Dry Eye Disease

Keratoconjunctivitis sicca is the medical word for dry eye disease and because it has many causes, it often requires a combination of treatments to control. There are no known cures for dry eye disease. Today, however, we have many good treatments that can improve your comfort and the quality of your vision. Dry eye disease has many causes including environmental factors, chronic allergies, reduced tear production, accelerated tear evaporation, poor quality of tears, ocular surface inflammation, hormone changes, medication side effects, and poor eyelid position and diminished blink response.

Dry eye disease can present in many different ways from burning, stinging, gritty feeling in your eyes, to excessive watering, redness, light sensitivity, poor contact lens tolerance, and blurry vision. The combination of changes in the tear film and the surface of the cornea contribute to eye pain as well as blurry vision or fluctuating vision when reading, watching TV or using a computer. Read below to learn more about dry eye disease and some of the treatments available.

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Environmental Factors Contributing to Dry Eye

There are many environmental exposures that can worsen dry eye. Being aware of the role your environment plays in dry eye can help you make some modifications and often improve control of your dry eye.

Today we rely heavily on computers, smart phones, tablets and TVs for work and entertainment. This high amount of “screen time” can significantly worsen dry eye. Normally you blink and refresh the surface of the eye about 15 times per minute. When you are reading, watching TV, or using a computer/tablet, your blink rate slows down to about 4 times per minute. In essence, you are getting into a staring contest with your device, and the device will always win. One way to help this is by taking breaks every 20 minutes when reading or on the computer or TV and fully close your eyes. We call it “Think Blink” and this can help refresh the ocular surface and trigger better tear production.

Wind is another environmental factor that can worsen dry eye. If possible, try to reduce wind exposure. This means avoid sleeping under a fan and directing air conditioning vents away from you in the car. Some patients find it helpful to wear protective sunglasses or motorcycle sunglasses to cut down on wind exposure when outside. If you wear a C-PAP device, make sure it is fit as well as possible to minimize air leak.

Oral medications can often exacerbate dry eye as well. We won’t cover all classes of medications here but some common ones include oral antihistamines (allergy) medicines such as Allegra, Zyrtec, or Claritin. Sometimes we can make changes to allergy treatments that don’t have the same drying effect so talk to your doctor if you take oral antihistamines.

Over the Counter Treatments for Dry Eye

There are many different lubricating eye drops and ointments on the market today. Try to avoid lubricating tears with preservatives as the preservative can cause irritation over time. Generally speaking, the best lubricating tear is the one that you remember to use and that feels the best in your eye. That said, here are some recommendations on over the counter lubricating eye drops.

Frequency: For mild to moderate dry eye try to use the drops 4 times per day. Roughly that equates to breakfast, lunch, dinner, and bedtime. For more severe dry eye you may need to use them 6-8 times per day. If you are needing them more frequently then you likely need to make other changes to your dry eye routine to improve control. Talk to your ophthalmologist about your options.

Oasis Tears are some of the best on the market today. They come in preservative-free ampules as well as a non-preserved bottle. They can be used with contact lenses as well to help refresh them during the day. These can only be acquired through your eye doctor’s office and are not available in stores or pharmacies. Visit our products page if you are interested in ordering Oasis tears.

Other good preservative-free tear brands: Refresh Omega3, Refresh Relieve, Retaine MGD, and Systane

Warm compresses can also be helpful to restore the oil composition of the tear film. There are many warm compress eye masks on the market. We recommend using the warm compress for 10 minutes once or twice a day to help improve the quality of your tear film.

Hydroeye Supplements

HydroEye is a dry eye supplement made by Science-Based Health that can work to improve the quality of tears you produce. The main ingredients in HydroEye are Gamma Linoleic Acid (GLA – Omega 6) with a small amount of Fish Oil (EPA and DHA – Omega 3) coupled with Vitamin E and B6 and other nutrients to help your body absorb and utilize the product efficiently. The GLA in HydroEye is derived from black currant seed oil and is not commonly found in our normal diet. The landmark clinical study by DREAM, the Dry Eye Assessment and Management Research Group, showed that fish oil alone (Omega 3) is no better than a placebo for dry eye disease. HydroEye was shown in a randomized controlled trial (published in the journal Cornea Oct. 2013) to be effective for improving the symptoms of dry eye, inflammation, and can help promote a smooth corneal surface. More information about clinical testing can be found online at SBH.com/HydroEyeTrial.

Hydroeye takes 8-12 weeks to work on average and the dose is 2 pills in the morning and 2 pills in the evening. Consult with a physician if you are pregnant or breastfeeding, or if you take a blood thinner prior to starting HydroEye. Some surgeons may request you stop HydroEye 10 days prior to surgery. If you take a blood thinner or are not sure what a blood thinner is, please consult with your ophthalmologist and primary care doctor before starting Hydroeye.

