What Are Treatments For Chronic Dry Eye?

Chronic dry eye, or “dry eye,” is a disease of the surface of the eye that can happen when your eye does not make enough tears or there is an issue with the tears that are made. Chronic dry eye may also be called dry eye syndrome (DES), dry eye disease (DED), or keratoconjunctivitis sicca.¹Managing dry eye disease means slowing the progress of the disease and improving comfort. This is not always easy. Dry eye disease can have multiple causes and can be hard to manage.

A stepwise approach to treatment

The cycle of dry eye disease, inflammation, and pain can frustrate both the people who experience it and the doctors who treat it. New developments in the treatment of dry eye disease offer hope to those with the disease.²

Step 1

This step begins with the least aggressive treatment. Education about lifestyle changes may include the following topics:²

• Dietary changes, such as drinking more water or adding supplements or vitamins as directed
• Stopping smoking
• Promoting good sleep habits
• Figuring out which medicines may be causing or making your dry eye symptoms worse
• Applying warm compresses to the eyes
• Using artificial tear eye drops
• Using eye masks made for dry eyes, such as Tranquileyes®
• Using a humidifier
• Wearing blue-light-blocking glasses and taking frequent breaks from computer screens or tablets
• Wearing sunglasses
• Removing makeup at night
• Performing blinking exercises or eye massages

Step 2

If the basic treatments and lifestyle changes in step 1 are not effective enough, certain treatments in step 2 may be needed. These may include:^2,4

• Tea tree oil eyelid washes for infestation of Demodex, which are normally harmless microscopic mites that can cause eye irritation. Your doctor may recommend tea tree oil washes to kill the Demodex.
• Using preservative-free artificial tears. Some over-the-counter (OTC) eye drops have preservatives added to them. Benzalkonium chloride (BAK) is the most commonly used preservative and has been shown to cause further inflammation and irritation to the surface of the eye.
• Undergoing a punctal plug procedure. This is an in-office procedure to plug the ducts that drain your tears, which can help tears stay on the eye surface longer.
• Procedures for meibomian gland dysfunction (MGD). During these procedures, intense pulsed light (heat), along with manual light pressure on the eyes, helps to improve the flow of the oily (lipid) layer of tears from the meibomian gland. Examples of these procedures include LipiFlow, TearCare, and MiBo Thermoflo.
• Taking prescription eye drops. These work to increase the number of tears, improve the quality of tears, or decrease the inflammation on the surface of the eye. Examples may include cyclosporine (Restasis® and Cequa™), lifitegrast (Xiidra®), loteprednol (Eysuvis™), and regenerative eye drops.

Step 3

If treatments in steps 1 and 2 are not effective, step 3 treatments may be prescribed, including:^2,4

• Oral medicines like cevimeline and pilocarpine. These drugs can help increase the number of tears the eyes secrete (discharge).
• Autologous eye drops, which are made with the person’s blood, such as autologous serum tears (AST) and plasma rich in growth factors (PRGF). This type of treatment may repair the surface of the eye by supplementing important regenerative factors normally found in blood.
• Therapeutic contact lenses, including rigid gas permeable (RGP) scleral lenses. When properly fit, these lenses can allow for an even distribution of tears under the lens to help protect and lubricate the surface of the eye while also decreasing irritation with blinking due to a damaged ocular surface.
• Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE), which is similar to an RGP contact lens. However, the PROSE is a larger, clear dome filled with sterile saline solution to keep the damaged eye surface constantly lubricated and protected.

Step 4

The most severe cases of dry eye disease may require surgery to manage the condition. The most common type of surgery is punctal occlusion surgery by cautery. This procedure physically blocks the tear ducts that drain tears, which may restore the right balance of tears the eye needs.^2,5

Other surgeries may involve changing the position or height of the eyelids to allow for more even distribution of tears or less exposure and evaporation of tears.^2,5

Complementary and alternative treatments

Non-traditional, complementary, and alternative treatments may be an option for treating some chronic dry eye symptoms. Like traditional medicine, some treatments may work for some and not for others. Your doctor should be aware of alternative or complementary therapies you are considering. Some of these therapies may include:⁶

• Eye yoga or exercises to prevent tired eyes
• Ayurvedic medicine, an ancient holistic and natural approach to medicine. Ayurveda includes compounds of natural herbs and plants. This approach also focuses on diet, exercise, and lifestyle.
• Traditional Chinese medicine and acupuncture
• Other alternative therapies, such as omega-3 fatty acids, have been reportedly used by some to treat dry eye symptoms.

Talk to your doctor about how complementary or alternative treatments may fit into your treatment plan.

Treatments and technologies change often. Some treatments used for dry eye in the past are no longer being used. Talk to your doctor about your dry eye symptoms and history to make sure you get the best treatment for your condition.