Dry Eye

Overview

Tears come from the lacrimal glands and include several important components, such as water, mucus and an oily substance. You might experience dry eye if your lacrimal glands do not produce enough tears or if your tear components are out of balance. For example, if your tears do not have enough of the oily substance or qualitative changes, they can evaporate too quickly.

Symptoms

Symptoms of dry eye include dryness, burning, foreign body sensation, redness, sensitivity to light, and intermittent blurry vision. Dry eye can make performing some activities difficult, such as reading or working on a computer. Untreated, dry eye can cause the eye’s surface to become inflamed, resulting in pain, ulcers and scars. However, permanent vision loss is rare.

Irritation caused by dry eye sometimes triggers overproduction of tears. This extra moisture overwhelms the eye’s drainage system and flows away.

Causes

Dry eye often occurs with age as tear production slows down, especially in women.

Other causes include:

• Burns from chemicals or heat
• Contact lenses
• Cold and allergy medicines
• Dry environments
• Disorders of the glands in the eyelids
• Eyelids failing to close during sleep
• Hormone replacement therapy in women
• Immune disorders, such as Sjögren’s syndrome

Dry eye generally does not lead to serious vision problems, but it can interfere with your ability to live a productive and enjoyable life.

Treatment

Dry eye is treated in a stepwise approach. For mild cases, you might be able to control dry eye with warm compresses over the eyelids, eyelid massage, using over-the-counter drops and gels, wearing close-fitting glasses or sunglasses, using a humidifier and avoiding tobacco smoke. Keeping away from wind and dry air can also help. For tougher cases, IU Health ophthalmologists offer a variety of options for managing dry eye, depending on your specific conditions, needs and preferences.

Treatment options include:

Artificial Tears

Many brands of artificial tears are available without a prescription. Artificial tears provide temporary relief, and you may need to use them several times each day. If you need to use them more than four times a day, preservative free artificial tears should be used. Gel and ointment versions are also available.

Medicine Therapy

Some prescription medications are approved for anti-inflammatory treatment of dry eye such as cyclosporine and lifitegrast. The treatment relieves symptoms and/or signs of dry eye. You might need to take the medicine for a few weeks or months before seeing the results. Neurostimulators can trigger or increase tear production. Perfluorohexyloctane ophthalmic solution targets too much tear evaporation. Short-term use of corticosteroid eye drops is another option for reducing inflammation in severe cases of dry eye. For severe cases, autologous serum tears can be helpful.

In-Office Procedures

Some in-office procedures can help your dry eye. Lacrimal plugs block the tear drainage to keep more tears in the eye. Plugs made of silicone, collagen or other materials can be placed in the tiny drainage holes at the inner corners of the eyelid to prevent tears from leaving. Many plugs are semi-permanent, meaning they stay in place indefinitely, but can be removed if necessary. Some plugs dissolve over time. Lacrimal plugs, also known as punctal plugs, can be placed in your eyes during an office visit. Normally, you will not feel the plugs when they are in place.

Depending on the specific situation, other helpful procedures include amniotic membrane grafting, Meibomian gland expression and intense pulse light application, permanent punctal occlusion and eyelid closure. Sometimes, bandage or scleral contact lenses can also be helpful.