Treatment
Effective treatment begins with a careful examination to determine which
factors may be causing your symptoms. The goal of treatment is to keep
your eyes moist. This can be done in a couple of ways:
-
Adding tears.
You can usually treat a mild case of dry eyes with over-the-counter
artificial tears. Your doctor or eye doctor can suggest what drops
might be best for you. You can use the lubricating drops as often as
you need, even several times an hour, to provide relief. Using drops
proactively, before you begin an activity that tends to aggravate
your symptoms, also helps. If you use drops frequently,
preservative-free eyedrops might be the best choice to avoid an
allergic or toxic reaction to preservatives. People with dry eyes
are often more prone to irritation from the preservatives in
eyedrops. You can also use ointments to ensure lubrication. These
ointments can blur vision, so it's best to use them only at bedtime.
-
Conserving
tears.
Your eye doctor may also suggest methods to keep your natural tears
around longer. This can be done by partially or completely closing
your tear ducts, which normally serve to drain tears away. The tear
ducts can be plugged with tiny silicone plugs. The closure conserves
both your own tears and artificial tears you may have added.
Silicone plugs can be removed or left in. A more permanent option is
thermal cautery. In this procedure the doctor numbs the area with an
anesthetic and then applies a hot wire that shrinks the tissues of
the drainage area and causes scarring, which closes the tear duct.
People with mild dry eyes respond well to treatment with artificial
tears. People with severe dry eyes require more aggressive treatment,
such as the silicone plugs. If you have an eyelid condition such as an
anatomic abnormality or an incomplete blink that aggravates your dry
eyes, your doctor may refer you to a plastic surgeon who specializes in
eyes (oculoplastic surgeon) for treatment. People with severe dry eyes
may benefit from a special customized contact lens (Boston Scleral
Lens). This lens rests on the white part of the eye (sclera), creating a
fluid-filled layer over the cornea that keeps it from drying out.
Some people have persistent symptoms and don't respond to artificial
tears alone even though their eyes appear fairly normal. This is because
the sensory nerves in the cornea are densely packed, so that even small
amounts of tear dysfunction can cause irritation.
It's possible that more than one variable may be contributing to your
symptoms. Together with your doctor, you can devise a plan to address
the factors that appear to be contributing to the problem. This process
often takes time and requires patience and a trusting relationship with
your doctor.
When dry eyes don't respond to artificial tears alone, some people may
worry that they have an autoimmune disease such as Sjogren's syndrome.
While many people with autoimmune disease have dry eyes, the large
majority of people with dry eyes don't have autoimmune problems.
Medications
Dry eyes caused by problems with the meibomian glands and blepharitis
generally respond to treatment with an antibiotic such as tetracycline (Sumycin).
The underlying cause of dry eyes may be an inflammation both in the
lacrimal glands and on the surface of the eyes. When the eye is quite
irritated from dry eyes, it can overstimulate the nerve fibers that
travel from the eye to the lacrimal gland. That overstimulation causes
lacrimal gland inflammation, which in turn reduces tear formation even
further. Anti-inflammatory medication to the eye can dampen this cycle
by reducing eye inflammation. When people experience intolerable
irritation from dry eyes despite the frequent use of lubricating
eyedrops, doctors may prescribe steroid drops.
Dry eye syndrome
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