Note: this product is a vitamin/supplement. As such this product has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

LipiFlow Treatment for Dry Eye

Meibomian gland disease is a common factor in dry eye disease and LipiFlow is a targeted treatment for it. LipiFlow is an FDA cleared in-office treatment typically done while resting in a chair that lasts 12-15 minutes that can improve the quality of your tear film and reduce the mechanical blockages of your Meibomian glands. Unlike other treatments for dry eye, it isn’t another eye drop to remember or pill to take. The treatment works by targeting the oil-producing glands of the eyelids called the Meibomian glands.

The Meibomian glands make the essential oil component of your tear film and without it the tears can evaporate too quickly (Meibomian gland dysfunction). The natural oils in the glands can thicken over time and from chronic inflammation which causes poor quality tears. This treatment will heat and massage the eyelid glands from the inside out, clearing out the trapped thickened gland oils and helping reset the Meibomian gland function.

After numbing the eye with an anesthetic eye drop, LipiFlow applicators are placed on the surface of the eye. They are then activated and the eyelids heated and then gently massaged. The combination of heating and massaging loosens and clears the trapped oils from the glands. Many of our patients report the treatment feels like a trip to the spa for your eyelids. The treatment is safe and effective for most patients can last 6-12 months, and is repeatable.

Punctal Occlusion

Punctal occlusion is the closure of the tear drainage ducts in the lower, and sometimes the upper, eyelids. This keeps the tears on the eye longer which can help in dry eye. The tear drain (punctum) can be closed in the office by placing silicone plugs, placing dissolvable collagen plugs, in a semi-permanent fashion with custom plugs, and in a permanent fashion with cautery (a heating element). Punctal plugs are not recommended as a first-line treatment for dry eye but can be helpful for patients who are already on treatment for dry eye. Side effects can include overflow or excessive tearing however usually the plugs are well tolerated. They do tend to fall out over time but can be quickly replaced in the office.

Prescription Medications for Dry Eye

There have been many advances in medications for dry eye disease in the last few years. These treatments primarily focus on reducing ocular surface inflammation which over time can cause destructive changes to the tear film and the oil-producing glands of the eye.

Xiidra (lifitegrast 5%) is a drug that reduces T-lymphocyte activity on the surface of the eye. It can work as quickly as 4-6 weeks to improve the signs and symptoms of dry eye disease.

Restasis (cyclosporine 0.05%) is a drug that acts as an immune modulator to increase tear production and takes 4-6 months for full effect. The exact mechanism of action of cyclosporine to increase tear production is not known.

Cequa (cyclosporine 0.09%) is a drug that acts as an immune modulator to increase tear production and can work as quickly as 4 weeks. Cequa is different from Restasis in its formulation. Cequa uses micelle technology (NCELL) to improve the delivery of the cyclosporine through the tear film.

Prokera Amniotic Membrane

A Prokera amniotic membrane ring can be placed on the eye to help rehabilitate the cornea when damaged by dry eye. The amniotic membrane helps reset the tear film and remove ocular surface inflammation. The amniotic membrane graft is attached to a plastic ring, and it is placed on the surface of the cornea like a contact lens. The plastic ring allows the membrane to stay in place without needing stitches and can be placed and removed in the clinic. You will feel the ring in place on the eye until it is removed. The amniotic membrane has anti-inflammatory properties that can give pain relief and break the cycle of dry eye and filamentary keratopathy. The ring is left in place on the eye for 5-7 days and then removed in the office. The benefits of this treatment and improvement in your dry eye typically last for 3-6 months but it can be repeated as needed.

Serum Tears

Serum tears are lubricating eye drops made out of the serum component of your own blood. These tears contain powerful healing properties and can help treat dry eye and improve pain control, especially in its more advanced stages.

The process of obtaining serum tears involves having your blood drawn and sending it to a compounding laboratory to process them and package them into tears. The tears typically arrive a few days later and must be kept frozen. One bottle at a time is removed from the freezer and placed in the refrigerator. The serum tears are not allowed to warm to room temperature or they may grow bacteria. It is important to follow the instructions closely to reduce your risk of infection when using serum tears. The need to have blood drawn and to keep them chilled makes them a more cumbersome choice for treating mild dry eye disease but these tears are very helpful for more advanced dry eye disease.

We use a company called Vital Tears to simplify the process of obtaining serum tears. They help arrange the blood draw and greatly simplify the process for patients to obtain serum tears.

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