It is typically caused by poor quantity of tear production or poor quality of tears. Tears are more complex than just water that keep the eyes moist. They are a complex of multiple components, each with its own necessary function. Dry eye can be caused by a dysfunction in any of the components of tears, and treatment needs to be directed to fixing the specific problem.
2 Types of Normal Tears
Normally, a thin layer of tears is spread over the surface of the eye with each blink. This creates a smooth, clear optical surface. If this tear film is disrupted, clear vision is not possible.
Treatment begins with a thorough eye exam to determine the cause of your dry eye disease. There are many options treatment should be directed to the specific causes of your dry eye disease. Often, it requires several different treatments working together to restore comfort to your eyes. It is important to realize that we cannot cure dry eye disease, but all treatments are meant to reduce the symptoms of dry eye and prevent chronic damage.
Artificial tear drops and gels used consistently, at least 2-3 times a day, are the first line of treatment. There are many different brands of tears and a variety of formulations. I recommend using a name brand of tears and trying different ones until you find one that seems to give you the most relief. Avoid using redness relieving drops on a daily basis as these have the potential to cause a rebound effect making your eyes constantly red.
If symptoms are worse at night or first thing in the morning, using an ophthalmic ointment just prior to going to bed may be beneficial. Ointments are petroleum based and do not evaporate like artificial tears and gels. They can provide a moisture barrier over the ocular surface while you sleep allowing your eyes to recover over night and feel refreshed for the new day. Many companies that produce artificial tears also make ophthalmic ointments usually designated with a “nighttime” or “PM” label.
Your upper and lower eye lid have tear drainage canals and the opening to these canals are called puncta. Their purpose is to drain your normally produced basal tear secretions away from your eyes to your nasal cavity carrying with them dirt, allergens, and debris.
Did you ever wonder why your nose runs when you cry? The reflexive tears produced in response to crying and ocular irritation drain through this system to your nose causing your nose to run.
If you have deficient tear production, punctal plugs can be used to block the tear drainage canals in the lower or upper eyelid slowing the rate of tear drainage and allowing the tears you make as well as the artificial tear drops you put on your eye to stay longer providing benefit for dry eyes. These have been used successfully for years and are a great, safe adjunctive treatment for dry eyes.
One of the most common underlying causes of dry eye disease is chronic inflammation of the tear and oil producing glands of the eye. Prescription eye drops such as Restasis® and Xiidra® help to reduce the chronic inflammation that can lead to poor tear quantity and quality. These drops are available by prescription only and do not replace artificial tear use.
These are medications, not artificial tears. They work best in conjunction with a good artificial tear regimen. Often, they take weeks to months to get good, noticeable benefit from them and with continued use, their benefits improve. Typically, patients are on these medications for a year or longer and they are safe to use long-term. Unlike artificial tears, they attack dry eye disease at the source of the problem, inflammation, creating a healthier tear and ocular surface. They are not simply a supplement the deficient amount of natural tears.
Other nutritional and medical options exists as well including omega 3 fatty acids. The anti-inflammatory properties of omega 3 fatty acids have been shown in multiple anecdotal studies to provide relief for many patients with dry eye. Adding these to your supplement regimen or making sure you are eating a healthy amount of omega 3 fatty acids in your diet may be of some benefit.
Vital Tears® are eye drops made from a patient’s own blood. The serum in blood more closely mimics natural tears than artificial tears. Use of serum eye drops can reduce the ocular surface inflammation and provide better relief from symptoms in patients with moderate to severe dry eye.
Prokera® is a combination medical device used by eye doctors around the world for anti-inflammation, anti-scarring and promoting healing of damaged eye surfaces. It is made from amniotic membrane which has natural anti-inflammatory and into-scarring properties. It can provide quick symptom relief and reduce inflammation associated with many ocular surface diseases including dry eye.
Amniotic membrane is part of the placenta. It’s therapeutic action to decrease inflammation can be very helpful with moderate to severe dry eye flare-ups or to heal dry eye ocular surface damage prior to cataract surgery making the surgery more successful and more comfortable in the recovery period.
Oil glands in the eye lid produce an oil that is a critical part of the tear film. With out it, tears evaporate quickly from the ocular surface.
Oil gland inflammation and dysfunction is a very common cause of dry eyes and needs to be addressed if present. A common safe, simple treatment involves using a warm compress placed over the eye lids for a few minutes followed by a lid scrub using baby shampoo or a commercially available lid wipe. This clears off any inflammatory debris on the lids that can promote gland dysfunction and it helps to express the oil out of the glands onto the ocular surface.
Making this lid hygiene routine a daily part of your dry eye regimen may be an important part of your treatment if eye lid inflammation is an underlying cause of your dry eye.
LipiFlow® Thermal Pulsation System may be an option for stubborn meibomian oil gland disease.
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