You might be wondering which comes first: inflammation or chronic dry eye? It turns out it could be both.
Chronic (long-term) irritation and inflammation of the surface of the eye can lead to damage and symptoms of chronic dry eye. Once dry eye sets in, inflammation continues and gets worse over time without management. This vicious cycle of inflammation and damage is common to chronic dry eye.1
It is difficult for healthy cells to grow in an environment that is chronically inflamed. Decreasing inflammation on the ocular surface can lead to better functioning of the glands that make tears and help overall healing.1
Understanding the treatment options used to decrease pain and inflammation in chronic dry eye can help you get relief from your symptoms.
Long-term anti-inflammatory treatment
Long-term management of chronic dry eye involves both healing the surface of the eye and stopping inflammation. Immune modulating eye drops work on specific inflammatory markers on the surface of the eye. These drops have been shown to be effective in treating chronic dry eye long-term, though the exact way they work is unknown.2
Examples of immune modulating drops include:3-5
Steroids
Corticosteroids, also known as simply “steroids,” are strong anti-inflammatories. This type of drug decreases and stops all kinds of inflammation on the surface of the eye, reducing pain and other chronic dry eye symptoms.13
Steroid eye drops are a type of topical treatment, meaning they are applied directly to the surface of the eye. While these drops treat inflammation, they are not as specific as immune modulating drops in treating chronic dry eye.13
There is only 1 topical steroid that is FDA-approved for specifically treating the symptoms of chronic dry eye:6
- Eysuvis™ (loteprednol etabonate ophthalmic suspension)
Other formulations of topical corticosteroids may be used to treat your symptoms. Some of these include:7-9
- Pred Forte® (prednisolone acetate ophthalmic suspension)
- Maxidex® (dexamethasone ophthalmic suspension)
- FML® (fluorometholone ophthalmic suspension)
What are the possible side effects of topical steroids?
The most worrisome side effect from steroid eye drops is an increase in intraocular pressure (IOP). This is when the pressure inside the eye is higher than normal. Increased IOP may lead to glaucoma. This is a disease where eye pressure damages the optic nerve, leading to loss of vision. Increased IOP is not common but can be painless and go unnoticed. For this reason, your doctor should regularly check your eye pressure.10
Steroid drops should not be used if you have any signs of an eye infection. These drugs are prescribed for short-term relief of dry eye symptoms or other inflammatory conditions of the eye.10
These are not all the possible side effects of topical steroids. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with topical steroids.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs that decrease inflammation and pain. When applied to the surface of the eye, these drops can reduce inflammation and pain in the eye.11
Eye drops containing NSAID painkillers are not as strong as steroid eye drops. NSAID eye drops may be used after cataract eye surgery to help decrease pain and swelling. There may be off-label uses for NSAIDs.11,12
NSAID eye drops are not usually used as first-line treatment for chronic dry eye. This is because they can be irritating to the ocular surface if used for long periods of time. Your doctor will be able to tell you if this treatment is right for you.11,12
Examples of NSAID eye drops include:13,14
- Acular® (ketorolac tromethamine ophthalmic solution)
- Bromday™ (bromfenac ophthalmic solution)
What are the possible side effects of NSAID drops?
Complications from NSAID drops are rare but serious. Rare side effects may include:11
- Keratitis (inflammation of the surface of the eye)
- Corneal ulceration, or open wound
These are not all the possible side effects of NSAID drops. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with NSAID drops.
Things to know about anti-inflammatory eye drops
Your doctor may prescribe anti-inflammatory eye drops when you have dry eye symptoms. In most cases, these drugs are used for short-term treatment of less than 2 weeks.
Both steroid and NSAID drops have been linked to delayed healing. Like any other drug, these should only be taken if prescribed by your doctor and used in the dose and frequency recommended.
Before beginning treatment for chronic dry eye, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.