Dry Eye Disease is an increasing epidemic affecting patients of all ages and demographics. As more patients are diagnosed, more efforts have been made to find effective treatments to improve signs, symptoms, and quality of life. There are a wide range of options available, including over-the-counter treatments, lifestyle modifications, prescription medications, and in-office treatments. Your eye doctor will determine which treatment options are right for you after a thorough dry eye evaluation.
Lifestyle Changes
There are several lifestyle modifications one may make to reduce environmental factors contributing to dryness. By participating in these healthy habits, there is improved blink rate, reduced ocular surface irritants resulting in reduced inflammation, and improved tear quality.
- Improve your sleep quality
- Increase your water intake
- 20/20/20 Rule: Take a break from your screen every 20 minutes to look 20 feet into the distance for 20 seconds
- Limit screen time and take frequent blink breaks. You may leave yourself a note on your desk to remind yourself to blink!
- Use a humidifier in your living spaces and sleep spaces. This is particularly helpful during the drier months of the year.
- Quit smoking
- Remove eye-make up daily. It is best to use a micellar water product to effectively remove all make up debris.
- Wear sunglasses with a wrapped frame while outside
Over-the-Counter Treatment
There are several over-the-counter treatment options available for Dry Eye Disease. Oftentimes, over-the-counter treatments are the first step toward treating Dry Eye Disease. Over-the-counter treatments are aimed at relieving symptoms of dryness. However, most over-the-counter treatments do not treat the root cause of dryness. Therefore, over-the-counter treatments are often paired with medications or in-office treatments for optimal symptom relief.
Artificial tears are the most common form of over-the-counter treatment for Dry Eye Disease. Artificial tears serve to instantly provide relief by lubricating the eye. Artificial tears may provide variable degrees of relief, with some patients needing tears only occasionally and other patients requiring tears multiple times throughout the day. It is best to use preservative free artificial tears, as the preservatives used in eye drops may exacerbate the signs and symptoms of Dry Eye Disease if used more often than four times per day. For more severe dryness, gel drops may be recommended to increase the contact time of the drop with the surface of the eye. If there is evidence of incomplete lid closure, an ointment may be recommended to provide sustained lubrication and comfort, especially while sleeping. There are several brands of artificial tears available on the market. While use of branded artificial tears often comes down to personal preference, your doctor may recommend specific formulations if there is evidence of particular patterns of dryness. Visine, Clear Eyes, and Lumify are not artificial tears and should not be used to treat symptoms of Dry Eye Disease!
A warm compress with a heat mask is often recommended for patients showing signs of Meibomian gland dysfunction. To perform a warm compress, you should apply heat over both eyes with your eyelids closed for 5-10 minutes daily (or as directed by your doctor). The application of heat should help liquefy the impacted oils within the eyelid oil glands, improving the quality of oils within tear film.
If crusting or debris are present in your eyelashes, or if you are a makeup wearer, lid scrubs are often recommended to remove debris from the lashes and tear film. There are several brands of over-the-counter lid scrubs available at retail pharmacies. When using a lid scrub, you will gently massage over eyelids with the cleanser to remove debris from eyelashes and lid margin. Lid scrubs come in both wipe and spray formulations.
Nutritional supplementation is often recommended to help improve tear quality. Omega 3 nutritional supplements improve the quality of oils within tear film. The recommended dose for omega 3 supplementation is 1000-2000 mg daily. It is best to take omega-3 supplements with food containing fat (avocado, cheese, yogurt, egg, etc) to improve absorption. Other formulated supplements for dry eye exist, including OcuSci Ultra Dry Eye TG, HydroEye, and Blink Nutritears. These supplements combine vitamins, extracts, omega-3s, and antioxidants to reduce inflammatory mediators in the tears and improve the quality of the watery and oily component of the tears. All nutritional supplementation is available over-the-counter and can be found at most major retail pharmacies.
Medicated Eye Drops
There are several medicated eye drops on the market that serve to treat the root cause of dry eye disease. Your doctor will perform a dry eye evaluation with diagnostic tests to determine which medication is right for you.
