Your eyes have a built-in tear film to keep them moist and comfortable. But sometimes, your body doesn't make enough tears or the tears you do have evaporate too quickly. Then you can end up with dry eye disease symptoms like itchy, burning, and watery eyes.
Many things can cause dry eye. An autoimmune disease, eye surgery, a medication you take, or just staring at your computer screen for long periods of time can lead to dry eye disease symptoms.
If dry eye is irritating you and getting in the way of your daily routine, help is available. From eye drops that you buy over the counter to prescription medicines and procedures from your eye doctor, there are lots of dry eye treatment options available to manage your symptoms.
Prescription Medicines
A few prescription medications treat moderate to severe dry eye.
Eye drops
Many different types of eye drops treat dry eye. They work in different ways:
- Cyclosporine A (Cequa, Restasis, Vevye) works on your immune system to reduce inflammation in your eyes and help them produce more tears. You put one drop in each eye twice a day. These medicines can take three months or more to start working. They also can cause some burning or stinging in your eyes. This side effect should go away the longer you use them.
- Lifitegrast (Xiidra) also brings down inflammation, but in a slightly different way. You take it twice a day. Xiidra may take up to three months to start working. Side effects include eye irritation and a strange taste in your mouth.
- Perfluorohexyloctane ophthalmic solution (Meibo) treats dry eye specifically by targeting tear evaporation caused by meibomian gland dysfunction.
- Loteprednol etabonate ophthalmic suspension (Eysuvis) is the first corticosteroid eye drop for treating dry eye. It reduces inflammation in your eye faster than other medicines, but you can only use it for two weeks at a time because of risks like cataracts, glaucoma, and infection.
- Autologous blood serum drops are made from your own blood mixed with a salt solution. These drops contain nutrients and growth factors that protect and nourish your eyes. They may be an option if your dry eye hasn't improved with other drops.
Eye inserts
An eye insert called hydroxypropyl cellulose (Lacrisert) treats moderate to severe dry eye that hasn't improved with drops. The insert is about the size of a grain of rice. You put it between your lower eyelid and eyeball once a day. As the insert dissolves, it slowly releases the same medicine used in eye drops to keep your eyes moist throughout the day.
Antibiotics
Glands in your eyelids release oil that helps keep your eyes lubricated. Inflammation in these glands can prevent them from releasing oil. Antibiotics that you take as a pill, eye drop, or ointment can help to reduce swelling caused by the eye conditions blepharitis (eyelid inflammation) and meibomian gland dysfunction (MGD).
Cholinergic drugs
These medicines act like the chemical messenger acetylcholine in your body. One of its actions is to increase the release of fluids, including tears and saliva. Cholinergic medicines like pilocarpine (Salagen) and cevimeline (Evoxac) come as pills, gels, and eye drops. They can cause side effects like sweating, nausea, and a runny nose.
Surgeries and Procedures
If eye drops don't relieve dry eye enough, your doctor might recommend one of these procedures to improve your symptoms long term.
Punctal plugs
Tiny openings called ducts in the inside corner of each eye near your nose allow tears to drain from your eyes. Your eye doctor can insert a small plug in each duct to keep more tears on the surface of your eye. Punctal plugs come in two types:
Temporary plugs are made from a material like collagen. They slowly dissolve. If the plugs improve dry eye symptoms, your eye doctor can put in a more permanent plug.
Semi-permanent plugs are made from a plastic like silicone. These plugs can stay in your eyes for years. If they don't help, your eye doctor can always remove them.
Plugs can cause side effects like eye irritation, watery eyes, redness, and swelling. If these side effects bother you or they don't go away, your eye doctor can remove the plugs.
Thermal pulsation therapy (LipiFlow)
This treatment is for meibomian gland dysfunction (MGD). In MGD, glands in your eyelids are blocked and they don't release enough oil to keep your eyes moist. LipiFlow is a device your eye doctor uses to warm and massage your eyelids to clear the blockage. While this device can help with MGD, holding a warm moist washcloth to your eyelids might accomplish the same goal.
