Dry eye syndrome - Treating dry eye syndrome

There is no cure for dry eye syndrome and some people have recurring episodes for the rest of their lives, but there are treatments to help control the symptoms.

The exact treatment for dry eye syndrome depends on whether symptoms are caused by the decreased production of tears, tears that evaporate too quickly, or an underlying condition.

The first thing to consider is whether there are any obvious factors that could be changed, such as altering any medication that is causing symptoms.

If your dry eye syndrome is caused by an underlying medical condition, your GP will prescribe treatment for it or will refer you to an appropriate specialist.

You may also be able to help prevent dry eye syndrome or ease your symptoms by adjusting your environment, keeping your eyes clean and improving your diet. Read more about self-treating and preventing dry eye syndrome.

Lubricant treatments

Mild to moderate cases of dry eye syndrome can usually be treated using lubricant eye treatments that consist of a range of drops, gels and ointments. 

These lubricants are often called 'artificial tears' because they replace the missing water in the tear film. However, they do not contain the antibodies, vitamins and nutrients found in normal tears that are essential for eye health.

Some lubricants are available without a prescription over the counter from a pharmacy, whereas others are only available on prescription.

There are many different types of eye drops and gels, and it is often worth trying a number of different ones to find one that suits you. However, it is important you discuss any changes you wish to make to your treatment with your doctor.

Preservative-free drops

Some eye drops contain preservatives to prevent harmful bacteria from growing inside the medicine bottle. If your symptoms mean you need to use these eye drops more than six times a day, it's better to use preservative-free eye drops. 

This is particularly important if your ophthalmologist has told you that you have severe dry eye disease because preservatives used in large quantities or over a prolonged period of time (months or years) may damage the delicate cells on the surface of the eye or cause inflammation.

If you wear soft contact lenses, you may also need to use a lubricant that is preservative-free, as preservatives attach to the contact lens and damage the eye. These types of eye drops may be more expensive.

If you have any difficulty putting in your drops, please discuss this with your doctor.

'Oily' tear eye drops

Eye drops that replenish the oily part of the tear film and reduce evaporation from the surface of the eye are also increasingly used. These preparations include synthetic guar gums or liposomal sprays.

Liposomal sprays are over-the-counter medications and do not require a prescription. They are sprayed onto the edges of your eyelids when your eyes are closed. When you open your eyes, the solution spreads across the surface of the eye, creating a new oily film.

Oily tear drops are particularly useful if you have blepharitis (inflammation of the rims of the eyelids) or dry eye syndrome caused by your tears evaporating too quickly. 

Eye ointments

Eye ointments can also be used to help lubricate your eyes and help keep them moist overnight because your tears can evaporate while you sleep if your eyes are not fully closed.

These ointments tend to be used overnight because they can cause blurred vision.

If you wear contact lenses, do not use eye ointments while wearing them. Ask your pharmacist or GP for advice about alternative treatments that may be suitable for you.

Anti-inflammatory treatments

The underlying problem with long-term dry eye syndrome is inflammation in and around the eye. Therefore, one of the anti-inflammatory treatments mentioned below may also be recommended.

Corticosteroid eye drops and ointments

Corticosteroids are powerful anti-inflammatory medications that can be given as eye drops or ointments in severe cases of dry eye syndrome. They have side effects such as cataract formation and raising the pressure within the eye in about one in every three people. This group of treatments should only be used if you are being supervised by an ophthalmologist in an eye clinic.

Oral tetracyclines

Low doses of medications called tetracyclines can be used as anti-inflammatory agents for a minimum of three to four months, sometimes much longer.

The most common tetracycline used is doxycycline, but others such as oxytetracycline and lymecycline are sometimes prescribed.

Ciclosporin eye drops

Ciclosporin is a medication that suppresses the activity of your immune system and is sometimes used in the treatment of dry eye syndrome.

However, this treatment is only available through a hospital eye department.

Autologous serum eye drops

In very rare cases, where all other medications have not worked, autologous serum eye drops may be required.

Special eye drops are made using components of your own blood. It is only available from the National Blood Service through an ophthalmologist and after funding is approved.

To make autologous serum eye drops, one unit of blood is taken under sterile conditions (as for regular blood donation). The blood cells are then removed and the remaining serum is put into eye drop bottles. Because of quality standards, this process can take several months before the treatment is finally available to use.

Surgery

If your dry eyes are severe and fail to respond to other forms of treatment, surgery may be an option. Two types of surgery sometimes used to treat dry eye syndrome are described below.

Punctal occlusion

Punctal occlusion involves using small plugs called punctal plugs to seal your tear ducts. This means your tears will not drain into the tear ducts and your eyes should remain moist. 

Temporary plugs made of silicone are normally used first to determine whether the operation has a positive effect. If it does, more permanent plugs can replace the silicone ones.

In more severe cases, the tear ducts are cauterised (sealed using heat). This permanently seals the drainage hole to increase the amount of tears on the surface.

Salivary gland autotransplantation

Salivary gland autotransplantation is an uncommon procedure that is usually only recommended after all other treatment options have been tried.

This procedure involves removing some of the glands that produce saliva from your lower lip and placing them under the skin around your eyes. The saliva produced by the glands acts as a substitute for tears.