Dry Eye Treatment Options

Introduction  

Dry eye refers to a condition where the eyes do not make enough tears or do not produce the right type of tears. Tears are essential for nourishing and lubricating the eyes, maintaining the eye's health, and providing clear vision.

The condition can be temporary or chronic and mostly affects older individuals. Environmental factors are responsible for temporary dry eyes. These factors include exposure to wind, dry weather, or smoke. Over-wearing contact lenses can also lead to dry eyes. Chronic dry eye often results from an underlying eye and medical condition such as a skin condition around the eye area, eye gland diseases, diabetes, eyelid inflammation, thyroid problems, and rheumatoid arthritis. Certain medications, like blood pressure drugs, can lower the production of tears. 

Dry eye occurs when tear production does not equal tear drainage. The eyes become red, watery, and sensitive to light. There is also blurry vision, stringy mucous near the eye, and a burning sensation. 
 

Administration & Dosage

There are several options available for treating dry eye, all aimed at restoring or maintaining the right quantity of tears. 

Treatment of the underlying cause
Treating the underlying health problem may help resolve dry eye. For example, some people develop dry eye due to the use of certain medications. In this case, dry eye may be treated by withdrawing the offending drug and recommending an alternative without that particular side effect. If dry eye is caused by ectropion, a condition where the eyelid turns outward, surgery will fix the problem and probably resolve dry eye syndrome.
 

Adding tears
Over-the-counter artificial tears can help treat mild cases of dry eye as they moisten the eyes. These medications are supplements to natural tear production. Artificial tears without preservatives are preferred to those with preservatives because they do not irritate the eye. Preservative-free artificial tears are especially recommended for those who use them more than six times per day or are allergic to preservatives. The affected person is encouraged to try a few brands of these artificial tears until they find one that works best for them. Although ointments can be used, they can cause cloudy vision, so they are best used before bedtime. It is also advisable to avoid eye drops that decrease redness because they tend to constrict the blood vessels and irritate the eye.

Eye inserts that function as artificial tears can also be used in eyes moderately or severely affected. If artificial tears cannot treat dry eye, the inserts can assist. They resemble clear rice grain and are placed between the eyeball and lower eyelid once a day. These inserts will dissolve slowly and release a substance that helps to lubricate the eye.
 

Conserving or saving tears
Another way of treating dry eye is to close the tear ducts that usually drain the tears. This will keep the available natural tears in the eyes longer. Tiny, removable punctal plugs made of gel or silicone are inserted into the tear ducts to block them. Surgery can be used to close the tear ducts permanently.
 

Increasing tear production
Patients with chronic dry eye are treated with prescription medication designed to increase tear production. These medications are administered either orally or as eye drops. They help reduce eyelid inflammation since swollen eyelids prevent oil glands from getting oil into the tears. Lack of oil means the tears will evaporate too quickly. Examples of prescription medications include certain antibiotics that can stimulate oil production in the glands. Cyclosporine (Restasis) is another example of a prescription drug that is used to treat eyelid inflammation. The drug is also an immunosuppressant medication used to treat rheumatoid arthritis and psoriasis. Cholinergic medications come in gels, eye drops, or pills, and help increase tear production.
 

Use of natural treatments

Literature shows that some natural methods can help treat dry eye. They include:

• Warm compresses or eye masks. A warm, wet piece of cloth is held over the eye for about five minutes daily to help clear up blocked oil glands. It is said that a thermal pulsation device can help unclog oil glands, but this method’s advantages over the warm compresses remains unclear. 
• Eyelid massage. The patient can use a mild soap or a baby shampoo to massage the eyelids. With eyes closed, fingertips are used to apply the soap and gently massage the eyelids.
• Omega-3 fatty acid nutritional supplements. Research indicates that the addition of these supplements into one’s diet can help relieve dry eye symptoms since they increase the production of tears.
• Castor oil eye drops. It has been suggested that artificial tear drops containing castor oil can help reduce the evaporation of tears. However, the patient should consult the doctor before trying any natural treatment.
   

Other options

• Eye drops made from blood. Some people with severe dry eye may not respond to any treatment option. Autologous blood serum drops are developed from the patient’s own blood sample which is then combined with a salt solution. 
• Use of special contact lenses. Scleral or bandage lenses are specially designed to protect the eye’s surface and trap moisture. 
• Meibomian gland expression. The clogged contents from the meibomian glands are squeezed using a device resembling forceps. 
• The LipiFlow thermal pulsation system is a combination of meibomian gland expression and warm compress therapy.
   

Alternative therapies

• Acupuncture. Studies remain inconclusive, but one theory suggests that it can reduce pain and inflammation.
• Intense-pulsed light treatment can alleviate dry eye symptoms. A massage usually follows it.

Potential Side Effects & Interactions

The side effects depend on the type of treatment used.

LipiFlow dry eye treatment can result in pain in the eye, corneal abrasion, chalazion, red eyes, itchy eyes, swollen eyelids, transient blurry vision, and eyelid inflammation or irritation.

The insert can cause transient blurred vision, corneal abrasion, sticky eyelashes, eye discomfort, sensitivity to light, and redness if not correctly placed.

The different medications used come with various side effects. For example, prolonged steroid use can result in increased eye pressure or cataract development. Restasis can cause burning eyes in the first few weeks of treatment.
 

Symptoms of Overdose 

Symptoms of overdose depend on the particular treatment used. For example, for Restasis, they include redness, burning eyes, and increased eye irritation.