect your eyes from wind exposure, which can worsen dry eye symptoms.
- Visiting your primary care physician. Certain medications and health conditions can trigger dry eye symptoms. That’s why it’s a good idea to visit your doctor in addition to your optometrist, says Dr. Pinon. Your doctor can test you for underlying health conditions, such as Sjögren’s syndrome, that may be contributing to your dry eye. They can also evaluate the medications you take and see if your any of them have dry eye as a side effect.
Medical Treatments for Dry Eye Symptoms
If first-line dry eye treatments aren’t enough to ease your symptoms, don’t panic. Your optometrist can walk you through the other options. What they recommend typically depends on which type of dry eye you have.
For evaporative dry eye disease, some optometrists now offer:
- LipiFlow. During this treatment, activators placed on the eyelids apply heat and pressure to the meibomian glands in the eyelids. This helps clear blockages that are impairing oil secretion. These oils are part of what makes up tears.
- iLux: Similar to Lipiflow, iLux uses heat and pressure, but the heat is from a light (low) form.
For aqueous-deficient dry eye, your optometrist may:
- Prescribe eye drops. These include cyclosporine (Restasis) and lifitegrast (Xiidra). Both work by reducing inflammation in the eye. This helps increase tear production.
- Insert punctal plugs. These silicone or collagen plugs are inserted into the tear ducts in the corners of the eyes by the nose. This helps stop tears from draining out of the eye. It might sound scary, but most patients don’t feel the plugs at all. Punctal plugs can easily be removed if necessary.
If none of these strategies help ease your dry eye symptoms, your optometrist might refer you to a dry eye specialist for more advanced treatments. These include:
- Autologous serum eye drops. For this treatment, the eye care provider takes blood from the patient and centrifuges it. Then they collect the serous fluid to use as an eye drop, Dr. Pinon explains. “Unlike artificial OTC eye drops, autologous serum eye drops can mimic the biochemical properties of our natural basal tears,” she says.
- Amniotic membranes. During a procedure, your eye doctor will attach amniotic tissue from the innermost layer of a placenta to the eye. This helps reduce friction from the eyelid, decrease inflammation, and promote the growth of new tissue. Amniotic membranes are typically considered a “last resort”, says Dr. Pinon.
- Punctal cauterization. This surgery closes the tear duct in order to help keep tears on the surface of the eye. It’s only considered in severe cases of dry eye, Dr. Pinon says. In a study published in the journal Cornea, 80 participants underwent punctal cauterization. A year later, the percentage of people who reported severe dry eye symptoms dropped from 21% to 6%. And the percentage of people who reported moderate symptoms went from 25% to 17%. Still, there’s a good chance you’ll still need additional therapies (such as OTC or prescription eye drops) even if you undergo punctal cauterization, says Dr. Pinon.
It can be a bit of a process figuring out the best treatment for your dry eye symptoms. But don’t lose hope. If one or two treatments haven’t been successful, you can rest easy knowing you have other options.
Medically reviewed by Sandra Pinon, O.D.
See our sources:
Dry eye syndrome overview: American Academy of Ophthalmology
Punctal plugs to treat dry eye: American Academy of Ophthalmology
Punctal cauterization surgery: Cornea
Amniotic membrane for dry eye: EyeNet Magazine
How omega-3s can help treat dry eye: Acta Ophthalmologica