Dry Eye Therapy
Dry eyes are typically treated with eye drops, but there are many more therapeutic options to choose from. Eye drops can quickly relieve dry eye symptoms, but they often have to be applied several times per day. Other treatments can be used as an alternative to eye drops or in combination with them. They usually require less hands-on time and may be more effective for severe symptoms.
Artificial Moistening
One therapeutic approach is the artificial moistening of the eyes, which reduces dryness and thereby relieves the symptoms. Artificial moistening includes the following options:
Eye Drops
Eye drops immediately humidify the eyes, quickly relieving the symptoms. When dry eyes are caused by a dysfunction of the meibomian gland, lipid-containing eye drops should be used. Lipids stabilize the outer layer of the tear film and thereby stop the tear film from evaporating.1
There are many different eye drops on the market. It can help to try several products with different ingredients to find the eye drops that are most effective for you.
This article about different types of artificial tears provides more information on this topic.
Autologous Serum Eye Drops
Autologous serum eye drops can be useful to treat severe dry eyes that don’t respond to regular eye drops. They are made from the patient’s own blood – serum refers to the liquid part of the blood without clotting factors. The serum moisturizes the eye, and also contains vitamin and growth factors that promote the regeneration of the irritated cornea.2
Eye Sprays
Eye sprays are usually lipid-based and consequently stabilize the lipid-layer of the tear film. Their advantage over eye drops is that they don’t have to be applied as frequently. They stay on the eyelid surface for several hours, and therefore reach the ocular surface with each eyelid movement.3
Eye Ointments
Eye ointments are very viscous, and can therefore stay in the eye for multiple hours. The disadvantage is that they can temporarily blur vision. For this reason, it is better to apply them at night. For people with severe dry eyes, eye ointments are a good complement to eye drops applied during the day.
Anti-Inflammatory Agents
Dry eyes are usually associated with inflammation. Dry eyes trigger the body’s inflammatory responses, and, in turn, inflammation aggravates dryness. This leads to a vicious cycle during which dry eyes get worse over time. Anti-inflammatory agents such as cyclosporine A or corticoids can break the cycle.4,5,6
Antibacterial and Antiviral Agents
When dry eyes are caused by an infection, the infection needs to be treated. Bacterial infections are treated with antibiotics, viral infections are treated with antiviral agents.7,8,9
Heat Application and Eyelid Hygiene
Many people with dry eyes have a dysfunctional meibomian gland.10 Eyelid inflammation (blepharitis) can cause the gland to become blocked with oily secretions. Heat helps to liquefy and release these secretions.11 Warm compresses or a heated eye mask can be used for this purpose.
Hygiene is also important. Eyelids should be regularly cleaned. This helps to remove dried secretions from the lid edge, preventing inflammation.12
Punctual Plugs
Tear fluid can drain off through tear ducts, leaving eyes feeling dry. These ducts can be closed by applying punctual plugs – small plugs that are inserted into the opening of the ducts. The tear fluid consequently stays in the eye for longer. Punctual plugs also help eye drops remain in the eye, so that they don’t need to be applied as frequently. This approach is suitable for severe dry eyes.13
Avoiding Risk Factors
Dry air, wearing contact lenses, and working in front of a screen for many hours can cause dry eyes to develop.14,15 Air humidity can be easily increased with the help of humidifiers. People experiencing dry eyes when working at a computer usually have a low blink rate.16 A software that detects eyelid movements and reminds you to blink can help to increase blinking frequency and therefore prevent dry eyes.
References
1. Lee S-Y, Tong L. Lipid-Containing Lubricants for Dry Eye. Optometry and Vision Science. 2012;89(11):1654-1661. doi:10.1097/OPX.0b013e31826f32e0
2. Geerling G. Autologous serum eye drops for ocular surface disorders. British Journal of Ophthalmology. 2004;88(11):1467-1474. doi:10.1136/bjo.2004.044347
3. Understanding the benefits of liposomal eye sprays for dry eye patients | Advertising feature | Pharmaceutical Journal. https://www.pharmaceutical-journal.com/eye-care/understanding-the-benefits-of-liposomal-eye-sprays-for-dry-eye-patients/20201638.article?firstPass=false#fn_. Accessed November 25, 2019.
