Some people with dry eye disease only experience flares of the disease from time to time. Others may have had mild symptoms of chronic dry eye, and an increase in symptoms led them to see their doctor. Flares of dry eye are often treated with artificial tears and sometimes other short-term drugs.1
Cholinergic agonists
Cholinergic agonists work on the nerves in the body and result in increased saliva and tear production.2
What are the formulations of cholinergic agents?
There are several formulations of cholinergic agonists. Some of these agents are listed for the treatment of glaucoma. These drugs may be in the form of eye drops or in pill form that you swallow. When used for chronic dry eye, eye drops are typically prescribed. Cholinergic agonist eye drops may include:3,4
- Isopto® Carpine (pilocarpine ophthalmic)
What are the possible side effects of cholinergic agonists?
Drops applied directly to the eye are generally well tolerated with few side effects. Some side effects and complications may include:5-7
- Blurred vision
- Eye pain, spasm, or irritation
- Brow ache headache
- Retinal tear or detachment
Side effects can vary depending on the specific drug you are taking. These are not all the possible side effects of cholinergic agonists used for chronic dry eye. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with cholinergic agonists for chronic dry eye.
Things to know about cholinergic agonists
These drugs can affect how well you see at night or in low light because they constrict the pupil, allowing less light to enter the eye. Use caution while driving.5-7
There is not a lot of evidence showing that these drugs work effectively in chronic dry eye. Research continues on the use and effectiveness of cholinergic agonists for dry eye symptoms. However, this does not mean this treatment may not be right for you. Talk to your doctor about any other things you should know about cholinergic agonists.5-7
Topical antibiotics
Topical, as it relates to the eye, means applied directly to the surface of the eye. This is usually in the form of drops, ointment, or gel.8
Antibiotic eye drops may be needed if dry eye disease leads to infection of the surface of the eye. These drops may also be used to treat blepharitis, which is inflammation of the eyelid. Blepharitis may lead to dry eye disease symptoms, especially if the meibomian glands of the eyelids are affected. This leads to a decreased production of the oily layer of the tear film.9
What are the formulations of topical antibiotics?
There are many different formulations of topical antibiotics. Depending on the reason for the infection, your doctor may prescribe different ones. A few of these formulations include:10-12
- Erythromycin ophthalmic ointment
- Vigamox™ (moxifloxacin hydrochloride ophthalmic solution)
- Ciloxan® (ciprofloxacin ophthalmic ointment). Ciloxan also comes as an eye drop
What are the possible side effects of topical antibiotics?
The most common side effects of topical antibiotics include itching, redness, and swelling of the eye.10-12
Side effects can vary depending on the specific drug you are taking. These are not all the possible side effects of topical antibiotics used for chronic dry eye. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with topical antibiotics for chronic dry eye.
Things to know about topical antibiotics
Take these drugs as directed by your doctor. Topical antibiotics usually work within days of starting treatment. If your symptoms do not improve, be sure to let your doctor know. Overuse and/or misuse of topical antibiotics may lead to a resistant infection that is difficult to treat.13
Depending on your condition, you may need to take antibiotic drugs by mouth. Your doctor will tell you what treatment you need.
Low dose topical steroids
Corticosteroids, also known as simply “steroids,” are strong anti-inflammatories. Inflammation is a key factor in the development of dry eye disease. This type of drug works to decrease and stop this inflammation, decreasing symptoms of chronic dry eye.13
What are the formulations of topical steroids?
There is only 1 topical steroid that is FDA approved for specifically treating the symptoms of chronic dry eye:14-17
- Eysuvis™ (loteprednol etabonate ophthalmic suspension)
Additional formulations of topical corticosteroids may be used to treat your symptoms. Some of these include:14-16
- Pred Forte® (prednisolone acetate ophthalmic suspension)
- Maxidex® (dexamethasone ophthalmic suspension). Maxidex also comes as an eye ointment
- FML® (fluorometholone ophthalmic suspension). FML also comes as an eye ointment
What are the possible side effects of topical steroids?
The most worrisome side effect from topical steroids 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, a disease where eye pressure damages the optic nerve, leading to loss of vision.18
Increased IOP is not common but can be painless and go unnoticed. For this reason, eye pressure should be checked regularly by an eye care provider.18
Side effects can vary depending on the specific drug you are taking. These are not all the possible side effects of topical steroids used for chronic dry eye. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with topical steroids for chronic dry eye.
Things to know about topical steroids
Topical steroids should not be used if you have any signs of eye infection. These drugs are prescribed for short-term relief of dry eye symptoms or other inflammatory conditions of the eye.18
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.