Severe dry eyes can be a challenging condition to treat, as regular eye drops may not provide sufficient relief. However, there are several effective treatment options available that can help alleviate even the most persistent symptoms. In this article, we will explore various strategies to combat severe dry eyes and help you find lasting relief.
Identifying and Treating Underlying Causes
The first step in managing severe dry eyes is to identify and address any underlying causes. Dry eyes can be influenced by a variety of factors, including environmental conditions, medical conditions, and certain medications. A thorough medical history and examination can help pinpoint potential triggers.1
Conditions such as diabetes, hypothyroidism, and autoimmune diseases can increase the risk of dry eyes.2,3,4 Medications like antidepressants, antihistamines, and hormones can also contribute to dry eyes.5 Treating underlying conditions and adjusting medications, when possible, can significantly improve dry eye symptoms.
Improving Tear Film Stability through Eyelid Hygiene
Meibomian gland dysfunction is a common contributor to severe dry eyes.6 These glands produce the lipid layer of the tear film, which prevents tear evaporation. Blockage of the meibomian glands, often caused by blepharitis (eyelid inflammation), can lead to tear film instability and worsening dry eye symptoms.
Regular eyelid hygiene can help release clogged meibomian gland secretions and stabilize the tear film. This involves using warm compresses, eyelid massage, and gentle eyelid cleansing.7,8 Incorporating eyelid hygiene into your daily routine can provide significant relief for severe dry eyes.
Anti-Inflammatory Treatments for Severe Dry Eyes
Inflammation plays a key role in the vicious cycle of severe dry eyes. While artificial tears may be sufficient for mild cases, severe dry eyes often require targeted anti-inflammatory treatments.8
- Cyclosporine A: This medication has anti-inflammatory properties and stimulates tear production, making it an effective treatment for severe dry eyes.9,10
- Corticosteroids: Topical corticosteroids, in the form of eye drops or ointments, can reduce inflammation and alleviate dry eye symptoms.11
- Doxycycline: This antibiotic, taken orally or applied topically, has anti-inflammatory effects and can improve meibomian gland function by reducing the viscosity of gland secretions.12,13
Punctal Plugs for Tear Retention
Punctal plugs are small devices that block the tear ducts, preventing tear drainage and keeping the eye surface moist for longer periods. This treatment is highly effective for severe dry eyes and can reduce the need for frequent eye drop application.14
Autologous Serum Eye Drops for Corneal Healing
Autologous serum eye drops, prepared from a patient’s own blood serum, contain growth factors and nutrients that promote corneal healing. These eye drops are particularly beneficial for severe dry eyes that have caused corneal damage and inflammation. As they are derived from the patient’s own body, autologous serum eye drops are well-tolerated and have shown promising results in treating therapy-resistant dry eyes.15
Lifestyle Modifications to Minimize Dry Eye Triggers
In addition to medical treatments, making certain lifestyle changes can help alleviate severe dry eye symptoms:
- Use a humidifier to increase air moisture in dry environments.
- Limit contact lens wear, especially if you have severe dry eyes.16
- Take frequent breaks during extended screen time and consciously blink more often to maintain eye surface moisture.17,18 Consider using software that reminds you to blink regularly.
A Multifaceted Approach to Treating Severe Dry Eyes
Severe dry eyes often require a combination of treatments to effectively manage symptoms. If your dry eyes persist despite self-care measures, consult an eye care professional for a comprehensive evaluation and personalized treatment plan. With the right approach, it is possible to find relief from even the most stubborn dry eye symptoms and improve your overall quality of life.
References
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