Dry Eye Disease

Keratoconjunctivitis sicca is the medical name for dry eye. Dry eye has many causes and often requires a combination of treatments to improve symptoms. There are no known cures for dry eye, however, today we have many good treatments that can improve your comfort and the quality of your vision.

Common symptoms of dry eye include blurry vision, fluctuating vision, burning, stinging, or gritty feeling in your eyes, excessive watering, redness, light sensitivity, and poor contact lens tolerance. The symptoms of dry eye are exacerbated with certain activities such as reading, watching TV or using a computer. These activities reduce your blink rate which causes your tear film to evaporate too quickly. Ceiling fans, chronic allergies, hormone changes, certain medications, and poor eyelid positioning can all contribute to dry eye as well.

Read below to learn more about dry eye disease and some of the treatments available.

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Managing Environmental Dry Eye

There are many environmental exposures that can worsen dry eye. Being aware your environment can help you make changes to improve control of your dry eye.

Most of us rely heavily on computers, smart phones, tablets and TVs for work and entertainment. High amounts 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 read, watch TV, or use a computer your blink rate slows down to about 4 times per minute. Basically, you are getting into a staring contest with your device, and the device will always win. A simple solution is to build in breaks every 20-30 minutes where you fully close your eyes and hold them closed for a few seconds. We call it “Think Blink” and this can help refresh the ocular surface and trigger better tear production.

Wind is another factor that can worsen dry eye. If possible, try to avoid sleeping under a fan and direct 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 fits well 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, antidepressants, diuretics, and beta-blockers. Work with your primary care doctor to see if you can make changes to your medications or allergy treatments to reduce dry eye side effects.

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. The regular formulation can be used with contact lenses 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. For more severe dry eye try the Oasis Plus formulation, however the plus version is not suitable to use while wearing contact lenses.

Another fantastic brand of preservative free tear is the Optase intense formulation. We also carry this version of tears in our dry eye store as it is a favorite for many of our dry eye patients.

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

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.

TearCare and Lipiflow Dry Eye Treatment

Meibomian gland disease is a common factor in dry eye disease. The Meibomian glands make the essential oil part of your tear film and without it the tears 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.

Targeted in-office treatments like TearCare and LipiFlow can help improve dry eye by improving how the meibomian gland functions. Both treatments are FDA approved and can be done while you rest in a chair. Many of our patients report the treatment feels like a trip to the spa for your eyelids. The relaxing warmth is applied to the eyelids for about 15 minutes and the eyelid glands are then massaged. The combination of heating and massaging loosens and clears the trapped oils from the glands. Unlike other treatments for dry eye, these procedures aren’t another eye drop to remember or pill to take.

Unlike a lot of other dry eye treatments and medications, TearCare is now covered by traditional medicare, making this a wonderful option to help improve control of your dry eyes.

Lacrifill and Punctal Occlusion

Punctal occlusion helps treat dry eye by keep your tears on the surface of the eye longer. Like placing a drain stopper in your bath tub, a punctal plug slows down how quickly tears can leave the eye. There are many different ways to close the tear duct drains (puncta). The tear drain can be closed with silicone plugs, dissolvable plugs, form fitting gels/plugs, and in a permanent fashion with cautery.

Traditional punctal plugs are made of silicone. Common side effects are minimal but can include overflow tearing and that the plugs can fall out over time. Normally, however, punctal plugs are very well tolerated.

A new form of punctal occlusion called Lacrifill has been helping many dry eye patients feel better. Lacrifill is made of halyuronic acid which is a natural lubricant found in your joints and skin. Lacrifill is different from traditional plugs in a few ways. It is made from a lubricant your body produces which makes it very well tolerated, and since it is a gel it comfortably fills your puncta and does not fall out.

Prescription Medications for Dry Eye

There have been many advances in medications for dry eye disease in the last few years. Most of these treatments focus on reducing surface inflammation which over time can cause destructive changes to the tear film and the oil-producing glands of the eye. Newer treatments modulate your nervous system, helping you use your own body to make better quality tears.

Tryptyr (acoltremon 0.003%) is a neuromodulating eye drop that stimulates your trigeminal nerve to produce healthy basal tears. The drop starts working within minutes and lasts for 12 hours. The most common side effect is burning and stinging initially when you first put the drop in. The intense menthol-like feeling lasts about 30 seconds and then resolves. The tears you produce on Tryptyr replicate your healthy baseline tear film.

Vevye (cyclosporine 0.1% and perfluorobutylpentane) is a newer formulation and higher concentration of an old dry eye drug (cyclosporine) paired with a newer dry eye treatment (perfluorobutylpentane). The combination results in better penetration of the active ingredient and improvement in symptoms as quickly as 29 days.

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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