Intense pulsed light (IPL) therapy
This treatment for severe dry eye uses light energy to treat MGD. During the procedure, your eye doctor uses a small device to deliver pulses of light to the skin near your eyes. The heat from the light reduces inflammation in your eyes, melts away any blockages in your meibomian glands, and releases stuck oil. You may need more than one IPL treatment to relieve dry eye symptoms.
Newest Treatments
Researchers are studying new ways to treat dry eye. Their efforts have led to new treatments that work in different ways. These are a few of the medicines that have recently been approved or are in the late stage of development.
Varenicline (Tyrvaya). This is the first nasal spray approved to treat dry eye. Tryrvaya stimulates the trigeminal nerve in your face to increase tear production. You spray it into each nostril twice a day. The most common side effects are sneezing, coughing, and irritation in the nose and throat.
Perfluorohexyloctane ophthalmic solution (Miebo). This is the first eye drop approved to treat MGD. You put one drop into each eye four times a day. Miebo helps prevent your tears from evaporating. Blurry vision is a possible side effect. AZR-MD-001, another drug for MGD, is in phase III studies.
Lotilaner ophthalmic solution 0.25% (Xdemvy). This eye drop treats demodex mites, which are parasites that cause blepharitis. Dry eyes are a symptom of blepharitis You put one drop into each eye twice a day for six weeks. Stinging and burning are the most common side effects.
Reproxalap. It treats dryness from eye allergies. Reproxalap reduces inflammation in the eye in a different way than corticosteroids, with fewer side effects. This eye drop has finished phase III studies and is awaiting approval from the FDA.
Treat Underlying Causes
The key to relieving dry eye could be to manage the condition that caused it.
Control your blood sugar. Consistently high blood sugar from diabetes damages nerves all over your body. It also affects your lacrimal glands, which add fluid to your tears. If you have diabetes, follow your doctor's advice to lower your blood sugar with diet, exercise, and medicine if you need it.
Take breaks from your contacts. Contact lenses cause friction as they rub against your eyes. That constant rubbing can leave your eyes irritated and dry. Take breaks from your lenses and wear glasses for a few days or weeks to give your eyes time to recover.
Reduce screen time. Dry eye is a symptom of computer vision syndrome, a common eye problem in people who spend a lot of time on their computer, tablet, or cell phone. Normally, you blink about 15 times a minute. But when you're staring at a screen, you only blink five to seven times a minute. Blinking replenishes your tear film. The less you blink, the more quickly your tears evaporate.
To prevent dry eye, take breaks from your screen. Follow the 20-20-20 rule. About once every 20 minutes, look away from your computer. Stare at an object 20 feet in the distance for at least 20 seconds. You can also close your eyes from time to time.
Get good nutrition. Nutrients like omega-3 fatty acids, vitamins A, B, C, and E, lutein, and zeaxanthin help to keep your eyes healthy. You'll find them in foods like:
- Fatty fish such as salmon, mackerel, trout, sardines, and tuna
- Flaxseed, canola, and sunflower oils
- Vegetables like carrots, spinach, kale, sweet potatoes, broccoli, and Brussels sprouts
- Fruits like pumpkin, mangos, and apricots
- Dairy products such as low-fat milk and yogurt
Don't smoke. Cigarette smoke contains thousands of chemicals that irritate your eyes and break down your tear film. Smoking can make dry eye worse. If you have trouble quitting on your own, ask your doctor for tools that can help.
Home Remedies and Alternative Medicines
Treatments that you buy over the counter or have at home may be enough to relieve mild dry eye symptoms. You might want to try these first.
Use artificial tears. These eye drops act like your own tears to moisturize your eyes. Artificial tears are an option for mild to moderate dry eye and you can buy them without a prescription. If you use artificial tears more than six times a day, choose a preservative-free brand. It comes in single-use vials and is less likely to cause irritation or an infection.
Try an ointment or gel. These products don't evaporate as quickly as artificial tears, so they provide longer-lasting relief from dry eye. Because ointments and gels are thick, they can blur your vision. It's best to use them before bed.
