Visit Our Optometrists To Learn About Dry Eye Care
Early detection and aggressive treatment of dry eye syndrome may help prevent corneal degeneration and scarring. The frequency of your follow-up care depends on the severity of the signs and symptoms. Dry eye syndrome in its mildest form consists of the vague complaints of burning, watering and fluctuation of vision. It is common to think you need to change eyeglasses when the real solution is to improve your tear quality.
Although supplemental lubrication is the mainstay of treatment for mild and moderate dry eye, Dr. Daniel Newcomer, our dry eye specialist, strongly recommends that any lid disease or hygiene issues must also be treated. Blepharitis and Meibomian gland dysfunction are significant contributors to dry eyes. Red and thickened eyelids along with red eyes point to lid inflammation contributing to the dry eye. The use of topical cyclosporine (restasis) has been shown to enhance the production of the water component of the tear layer, as well as increase goblet cell density which increases the mucous and oil components of the tear film. The use of oral omega-3 fatty acids has also been shown to have beneficial anti-inflammatory properties that aid in the production of tears. Treating a dry eye requires all three components of the tear film be improved.
Other forms of treatment include the use of plugs that block the puncta (the hole that drains the tears on the lid). Environment-related issues that worsen Dry eye syndrome should be discussed; alternatives may be needed such as humidifiers in the home.
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Dry Eye treatment recommendations are stratified according to the severity of the disease.
Level 1 treatment consists of the following:
- Education and environmental or dietary modifications
- Elimination of offending systemic medications-antihistamines and decongestants
- Preserved artificial tear substitutes, gels, and ointments
- Eyelid therapy - warm compresses and cleansing to release the lubricating oils of the tears
If level 1 treatment is inadequate, level 2 measures are added, including the following:
- Nonpreserved artificial tear substitutes
- Anti-inflammatory agents( topical steroids, restasis)
- Tetracyclines (for meibomitis or rosacea)
- Punctal plugs (after inflammation has been controlled anti-inflammatory agents, is added.
Agents that have been used to treat dry eye include:
- Artificial tear substitutes
- Gels and ointments
- Anti-inflammatory agents -topical cyclosporine, topical corticosteroids
- Topical or systemic tetracyclines
- Systemic immunosuppressants
Lubricating supplements are the medications most commonly used to treat dry eyes. If these drops are to be used more frequently than every 3 hours, preservative-free formulations are the treatment of choice. Mild dry eyes can be treated with drops 4 times a day; more severe cases call for more aggressive treatment, such as drops 10-12 times a day. Thick artificial tear drops or gels can also be used in more severe cases, although these agents tend to blur the vision. Tear ointments can be used during the day, but they are generally reserved for bedtime use because of the poor vision after placement. The most important factor in treating your dry eye is to consistently stick to your regimen and follow up with with our office so we can monitor and improve your tear quality. This will lead to better vision and comfort.