Cyclosporine targets active pro-inflammatory cells to reduce inflammation within tear film for long term relief. Cyclosporine eye drops include generic cyclosporine, Restasis, Cequa, and Vevye). Xiidra (lifitegrast) targets active and inactive pro-inflammatory cells to reduce inflammation within tear film for long term relief. Miebo (perfluorohexyloctane) stabilizes the oil component of the tear film to reduce vision fluctuation and improve comfort. Tryptyr
(acoltremon) targets corneal nerve receptors to promote healthy aqueous tear production and promote excretion of healthy oils from the eyelid glands. Xdemvy (lotilaner) targets microbes living within lashes and oil glands that cause dryness, reducing the microbial load to reduce surface irritation. Steroids eye drops are used to reduce inflammation within the tears for short term relief.
Tyrvaya (varenicline) is currently the only FDA-approved nasal spray for treatment of Dry Eye Disease. Tyrvaya activates the trigeminal nerve (part of the tear production pathway) and results in aqueous tear secretion. Nasal sprays are great for patients who have difficulty with drop instillation or are contact lens wearers who do not wish to remove their lenses to instill eye drops.
In Office Treatments
At Eye Care Northeast, we offer several in-office dry eye treatments to improve the signs and symptoms of dryness. In-office treatments may replace medicated or over-the-counter treatments. However, we may perform these in-office procedures in conjunction with additional treatment to maximally treat Dry Eye Disease. Below is a brief overview of the treatments available at Eye Care Northeast.
Punctal plugs and Lacrifill are two in-office procedures which aim to increase tear retention. Punctal plugs are available in dissolvable and non-dissolvable forms. Dissolvable punctal plugs are composed of collagen, a natural connective tissue which exists in the body. These plugs are inserted within the canal of the tear drainage system and dissolve over the course of 3-6 months. Non-dissolvable (or “permanent”) punctal plugs are composed of silicon and sit at the opening of the tear drainage system. While non-dissolvable plugs are considered permanent, they may be removed by an eye care professional if removal is indicated. Lacrifill gel involves the insertion of dissolvable gel into tear ducts to plug the tear drain. Lacrifill gel dissolves over the course of 6-9 months, and therefore the insertion of Lacrifill can repeated every 6-9 months.
Prokera is a specialized amniotic membrane ring that is used to treat moderate to severe dryness with significant corneal involvement. The amniotic tissue is harvested, sterilized, and cryopreserved for safe application over the ocular surface. The membrane exists within a plastic supportive ring to maintain positioning over the surface for 3-5 days. Following removal of the membrane, the corneal surface will continue to heal for up to 6-8 weeks.
Meibomian Gland Expression is indicated for patients with Meibomian gland dysfunction. Gland expression involves application of heat using heat mask followed by evacuation of stagnant oils within oil glands of the upper and lower lids using special forceps, repeated every 2-3 months
The TearCare System aims to treat Meibomian gland dysfunction by heating the oil glands to reduce blockage. The TearCare System includes four heating pads that attach to the outside of each of your 4 eyelids. These pads will deliver heat to your eyelids for 15 minutes. Afterwards, your doctor will then gently squeeze your eyelids to unblock the oil glands and to remove the buildup in your eyelids.
Intense Pulsed Light (IPL) is an in-office topical broad-spectrum light energy treatment. The delivery of light results in decreased inflammatory mediators within the tear film, reduced abnormal blood vessels supporting inflammation, improved lipid composition within the eyelid oil glands, and reduction in microbes present within the eyelid glands and eyelash follicles. The OptiLIGHT device used at Eye Care Northeast is the only FDA-approved IPL device for dry eye treatment. IPL is performed in-office, with each session lasting about 10-15 minutes. You can expect to complete 4 sessions of IPL, scheduled 2-4 weeks apart.Following your 4 IPL sessions, you should plan to undergo a single IPL session every 6-12 months to maintain the results of your initial treatment.