Treatment

Dry eye syndrome (also called keratoconjunctivitis sicca) is a condition when there is not enough aqueous (the watery part of tears).

There are 3 main ways to treat dry eye syndrome. 

• Tear replacement
• Preservation of existing tears
• Reducing tear drainage 

Tear replacement

Tear replacement is the main treatment for dry eye syndrome. You will need to take tear replacement medicines regularly for them to work. They can reduce the symptoms of dry eye syndrome and prevent further damage to your eyes.

There are different types of artificial tears:

Eye drops

There are many different brands for different types of dry eye. Most are available to buy from a pharmacy or shop without a prescription, and are usually cheaper than the current prescription charge. Preservative-free drops are available in single doses if you become sensitive to preservatives. They are also advisable if you are using artificial tear drops more than 4 times a day. Eye drops need to be used often to work well, so make sure you follow your doctor’s instructions.

Eye gels, such as Viscotears^®

These last longer than eye drops, so you will need to use them less frequently.

Eye ointments, such as Lacri-lube^®

These can be useful in lubricating the eye overnight. However, eye ointments are sticky and tend to blur vision. This means they have limited use in the daytime.

Mucolytic eye drops, such as acetylcysteine (ILube^®)

These drops can be used to break up mucus in your tears.

Important 

• The patient leaflet that comes with your artificial tears will give advice on how to use and store them.  This can be found inside the packaging of your medicines.
• Throw away your artificial tears 28 days after opening the tube or bottle. Single-dose, preservative-free drops should usually be discarded after use.
• Do not use artificial tears after their expiry date.

Side effects of tear replacement

The main side effects are caused by an allergy to the drops, gels, ointments and other medicines used to treat your eyes.

These side effects include:

• worsening red eyes
• worsening sore eyes
• increased itchy eyes 
• mild stinging or blurred vision (which usually wear off after a few minutes)

The side effects are similar to the symptoms of dry eye. If you think your symptoms are getting worse, contact your nurse practitioner in the eye casualty department. 

Preservation of existing tears

By controlling your environment, you can help your tears work better and last longer. These changes can help with dry eye syndrome. 

• Slightly lowering room temperature will help to reduce tear evaporation. Remember that temperature should not be reduced too much, especially if you are elderly.
• Avoid air conditioning (you could try using a humidifier instead).
• Avoid smoking.
• Avoid or reduce your reliance on contact lenses.
• Take regular breaks when reading, using a computer or watching TV. You blink less when doing these types of activities, so your eyes dry out more quickly.

Apart from making changes to your environment, there are other ways of preserving your existing tears. These include:

• Lateral tarsorrhaphy. If your eyelids do not close properly, you can have surgery (lateral tarsorrhaphy). This involves sewing the outer edges of your eyelids together.
• Medicine to suppress your immune system. If you have a condition that is inflaming your lacrimal gland, your doctor might give you medicines to suppress your immune system.
• Cleaning and antibiotics. If you have blepharitis you should clean your eyelids regularly. You might also be given a course of antibiotics.
• Flaxseed oil/omega 3 supplements. These reduce the symptoms of dry eye by improving meibomian gland disease.

Reducing tear drainage

You have drainage holes (lacrimal puncta) on the inside corner of your upper and lower eyelids. These can be blocked temporarily with punctal plugs made of silicone or collagen, or permanently by cauterisation (burning).

This will reduce or prevent tears from draining from the surface of your eye. Most of the drainage (about 3/4) goes through the lower drainage hole. This is usually blocked with a temporary plug at first.

You can have temporary plugs inserted as an outpatient. The process is easy, quick and painless.

Silicone plugs need to be removed, but collagen plugs dissolve over the course of a few weeks. If your eyes water too much while the plug is in place, it might need to be removed.

If, while the plug is in place, your eyes are still too dry, your doctor might choose to block your upper drainage hole too.

Permanent closure of the puncta using cauterisation should only be done if temporary plugging has been successful. You can have this done as an outpatient. It is a simple operation, in which a doctor injects local anaesthetic into your eyelid. 

When to get help