What Works Against Severe Dry Eyes?

Eye drops are an effective treatment for dry eyes. They immediately moisturize the eyes and are especially useful for mild symptoms. However, eye drops are not very useful for the treatment of severe dry eyes. Despite regular use, they may not adequately relieve the symptoms.

Eye drops with a higher viscosity, eye gels and ointments are more effective against severe symptoms because they stay in the eye for longer. But in chronic cases, even these kinds of products do not help.

What other options exist and how can you soothe your dry eyes?

Eliminate the Cause

Dry eyes can have many causes that are influenced by a variety of factors. Environmental factors such as dry air, heated air, long hours in front of a screen, and contact lenses can all promote dry eyes.1

Severe dry eyes are usually also due to physical factors. An extensive medical anamnesis helps to identify potential causes. It typically includes a detailed analysis of your medical history, conditions of family members, and current health status.

Specific conditions such as diabetes, hypothyroidism, or autoimmune diseases increase the risk of dry eyes.2,3,4 Some medications can also cause dry eyes as a side effect.5 These include antidepressants, antihistamines, and hormones.

When underlying conditions are adequately treated, the symptoms of dry eyes will likely improve. When the symptoms are caused by medications, it can help to try an alternative treatment option.

This article about the causes of dry eyes provides more information on this topic.

Eyelid Hygiene

In many cases, a meibomian gland dysfunction contributes to dry eye symptoms.6 This gland produces the outer lipid (oil) layer of the tear film that protects the tear fluid from evaporation. Blepharitis (inflammation of the eyelids), can lead to a blockage of the meibomian glands.

Regular eyelid hygiene can help to release the clogged secretions, thereby stabilizing the oil layer of the tear film. This can be combined with other treatments, independent of therapeutic approach.

Eyelid hygiene includes the following methods:

Hot Compress or Heated Eye Mask

Heat helps to release the secretions of the meibomian gland.7 For this purpose, cover your closed eyes with compresses soaked in warm water or a heated eye mask for a few minutes.

The right temperature is crucial: to be effective, the compress should not be so hot that it hurts, but as warm as possible.

Eyelid Massage

After heat application, the meibomian gland secretions can easily be released by carefully massaging the closed eyelid. This can be done with your finger or a cotton swab.

Eyelid Cleaning

Regular cleaning of the eyelids helps to remove old, dried secretions, thereby preventing or relieving inflammation.8 Special cleaning products can be used for this purpose that also care for your eyelids.

Anti-inflammatory Treatments

Dry eyes promote inflammation, which in turn triggers dry eyes – a vicious cycle. In the case of mild symptoms, artificial tears can control the inflammation. For severe dry eyes, however, anti-inflammatory treatments are necessary.8

Cyclosporine A

Cyclosporine A is an anti-inflammatory that also triggers tear fluid production.9,10 For this reason, it is effective for the treatment of dry eyes.


Corticosteroids are anti-inflammatory hormones. Corticosteroid-containing eye drops or ointments reduce inflammation, thereby decreasing eye dryness.11


Doxycycline is an antibiotic that can be taken orally or applied topically (in eye drops or ointments).12,13 It also decreases the viscosity of the meibomian secretions and thereby releases blockages.

Punctual Plugs

Tear fluid drains off through tear ducts. Punctual plugs are small plugs that block the tear ducts. As a result, tear fluid stays in the eye for longer, and eye drops can be applied less frequently. Punctual plugs are an effective therapy for severe dry eyes.14

Autologous Serum Eye Drops

Autologous serum eye drops are prepared from the patient’s blood. Serum refers to the liquid part of the blood, without clotting factors. Serum contains vitamins and growth factors that help to regenerate the cornea. Severe eye dryness can irritate and harm the cornea, leading to inflammation – serum eye drops help to heal the damage.

Because serum eye drops are made from your own body fluid without additional substances, they are well tolerated. This innovative therapeutic approach is especially promising for severe dry eyes that have been resistant to therapy.15

Address Environmental Factors

Some environmental factors can cause the development of dry eyes. To address the symptoms, all these dry eye promoting factors should be eliminated as much as possible.

  • Dry air from air conditioning or heating: Air humidity can easily be increased with the help of humidifiers.
  • Contact lenses:16 People with severe dry eyes should avoid wearing contacts, and wear their glasses more often.
  • Too much screen time: Working for many hours in front of a screen also contributes to the development of dry eyes, as it decreases the blinking rate.17 Because the eye surface gets moisturized with each eyelid movement, computer work promotes eye dryness.18 A software that measures the blinking rate and regularly reminds you to blink can help to prevent dry eyes.

The Treatment of Severe Dry Eyes Can be a Challenge

In the case of severe dry eyes that do not respond to treatment, it is necessary to see a doctor. However, as you can see, there are many treatment options for severe dry eye symptoms. Since several factors usually contribute to the symptoms, you should combine multiple approaches to effectively treat your dry eyes.


1. 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.

2. Zhang X, Zhao L, Deng S, Sun X, Wang N. Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics. Journal of Ophthalmology. 2016;2016:1-7. doi:10.1155/2016/8201053

3. Kan E, Kılıçkan E, Ecemiş G, Beyazyildiz E, Çolak R. Presence of Dry Eye in Patients with Hashimoto’s Thyroiditis. Journal of Ophthalmology. 2014;2014:1-4. doi:10.1155/2014/754923

4. Akpek EK, Klimava A, Thorne JE, Martin D, Lekhanont K, Ostrovsky A. Evaluation of Patients With Dry Eye for Presence of Underlying Sjögren Syndrome. Cornea. 2009;28(5):493-497. doi:10.1097/ICO.0b013e31818d3846

5. Fraunfelder FT, Sciubba JJ, Mathers WD. The Role of Medications in Causing Dry Eye. Journal of Ophthalmology. 2012;2012:1-8. doi:10.1155/2012/285851

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Yoo S-E, Lee D-C, Chang M-H. The Effect of Low-Dose Doxycycline Therapy in Chronic Meibomian Gland Dysfunction. Korean Journal of Ophthalmology. 2005;19(4):258. doi:10.3341/kjo.2005.19.4.258

13. 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

14. 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

15. 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

16. 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

17. 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

18. Evinger C, Bao J-B, Powers AS, et al. Dry eye, blinking, and blepharospasm. Movement Disorders. 2002;17(S2):S75-S78. doi:10.1002/mds.10065

  • January 6, 2020