When Artificial Tears Are Not Enough

With Optometrist Dr. Jeff Sakai……

The most common medical condition that I diagnose and treat in my clinic is dry eye disease (DED), which is particularly common in patients with autoimmune diseases like Sjögren’s syndrome and lupus. Dry eye patients complain of a number of symptoms, including eye irritation, redness, burning, itching, mucus discharge, pain, blurred vision, contact lens intolerance, and even excessive watering. The severity of the symptoms can range from very mild to debilitating. It is important to note that DED is truly a “disease,” and that it is often incurable and can get progressively worse with age.

There are two major types of DED: aqueous-deficient and evaporative. In aqueous-deficient dry eye, the lacrimal glands in the eyelids do not produce sufficient amounts of the watery component of tears. In evaporative dry eye, the meibomian (oil-producing) glands in the eyelids do not function properly, resulting in unstable tear films that evaporate quickly. The ideal treatments for DED largely depend on the category of the condition. Unfortunately, many patients believe that the only treatment is artificial tears and they continue to suffer if that does not adequately resolve their symptoms. The following are some of the common treatments that can be used for DED when artificial tears are not sufficient.

Prescription Eye Drops. There are a number of topical prescription medications that may help with DED, particularly with the aqueous-deficient variety. This category of dry eye is characterized by inflammation of the lacrimal (tear-producing) gland as well as other external structures of the eye. Corticosteroid eyedrops (like loteprednol etabonate) can reduce inflammation and irritation symptoms. They are typically prescribed over a short time period because there are some risks associated with long term use, including cataracts and glaucoma. Alternatively, Restasis (cyclosporine) eye drops are safe for long-term use and work by reducing inflammation, which can increase the eye’s natural production of tears. Corticosteroids and cyclosporine are sometimes used together to treat DED.

Punctal Plugs. These are tiny devices that are inserted into the tear ducts by your doctor. They can help with aqueous deficiency because they block the tear drainage, so the eyes retain more of their natural moisture. Punctal plugs can either be temporary (dissolvable) or permanent.

Eyelid Massage and Warm Compresses. Evaporative dry eye is primarily caused by blocked and inflamed meibomian (oil-producing) glands in the eyelids. A warm and wet washcloth can be used to massage the closed eyelids, which help open up the plugged glands and allow for adequate oil production. This helps protect the tear film from evaporation, resulting in moisture retention.

Dietary Changes and Supplements. Numerous studies have shown that consumption of omega-3 fatty acids can improve dryness symptoms by reducing eye inflammation. Cold-water fish like salmon, cod and sardines are known to be high in omega-3s. Flaxseed is a good plant-based source as well. Fish oil and flaxseed oil supplements are available for those patients who are unable to obtain enough omega-3s with dietary changes alone. Make sure to consult with your doctor prior to starting omega-3 supplementation, as there can be side effects or drug interactions.

Oral Antibiotics. Certain oral antibiotics, like the tetracyclines (including doxycycline and minocycline), have been found to be effective in treating meibomian gland dysfunction. When used in conjunction with warm compresses, these medications can reduce eyelid inflammation and dry eye symptoms. These are prescription medications, so they must be prescribed by your doctor.

In moderate or severe dry eye disease, artificial tear supplementation alone is often not enough to relieve the symptoms. As you can see, there are a number of alternative mainstream treatments that can be tried, often in conjunction with each other. I recommend that you speak to your doctor about your specific symptoms so that an appropriate treatment regimen can be tailored for your unique condition. There are also many behavioral and environmental changes that you can make yourself that can help your dry eye disease. This will be discussed in a future blog post.

Please make sure to consult your eye doctor to discuss the best management options for you.

Remember everyone’s body is different and unique. Always discuss any areas of concern about your autoimmune disease with your doctor.

Take care!

Dr. Jeff Sakai

For more information or to contact Dr. Jeff Sakai, please visit him at: www.sakaioptometry.com.