Stinging and burning, sensitivity to light, redness, mucus in and around your eyes—all symptoms of dry eye, one of the most common reasons for eye doctor visits. Despite the fact that an estimated five million people over age 50 suffer from dry eye in the US, there is no consistent and well-accepted test to diagnose the condition…and worse, there are many suggested treatments that don’t help at all. In fact, dry eye has turned into an enormous industry, with many companies taking advantage of a vulnerable population suffering from this relatively new and painful condition.
Bottom Line Personal spoke with board-certified ophthalmologist Robert Latkany, MD, to find out what does—and what doesn’t—work…
Understanding Dry Eye
Along your lash lines are the meibomian glands. Their function is to make the oil that keeps tears from drying up too quickly. When these glands don’t work properly—often because they’re clogged—dry eye can develop. Problems with the tear glands themselves also can lead to dry eye, and dry air, low humidity, airborne irritants and allergens all can reduce tear flow.
For years, the standard treatment has been warm compresses and baby shampoo to clean the eyelid rims and unclog the meibomian glands. Many eye doctors still suggest this, but there are no studies proving its effectiveness and the baby-shampoo formula—which contains inflammatory artificial dyes—can be irritating for people with sensitivity around their eyes. For dry eye that stems from a lack of tears, a warm compress can be soothing, but there’s evidence that applying it to clogged meibomian glands can make them worse.
Options That Do Work
Strategies to try first on your own or with the help of your eye doctor…
Consider your environment, especially if the condition has developed recently or happens only under certain circumstances. Irritants or allergens could trigger dry or irritated eyes. One of my patients said it happened every time he spent time at his cabin—it turned out that the smoke from the roaring fires he enjoyed was the culprit. Another patient said it couldn’t be the new antiwrinkle cream she was using because it was labeled hypoallergenic—but it was. A third said her daily computer work didn’t bother her eyes, but watching TV every night did—thanks to the large fan in the room blowing right into her eyes. Also: Medications—even those for eye conditions such as glaucoma and medical conditions such as rosacea and Sjögren’s syndrome—could be at the root of the problem.
Wear moisture chamber goggles. The type of eyewear worn by motorcyclists and people engaged in high-velocity activities to keep wind, dust and other drying irritants out of their eyes can be helpful for dry eye. These goggles/glasses have eye cups, sometimes with shields on the sides, that create a seal around your eyes and slow tears’ evaporation. Wearing them throughout the day and during sleep, if it helps, protects against drying factors outdoors and indoors, such as air conditioning and forced heat. They are available in many styles, and some in the Airshield collection from 7EYE (7Eye.com) can be made with prescription lenses.
Punctal plugs. These tiny devices are placed in the eye’s tear ducts—the puncta—in an office procedure typically covered by insurance. About the size of a grain of rice, the plug stops fluid from draining from the eye, so your own tears—not artificial ones—can lubricate the eye. Plugs made of collagen or a suture material are meant to dissolve and can be replaced a few times a year if successful. You can try these first to see if the plugs provide relief. Permanent plugs are made of silicone, but these can fall out if you scratch or pull on your eye. Risks include a foreign-body sensation, tearing and, rarely, an infection. Note: If you try temporary or permanent plugs and your condition doesn’t improve, it’s likely that you do not have dry eye after all.
Contact lenses. Daily contact lenses—even if not needed to correct your vision—are a success story for some dry-eye sufferers. The lenses act as bandages, easing the symptoms of dry eyes. Wearing noncorrective contacts can be particularly helpful after laser eye surgery procedures that eliminate the need for glasses—once you no longer need glasses, your eyes are more exposed to drying irritants. They can be worn but only under close supervision by your eye doctor, and you should not wear them overnight or for extended hours unless you are told to do so by your eye doctor. Caution: Protein deposits tend to form on longer-use lenses, which can make eyes more irritated.
Scleral contacts are another option. Larger in diameter than regular contacts, they rest on the sclera, or whites of the eyes, to protect more surface area. They’re available in corrective prescriptions, even bifocals.
Some contact lens innovations are specifically designed for dry-eye treatment. Example: The Prokera brand is made out of a clear, flexible material with a piece of amniotic membrane to help the eye retain natural moisture and heal from dry-eye symptoms and eye injuries. Your doctor or optometrist will teach you how to insert and remove these lenses. Sleeping with them in your eyes risks infection.
Keep in mind that you may not be able to tolerate lenses if you have allergic conditions, ocular rosacea or an inflammatory disease in addition to dry eye.
What Might Help
Omega-3 fatty acid supplements. Whether fish oil-, krill- or plant-based, omega-3 fatty acids may improve dry-eye symptoms is still up for debate, but they tend to be most beneficial for people who have overall dryness—dry skin, dry hair and dry mouth, too. Less costly alternative: Eat fatty fish such as salmon and sardines at least once a week, and use cooking oils high in omega-3s such as flaxseed oil and canola oil.
Humidifier. A whole-house humidifier or a portable one for your bedroom, office or other area can be helpful, especially in winter if your home’s heating system creates a low-humidity environment. Ideally, your home’s humidity level should be between 40% and 60%. Cool-mist humidifiers release cooler moisture into the air, which you may prefer in warmer months. You might switch to a warm-mist humidifier in cold weather months, especially if your heating system dries out your nose and throat or you have allergies and congestion. Some brands, such as Pure Guardian, make humidifiers that can operate both ways. If you also have an allergic condition or rosacea, an air purifier will help get rid of airborne chemicals and ease dry eye. There are combination humidifier/purifier products available from companies such as Dyson and Sharp.
Ophthalmic solutions (eyedrops). Over-the-counter artificial tears offer temporary relief at best, are inconvenient and need to be repeated throughout the day. Warning: The higher the viscosity of the solution, the more likely it can cause blepharitis—inflammation along the eyelids—and other issues. To determine a product’s viscosity: If you place an eyedrop between your fingers and it feels like water, it is less viscous…if it feels like oil, it is more viscous.
Many prescription eyedrops are available, but they have a high failure rate…side effects such as blurry vision and a bad taste in the mouth…and are expensive—dry eye isn’t like an infection that can be treated with a single course of a drug.
Restasis (cyclosporine ophthalmic emulsion) is for symptoms related to Sjögren’s syndrome, a chronic autoimmune disorder in which the glands that produce tears do not function correctly, causing dry eyes as one of the condition’s many symptoms. It can take up to six months to feel the full benefit of Restasis, and the aim is not to produce tears but prevent further damage to your tear glands.
Cequa (cyclosporine ophthalmic solution) has the same active ingredient as Restasis but uses nanomicellar technology, which synthesizes the drug into a very tiny particle size to better deliver it into the eye. It might work better than Restasis for some people and possibly in as few as four months.
Xiidra (lifitegrast ophthalmic solution) is designed to block a protein that could be inhibiting tear production. It may improve symptoms faster than Cequa and Restasis.
If ocular allergies are causing dry eye, topical or systemic antibiotics can improve symptoms. Other ophthalmic prescriptions may help if you have an inflammatory condition.
What Doesn’t Work
From the humble beginnings of warm compresses to unclog the meibomian glands has emerged a market of medical devices that aim to do this, often with heat and pressure. These expensive treatments (they can run $800) are not usually covered by insurance and, by and large, not worth it.
If you’re not seeing results with your current eye doctor, consider getting another opinion, especially if you’ve spent a lot of money on various treatments. Important: As you move forward, try only one option at a time. Some patients are given 10 things to do at once, which makes it impossible to know what’s working and what isn’t.