Dry eyes are a frequent problem for many adults. Dry eyes are most commonly caused by normal aging process. Some medical conditions (rheumatoid arthritis, lupus, Sjogren's) and medications (antihistamines, anticholinergics, diuretics, ACE inhibitors, sleeping pills and antidepressants) may contribute to dry eyes. Symptoms of dry eyes include: Burning, Redness, Foreign Body Sensation, Stinging and ironically tearing.
It's ironic that tearing is a symptoms of dryness. When the eye becomes very dry, a reflex tear gland is turned on. This tear gland releases a flood of tears. These tears are good for washing something out of the eye, but are not good for rewetting or lubricating the eye.
Dry eye treatment is performed in a stepwise fashion:
Step One: Over the counter Artificial Tears 2 to 4 times per day. We suggest starting with a basic tear from Systane, Refresh, Genteal, or Thera Tears which are all excellent brands. If symptoms are not better in 1 to 2 weeks then proceed to step two.
Step Two: Try a thicker or longer lasting daytime tear. Again, many choices are available. Some examples are: Systane Ultra, Refresh Plus, Genteal Plus, and Refresh Celluvisc (thickest). When any of these drops are applied they may cause blurry vision for a few seconds. If you are still having symptoms after 10 to 14 days then proceed to step three. Continue using tears when moving to step three.
Step Three: Add a nighttime ointment. Place the ointment inside the lower eyelids at bedtime. When your eye close it will coat the cornea and lubricate your eyes while you are sleeping. Any residue on the eyelids in the morning can be cleaned with a moist washcloth. A good choice for nighttime ointment is Refresh pm, Genteal, or Systane. Nighttime ointments can blur vision so make sure it's the last thing you do before going to bed. If symptoms persist proceed to step four.
Step Four: Consider placement of silicone punctal plugs. This allows tears more contact time on the surface of the eye resulting in less dryness. Insertion of punctal plugs is a brief ofice procedure with only eye drop anesthesia. A small silicone plug (smaller than 1x2 mm) is placed in the tear drainage duct opening of the lower eyelid. Tears that are produced naturally or artifical tears put in the eye have to travel to the tear duct opening on the upper eyelid. This increases the time tears are in contact with the surface of the eye, thus lubricating the eye better. Patients not only benefit from the increase comfort of a well lubricated eye, but they sometimes are able to reduce the number of drops used each day.
Step Four Alternative: A prescription medication, Restasis or Xiidra, used twice daily can increase natural tear production in many patients. You do not get immediate relief with these drops. They usually take 2 to 4 weeks to start working. The drops may also burn when first used, which is a normal side effect. To minimize burning the drops can be refigerated.
Vitamins and nutritional supplements: Flaxseed oil at 2000mg per day is helpful for many patients. Fish oil (omega-3 fatty acids) has also been shown to be beneficial in several studies at 1000mg/day. These supplements can be taken alone or in combination. TheraTears Eye Nutrition combines both flax seed oil and fish oil together in one capsule for patient convenience. These are available without a prescription.