Wash your eyelids. Gently massage your closed eyelids with a mild soap or baby shampoo and water. Then rinse. Washing your eyelids will help clear out any dirt or debris that's blocking the oil glands. You can also buy lid scrubs.
Hold warm compresses to your eye. Wet a washcloth with warm water, rinse it, and hold it to your eye for five minutes. This will help reduce inflammation and open up the oil-producing glands in your eyelids.
Humidify the air. Dry air makes the tears in your eyes evaporate faster. Turn on a humidifier to add moisture to the air, especially during colder months when the air is dryer. You can also put a pan of water next to your radiator to humidify the air in your home.
Wear wraparound sunglasses. They'll protect against wind, which increases eye dryness. Sunglasses also protect from the sun's damaging UV rays, another cause of dry eye.
Ask your doctor about omega-3 fatty acids. These healthy fatty acids have anti-inflammatory properties. Studies haven't confirmed that omega-3 supplements relieve dry eye symptoms. But because of their other health benefits, it doesn't hurt to eat more foods that are rich in these nutrients.
Drink more water. Staying well hydrated adds more fluid to your tears. Try to drink at least 8 cups of water each day, and even more if you live in a hot or dry climate.
Acupuncture. This alternative remedy involves placing very thin needles into your skin in specific parts of your body. Studies on acupuncture for dry eye have been mixed, but some people who've tried it said it improved their symptoms. Acupuncture might help with dry eye by reducing inflammation, increasing blood flow to the eyes, and relieving pain. Acupuncture is generally safe, but be sure to see a certified practitioner who uses sterilized needles.
What Are Realistic Results?
You might have to try a few different treatments to get relief. Keep in mind that many dry eye medicines take time to start working. Others cause side effects like stinging or burning. Almost 70% of people with dry eye in one study said they stopped taking their medicine, often because their symptoms didn't improve.
If the first medicine you take doesn't help or it causes side effects, go back to your eye doctor. They can recommend another type of treatment that may work better.
Show Sources
Photo Credit: iStock/Getty Images
Sources:
American Academy of Ophthalmology: "Can Fish Oil Relieve Dry Eye?" "Computers, Digital Devices, and Eye Strain," "Improved Dry Eye Drugs for 2022 and Beyond," "Punctal Plugs," "What Is Dry Eye? Symptoms, Causes and Treatment."
Annals of Medicine & Surgery: "Meibo (perfluorohexyloctane): A Novel Approach to Treating Dry Eye Disease."
Azura: "R & D Pipeline."
Cleveland Clinic: "Dry Eye."
Clinical Ophthalmology: "Acupuncture and Dry Eye: Current Perspectives. A Double-Blinded Randomized Controlled Trial and Review of the Literature."
Drugs: "Lotilaner Ophthalmic Solution 0.25%: First Approval."
FDA: "Eyesuvis: Highlights of Prescribing Information," "Miebo: Highlights of Prescribing Information," "Tyrvaya: Highlights of Prescribing Information," "Xdemvy: Highlights of Prescribing Information."
Investigative Ophthalmology & Visual Science: "Contact Lens-Associated Dry Eye Disease: Recent Advances Worldwide and in Japan."
Journal of Clinical Medicine: "Treatment Trends in Dry Eye Disease and Factors Associated with Ophthalmic Follow-Up Discontinuation in Japan."
Mayo Clinic: "Acupuncture," "Dry Eyes."
MedlinePlus: "Cevimeline."
NHS: "Dry Eyes."
Northern Clinics of Istanbul: "Effects of Long-Term Computer Use on Eye Dryness."
Optometrists Network: "Dry Eyes: What Is Intense Pulsed Light Therapy?" "Natural Remedies for Dry Eyes," "Which Foods Help Dry Eye?"
Aldeyra Therapeutics: "Aldeyra Therapeutics Achieves Primary Endpoint in Phase 3 Dry Eye Disease Clinical Trial of Reproxalap."
University of Miami Bascom Palmer Eye Institute: "Dry Eye."
