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Dry eyes? Finding the right lubricating drops is essential

Get an exam to pinpoint the cause and then choose.

For dry eyes that keep coming back, you may need special drops to give your eyes’ natural lubrication system an extra boost. Proper treatment of chronic dry eye also reduces the risk of infections or damage to the outer surface of the eye.

Of the many types of drops available, which is right for you? It depends on the cause of the problem. “Without seeing a doctor, it’s hard to know which drop you need,” says Dr. Jason Rothman, an ophthalmologist at Harvard-affiliated Massachusetts General Hospital. “Get an exam to determine the type of dry eye and target the therapy more accurately.”

Why eyes get dry

Many people describe dry eye as the sensation of having a grain of sand stuck in your eye. Other typical symptoms are sensitivity to light, itching and burning, excessive tearing and redness, and blurry vision.

Chronic dry eye is usually brought on by malfunctions in the eye’s lubrication system. Glands under the eyelids produce a protective coating called the tear film. It has two major components:

  • A watery layer adheres to the mucus on the surface of the eyeballs. The lacrimal glands supply the tears, while cells on the eye surface produce a mucus. If the lacrimal glands don’t produce enough fluid, you could develop dry eyes.

  • An oily film caps the watery layer and keeps it from evaporating. This layer is produced by the meibomian glands, which line the margins of the lids. An insufficient oily cover allows the watery layer beneath to evaporate more quickly.

Every eye blink replenishes the tear film. Watching TV or working at a computer makes you blink less, which can worsen dry eyes. Dryness often comes with inflammation, made worse by rubbing.

Dry eyes become more common with aging and may arise from medical causes. It’s the signature symptom of Sj√∂gren’s syndrome, an autoimmune disorder. Parkinson’s disease, which suppresses blinking, can cause dry eyes. So can a variety of medications, including antihistamines and antidepressants.

First steps

Start with an eye exam. Simple tests can help your doctor figure out whether something isn’t working right. The first-line treatment is a trial run of “artificial tears” eye drops, applied daily. If you use artificial tears more than four to six times per day, use a brand without preservatives, which can irritate the eyes. Thicker gels and ointments should be used at night, before bed, since these could interfere with vision. It may require some trial and error to find the right one.

Also, check your home or working environment. If the air is dry, use a humidifier to add moisture and see if it helps. Ceiling and room fans can worsen the problem by blowing air across your eyes and drying them out.

Artificial tear buyer’s guide

Dozens of brands of lubricating drops, gels, and ointments are available to relieve symptoms of dry eye. Different products contain a variety of ingredients, and no single ingredient or formulation is proven to be superior to any other. You may need to try more than one to find a product that works for you. Read labels carefully and ask your eye doctor for recommendations.

Type of lubricant/features

Use for…

Cautions

Liquid drops & Gels

  • Reclosable, multiple-use bottle with preservatives to prevent bacterial contamination of drops.

Mild dry eye

  • Limit use to 4-6 applications per day because preservatives can damage the eye.

  • Reclosable, multiple-use bottle with “vanishing” preservatives that break down when put into
    the eye.

Mild dry eye

  • In some people, “vanishing” preservatives may not completely break down and could irritate the eye if used more than 4-6 times per day.

  • Preservative-free but packaged in small vials that contain enough for a single use.

Moderate/Severe

  • More expensive and less convenient than multiple-dose packaging.

  • Can become contaminated if used more than once.

Ointments

  • Made to a thick consistency like
    petroleum jelly.

  • Ointments generally
    do not contain preservatives

Moderate/Severe

  • Ointments can blur vision, so use only at night, and never when driving or engaging in major physical activity.

  • Ointments containing parabens may irritate the eyes.

Lid cleaning

Clogged and inflamed meibomian glands, a condition called blepharitis, is a common cause of dryness. “It’s the most under-recognized condition that gives people dry eyes,” Dr. Rothman says. One sign of blepharitis is crusting along the lash line. Treat this with daily gentle cleaning with a diluted soap solution or special lid cleaning products, such as foams or wipes.

Applying a warm compress across the eyes for five minutes or so also helps to keep the oil glands flowing. You can use a warm, wet cloth. An alternative Dr. Rothman recommends is filling a clean cotton sock with rice and warming it moderately in a microwave. “It will hold the heat longer and is less messy,” Dr. Rothman says.

When drops don’t fix it

If chronic dry eye persists despite a trial of lubricating drops, there are additional options. If inflammation is part of the picture, your doctor can prescribe prescription anti-inflammatory drops. It may take a few months for the medication to start having a noticeable effect.

Another option is having tiny plugs inserted in the ducts (the puncta) that normally drain tears from around the eyes. These punctal plugs can help if the cause is insufficient tear supply. For a more permanent solution, the ducts can be sealed shut with an electric current (a procedure called cautery).

Posted by: Dr.Health

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