Treatment for dry eye syndrome varies depending on the severity and cause of the condition. Sometimes a change in lifestyle, such as discontinuing contact lens wear, reducing computer use or avoiding allergens, can alleviate symptoms. Over-the-counter artificial tears may adequately treat a mild case. However, for more severe cases, an ophthalmologist may prescribe medications, perform surgery or give Botox treatment.
Artificial Tears and Lubricants
Some medications such as antihistamines can worsen dry eyes, so patients should review all medications with their ophthalmologist. Over-the-counter artificial tears promote eye lubrication with "viscosity-enhancing" ingredients that make the tears stick to the eyes more effectively. Doctors can recommend the best eye drops, but use ones that do not contain preservatives that may cause an allergic reaction. The Mayo Clinic recommends avoiding drops with redness remover since they may worsen dry eye symptoms. In addition, over-the-counter lubricants that moisten the eyes but cause blurriness may be used at bedtime. Ophthalmologist Dr. Steven L. Maskin, author of "Reversing Dry Eye Syndrome," reports that the higher the percentage of cellulose, the more viscous the drops. He says patients should try various types to see which one works best.
Prescription Medications
Sometimes dry eye syndrome is caused by problems with the meibomian gland--the oil-producing sebaceous gland at the rim of the eyelids--causing inflammation, redness and eye pain. Maskin reports that for significant meibomian gland dysfunction, he often prescribes doxycyline, an antibiotic that kills bacteria and controls inflammation. According to the Sjogen's Syndrome Foundation, prescription medications that treat dry eyes include cyclosporine opthalmic emulsion, or Restasis, and hydroxypropyl celluslose opthalmic insert, or Lacrisert . Restasis helps the body to produce more tears. The All About Vision website describes how Lacrisert involves placing an insert filled with hydroxypropyl cellulose inside the lower eyelid so that it can continuously lubricate throughout the day. Inflammation may be treated with topical steroid drops or oral tetracyclines. Patients with Sjogen's syndrome, a disorder that causes dry mouth and eyes, may be prescribed medications called "secretagogues" that increase saliva and tear production. In severe dry eye cases, patients may be prescribed an eyedrop serum made from a patient's own blood or powerful medications that treat systemic diseases. These medications can cause serious side effects because the body will be less able to fight off infections.
Medical Procedures
A doctor may provide a punctal plug and cautery when artificial tears fail to eliminate pain caused by dry eyes. According to DryEyeDoctor.com, plugging stops the tears from leaving the eye. Absorbable plugs are temporary to see whether they are beneficial. Non-absorbable permanent plugs are commonly made of silicone or a hydrophilic acrylic. Maskin reports that plugs can become dislodged and lost in the eye. Therefore, he prefers to do a procedure called "thermocautery" which seals the tear duct. Other techniques for preventing tear drainage include lasers, radiofrequency needles and sutures. Ocular surface reconstruction and eye-lid surgery can also reduce dry eye pain. According to Drs. Alice Y. Matoba and Charles N.S. Soparker of Baylor College of Medicine, a procedure called a "tarsorrhaphy" partially closes the eyelids to reduce tear evaporation.
Botox Treatment
Botulinum toxin--commonly called Botox--is another nonsurgical option. This is the same drug used to treat wrinkles and reduce muscle tone in children with cerebral palsy. According to Maskin, botox causes the eyelid to become droopy, which in turn reduces exposure of the ocular surface. One possible side-effect of this treatment is decreased blinking--worsening instead of improving the condition.
References
- Dry Eye: Causes of Dry Eye
- Dry Eye Doctor: Punctal Plugs
- Mayo Clinic: Dry Eyes Treatments and Drugs
- All About Vision: Dry Eye
- "Reversing Dry Eye Syndrome"; Steven L. Maskin, M.D.; 2007