4. Turner K, Pflugfelder SC, Ji Z, Feuer WJ, Stern M, Reis BL. Interleukin-6 Levels in the Conjunctival Epithelium of Patients with Dry Eye Disease Treated with Cyclosporine Ophthalmic Emulsion. Cornea. 2000;19(4):492-496. doi:10.1097/00003226-200007000-00018
5. YOSHIDA A, FUJIHARA T, NAKATA K. Cyclosporin A Increases Tear Fluid Secretion via Release of Sensory Neurotransmitters and Muscarinic Pathway in Mice. Experimental Eye Research. 1999;68(5):541-546. doi:10.1006/exer.1998.0619
6. Pflugfelder SC, Maskin SL, Anderson B, et al. A randomized, double-masked, placebo-controlled, multicenter comparison of loteprednol etabonate ophthalmic suspension, 0.5%, and placebo for treatment of keratoconjunctivitis sicca in patients with delayed tear clearance. American Journal of Ophthalmology. 2004;138(3):444-457. doi:10.1016/j.ajo.2004.04.052
7. Zhang Z, Yang W-Z, Zhu Z-Z, et al. Therapeutic Effects of Topical Doxycycline in a Benzalkonium Chloride–Induced Mouse Dry Eye Model. Investigative Opthalmology & Visual Science. 2014;55(5):2963. doi:10.1167/iovs.13-13577
8. Magnuson RH. Gentamicin Sulfate in External Eye Infections. JAMA: The Journal of the American Medical Association. 1967;199(6):427. doi:10.1001/jama.1967.03120060125030
9. Spertus CB, Mohammed HO, Ledbetter EC. Effects of topical ocular application of 1% trifluridine ophthalmic solution in dogs with experimentally induced recurrent ocular canine herpesvirus-1 infection. American Journal of Veterinary Research. 2016;77(10):1140-1147. doi:10.2460/ajvr.77.10.1140
10. Tong L, Chaurasia SS, Mehta JS, Beuerman RW. Screening for Meibomian Gland Disease: Its Relation to Dry Eye Subtypes and Symptoms in a Tertiary Referral Clinic in Singapore. Investigative Opthalmology & Visual Science. 2010;51(7):3449. doi:10.1167/iovs.09-4445
11. Olson MC, Korb DR, Greiner J v. Increase in Tear Film Lipid Layer Thickness Following Treatment with Warm Compresses in Patients with Meibomian Gland Dysfunction. Eye & Contact Lens: Science & Clinical Practice. 2003;29(2):96-99. doi:10.1097/01.ICL.0000060998.20142.8D
12. Pflugfelder SC, de Paiva CS. The Pathophysiology of Dry Eye Disease. Ophthalmology. 2017;124(11):S4-S13. doi:10.1016/j.ophtha.2017.07.010
13. Baxter SA, Laibson PR. Punctal Plugs in the Management of Dry Eyes. The Ocular Surface. 2004;2(4):255-265. doi:10.1016/S1542-0124(12)70113-1
14. Dry Eye. https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/dry-eye. Accessed October 25, 2019.
15. Kojima T. Contact Lens-Associated Dry Eye Disease: Recent Advances Worldwide and in Japan. Investigative Opthalmology & Visual Science. 2018;59(14):DES102. doi:10.1167/iovs.17-23685
16. Freudenthaler N, Neuf H, Kadner G, Schlote T. Characteristics of spontaneous eyeblink activity during video display terminal use in healthy volunteers. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2003;241(11):914-920. doi:10.1007/s00417-003-0786-6