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How Can Chronic Dry Eye Be Successfully Treated?

Reviewed by: HU Medical Review Board | Last reviewed: August 2022 | Last updated: August 2022

Chronic dry eye, often simply called “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.1

Successful management of dry eye disease means slowing the progression of the disease and improving comfort. This is not always easy, since dry eye disease can have multiple causes and can be hard to manage.

Treatment goals of chronic dry eye focus on the tears and finding what is causing dry eyes. Tears are needed to maintain the health of the surface of your eyes and make sure you see clearly.2

How do tears work?

Every time you blink, your eyes are coated with a thin layer of tears. This layer of tears is known as the tear film. This film has 3 layers, all with different functions:3

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  • Oily (lipid) layer – This is the outside layer of the tear film. This layer helps to keep the tears from drying out too quickly. The meibomian glands make this layer of the eye.
  • Watery (aqueous) layer – This is the middle layer of the tear film, which is made by the glands of Krause and Wolfring and the lacrimal gland. This is a watery layer that makes up most of what we see as tears. Its purpose is to clean, protect, and lubricate the eye.
  • Mucus (mucin) layer – This is the inner layer of the tear film, which helps to spread the watery layer evenly over the surface of the eye. Special cells known as goblet cells make proteins called mucin, the building block of the mucus layer. This layer helps to keep the eyes moist and free from particles. Without this layer, the tears could not stick to the eye properly.

Treatment goals

The overall goal of treatment for chronic dry eye is to improve or maintain the normal amount and quality of tears on the surface of the eye. This decreases dryness and the overall discomfort related to chronic dry eye.

Goal 1: Find the cause

The most effective way to manage dry eye disease is to find the cause of why it is happening. This presents a challenge, since many things can lead to or contribute to dry eye disease. Medicines, other diseases, and eyelid conditions are just a few things that can lead to chronic dry eye. Finding these and treating the underlying causes will help to effectively manage dry eye disease.2

Goal 2: Adding tears

Your doctor may prescribe preservative-free artificial tears to add to the tears you produce. Most of these eye drops are available over the counter. These may be helpful in mild to moderate cases of dry eye.2

Goal 3: Keeping tears on the eye

Sometimes the problem is that tears do not stay on the surface of your eye long enough. Your doctor may recommend a reversible, in-office procedure to plug the ducts that normally drain your tears. This procedure is known as a punctal plug procedure. If necessary, eyelid surgery can permanently seal the ducts. These are options to discuss with your doctor.2

Goal 4: Increasing the tears produced

Your doctor may prescribe medicines that will help your body make more tears. Sometimes, adding vitamins or supplements may help with this also. Your doctor may have other options as well.2