Dry Eye Treatment

Purposefully blinking more often, and resting the eyes are basic steps one can take. Rubbing one’s eyes can irritate them further, so it should be avoided. Persons with dry eyes caused by an eyelid disorder should undergo treatment for the underlying condition.

Rehydration

For mild and moderate cases, supplemental lubrication is the most important part of treatment. Artificial tears

Application of artificial tears every few hours can provide temporary relief.

Additional options

Lubricating tear ointments can be used during the day, but they generally are used at bedtime due to poor vision after application. They contain white petrolatum, mineral oil, and similar lubricants. They serve as a lubricant and an emollient. Application requires pulling down the eyelid and applying a small amount (0.25 in) inside. Depending on the severity of the condition, it may be applied from every hour to just at bedtime. It should not be used with contact lenses.

Environmental control

Avoiding dry or drafty environments, or environments with smoke and dust may help. This also includes avoiding environmental aggravation caused by hair dryers, heaters, air conditioners or fans, especially when directed toward the eyes. Wearing wraparound glasses when outside can help reduce the drying effects of the wind.

Using a humidifier, especially in the winter, adds moisture to dry indoor air. Specially designed glasses that form a moisture chamber around the eye may be used to create additional humidity.

Supplementation

Consumption of dietary omega-3 fatty acids is associated with a decreased incidence of dry eyes syndrome in women. This finding is consistent with postulated biological mechanisms.

Medication

Inflammation occurring in response to tears film hypertonicity can be suppressed by mild topical steroids or with topical immunosuppressants such as cyclosporine. Elevated levels of tear NGF can be decreased with 0.1% prednisolone.

Restasis

Topical cyclosporine A (tCSA) 0.05% ophthalmic emulsion, marketed in the United States by Allergan under the trade name Restasis, is the only prescription product approved for chronic dry eyes. Approved by the U.S. Food and Drug Administration in 2002 for this indication, the drug decreases inflammation on the eye surface. Cyclosporine appears to work since the chronic inflammation of the ocular surface is mediated mainly by T-lymphocytes and cyclosporine’s proposed mechanism of action in immunosuppression is through T-lymphocyte inhibition through “binding an intracellular protein that ultimately controls transcription factors required for cytokine production and T-lymphocyte maturation”.

It increases healthy tear production, which may be reduced because of inflammation on the eye surface. In a clinical trial involving 1,200 individuals, Restasis increased tear production in 15 percent of patients, compared with 5 percent of patients in the placebo group.

Usually, 1 gtt (drop) of Restasis is instilled in each eye twice a day, 12 hours apart. It should not be used when wearing contact lenses, or by persons with eye infections or hypersensitivity to the ingredients. It has not been tested in people with herpes viral infections of the eye, and it should not be used by anyone with a history of such an infection. The most common side effect is a burning sensation. Other side effects may be eye redness, discharge, watery eyes, eye pain, foreign body sensation, itching, stinging, and blurred vision.

Generic alternatives

Cheaper generic alternatives to Restasis are available in some countries. In India, it is marketed as Cyclomune by Sun Pharma.

Conserving tears

There are methods that allow both natural and artificial tears to stay longer.

Blocking tear drainage

In each eye, there are two puncta — little openings that drain tears into the tear ducts. There are methods to partially or completely close the tear ducts. This blocks the flow of tears into the nose, and thus more tears are available to the eyes.

Punctal plugs

Punctal plugs are inserted into the puncta to block tear drainage. For people who have not found dry eye relief with drugs, punctal plugs may help. They are reserved for people with moderate or severe dry eye when other medical treatment has not been adequate.

Cauterization

If punctal plugs are effective, thermal or electric cauterization of puncti can be performed.

In thermal cauterization, a local anesthetic is used, and then a hot wire is applied. This shrinks the drainage area tissues and causes scarring, which closes the tear duct.

Customized contact lenses

Persons with severe dry eyes may benefit from the Boston Scleral Lens which is a customized contact lens. Resting on the sclera, it creates a fluid filled layer over the cornea, thus preventing it from drying.

Surgery

In severe cases of keratoconjunctivitis sicca, the eyelids may be partially sewn together to reduce tear evaporation.

References:

  • Dry eyes. MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine (2006-10-04). Retrieved on 2006-11-16.
  • Dry eyes. Mayo Clinic. Mayo Foundation for Medical Education and Research (2006-06-14). Retrieved on 2006-11-17.
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  • Keratoconjunctivitis Sicca. The Merck Manual, Home Edition. Merck & Co., Inc. (2003-02-01). Retrieved on 2006-11-12.
  • Miljanovi, Trivedi K, Dana M, Gilbard J, Buring J, Schaumberg D (2005). “Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women.”. Am J Clin Nutr 82 (4): 887-93. PMID 16210721.
  • Tatlipinar S, Akpek E (2005). “Topical cyclosporine in the treatment of ocular surface disorders.”. Br J Ophthalmol 89 (10): 1363-7. PMID 16170133.
  • Barber L, Pflugfelder S, Tauber J, Foulks G (2005). “Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years.”. Ophthalmology 112 (10): 1790-4. PMID 16102833.
  • Micromedex® Healthcare Series, (electronic version). Thomson Micromedex, Greenwood Village, Colorado, USA. Available at: http://0-www.thomsonhc.com.library.uchsc.edu:80 (cited: 09/05/06).
  • Meadows, Michelle (May-June 2005). Dealing with Dry Eye. FDA Consumer Magazine. U.S. Food and Drug Administration.
  • Sun Pharma Product List. Sun Pharma. Retrieved on 2006-11-27.
  • Dry eye syndrome. Health encyclopaedia. NHS Direct (2006-04-10). Retrieved on 2007-02-26.

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