Dry Eye Therapy

Putting Eye Drops

What is Dry Eyes?

The eye depends on the presence of a tear film to provide constant moisture and lubrication to maintain vision and comfort. Tears are a combination of:

  • Water, for moisture

  • Oils, for lubrication and to prevent evaporation of tear liquid

  • Mucus, for even spreading of tears on the surface of the eye

  • Antibodies and special proteins, for resistance to infection

These components are secreted by special glands located around the eye.

When there is an imbalance or deficiency in this tear system, or when the tears evaporate too quickly, a person may experience dry eye.

When tears do not lubricate the eye enough, you may experience:

  • Pain

  • Burning

  • A gritty sensation, like a feeling of a foreign body or sand

  • Itching

  • Redness and blurring of vision

Sometimes, a person with dry eyes will have excess tears running down the cheeks. This happens when the eye isn't getting enough lubrication. The eye sends a distress signal through the nervous system and, in response, the eye is flooded with emergency tears.

However, these tears are mostly water and do not have the lubricating qualities or the rich makeup of normal tears. They will wash dirt away from the eye, but they will not coat the eye surface properly. In addition, because these emergency tears tend to arrive too late, the eye needs to regenerate and restore itself, and treatment is necessary.

Solution to Dry Eyes

  • Topical cyclosporine A eye drops (Restasis®): These are given twice a day in each eye to treat the underlying inflammation in the tear glands so they produce more and better quality tears. It typically takes 1 to 4 months before the cyclosporine A drops reduce symptoms and signs of dry eye. 

  • Lifitegrast (Xiidra®): These drops are also done twice a day in each eye, to treat the underlying inflammation in the tear glands. The Food and Drug Administration (FDA) has approved Xiidra to treat both the signs and symptoms of dry eye diseases with an onset of action in as little as 2 weeks. 

  • Artificial teardrops and ointments: The use of artificial teardrops is a palliative treatment that helps symptoms for a few minutes but does not treat the underlying cause of the dry eye disease. Artificial tears are available over the counter. No one drop works for everyone, so you might have to experiment to find the drop that works for you. 

  • Temporary punctal occlusion: Sometimes it is necessary to close the ducts that drain tears off the eye. This is done via a painless procedure where a plug is inserted into the tear drain of the lower eyelid. The plug will dissolve quickly. This is a temporary procedure, done to determine whether permanent plugs will help reduce symptoms and signs.

  • Permanent punctal occlusion: If temporary plugging of the tear drains works well or plugging is thought to be important for the health of the eye, then silicone plugs may be used. (Some physicians will go directly to silicone plugs without using temporary punctual occlusion.) The permanent plugs will hold tears around the eyes as long as they are in place. They can be removed. Rarely, the plugs may come out on their own or move down the tear drain. Many patients find that the plugs improve comfort and reduce the need for artificial tears.

  • Surgery: If needed, the ducts that drain tears into the nose can be permanently closed to allow more tears to remain around the eye. 

  • Autologous serum drops: In severe cases of dry eye, artificial tears made from the patient’s own serum can be prepared and given 6 to 8 times a day in both eyes. This treatment, although often effective, is not covered by Medicare or insurance.

  • In some cases, dry eye is caused by another disease or condition, like rheumatoid arthritis or systemic lupus erythematosus. If this is the case, the systemic disease should also be treated in order to relieve the dry eyes.

The eye doctors at Site to See will work with you on finding the right treatment option for you and your lifestyle. In most instances a step-wise fashion of treatment will be implemented from least invasive to most invasive until the desired outcome is reached.