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Ultimate Starter Guide to Dry Eye

Dry eye is one of the most common eye conditions in our practice. Eye dryness is closely related to blepharitis or inflammation of the eyelids. The eyelids are like the windshield wipers of the eye, so it makes sense that problems with your eyelids can also result in dry eye symptoms. Dry eye and blepharitis are inter-related conditions; fortunately, the treatments for both dry eye and blepharitis overlap.

Dry eye exam with eye doctor

Sufferers of dry eye and ocular surface diseases report a wide range of symptoms, from tired eyes to burning, redness, itching, pain, and blurry vision. While there is no cure for dry eyes, there are many things we can do to manage the illness and improve how your eyes feel. The best treatment for dry eyes is the least amount of treatment that gets your eyes feeling better. Unfortunately, we cannot cure dry eyes, so the treatments aim to manage the symptoms, and ongoing maintenance treatment for dry eyes is required. That is, if the treatment is stopped, the symptoms return.


DO DRY EYES CAUSE BLURRY VISION?

The answer to this is overwhelming, YES! Let me explain. The eye's surface is kind of like the windshield of your car. Imagine you're driving your car. You pull the little lever to spray washer fluid on your windshield, but you don't have enough left. What happens? Your view through the windshield is blurred. The surface of your eye works the same when it's dry. Every time you blink, your eyelids (the windshield wipers) smear the tears around, but if there aren't enough tears (washer fluid), you cannot see clearly.

WHAT IS THE MAIN CAUSE OF DRY EYES?

The most recent report from world's dry eye experts at the Tear Film and Ocular Surface Society tells us that the primary reason people have eye dryness is that the tears on the surface of their eyes evaporate too fast. Less common reasons you could have dryness are because you do not naturally produce enough tears or a combination of low tear production and fast evaporation(1).

Dry eye is considered a multifactorial illness. Not just one thing that causes dry eye, but many things play against each other that result in you experiencing eye dryness. Some of the things that can increase your chances of having dry eyes are(1):

  • Advancing age

  • Female assigned sex at birth

  • Race - people from the Asian subcontinent more often have dry eye

  • General medical conditions - autoimmune diseases, hormone replacement, stem cell transplants, diabetes, thyroid disease

  • Medicine - antihistamines, antidepressants, anti-epilepsy drugs, Accutane

  • Smoking

  • Environment - computer use, air conditioning, forced-air heating.

WHAT IS THE BEST TREATMENT FOR DRY EYES?

Your treatment needs to be tailored to your specific needs for the best results. We recommend having a consultation with one of our eye doctors <book appointment> to get personalized recommendations for your dry eye.

However, we recommend some essential starting points that are effective for most people. These starting points have good-quality evidence from the Tear Film & Ocular Surface Society's Dry Eye Workshop Reports. If you have been employing these strategies for a couple of months and are not enjoying relief from your dry eye, follow up with our eye doctors to have a more customized treatment for your dry eye.

  1. Change your local environment. Examples include increasing the humidity in your home or sleeping with a humidifier by your bed, aiming the heating and air conditioning vents away from your face, adjusting the height of your computer monitor lower (so your eyes are more closed when you use the computer), and taking frequent breaks to rest your eyes.

  2. Discuss your dryness with your family doctor. Ask about the possibility of some of your medical conditions or the medicines used to treat your conditions that can worsen your dry eyes. It should go without saying but do not make any adjustments to your medications without consulting your family doctor.

  3. Supplement with omega-3 fatty acids. The research on omega-3s and dry eye disease is inconsistent(2). There is about as much data proving it helps dry eyes as there is proving it doesn't help dry eyes. However, in general, we could use more omega-3 in our diet. We recommend 1500mg to 2000mg of omega-3 daily. If you take any type of medicine that works as a blood thinner, speak with your family doctor before starting a high dose of omega-3 supplement.

  4. Warm compresses. Warm compresses for 10 minutes every day have enormous benefits for dry eyes. There are some finer points to getting the most bang for your buck from a warm compress. Check out my other post about warm compresses for more details.

  5. Over-the-Counter Lubricating eye drops. There are so many different types of lubricating eye drops it's hard to recommend just one. Right now, the best OTC eye drops we recommend are Thealoz Duo, iDrop MGD, or Hylo Gel. If you're not sure which one is best for you or where to get your hands on a bottle of these drops, book an appointment with one of your eye doctors, and we can point you in the right direction.


Regardless of which eye drop you choose, stay away from the Visine or Clear Eyes type of eye drops. While these drops make your eyes look white, they do nothing to treat the dryness of your eyes that is ultimately causing the redness. Worse, if you take these drops too often, they can make your eyes redder than before (3).

HOW MANY TIMES A DAY CAN YOU USE LUBRICATION DROPS?

Well, it depends on the drops that you're using. Suppose you use a preserved lubrication drop (for example, Systane Ultra, Refresh, TheraTears). In that case, you should not use it more than four times a day. Suppose you are using a preservative-free drop, which may come in a single-use vial or a multiple-dose bottle, depending on the brand. In that case, you can use it as many times as you need to feel comfortable. However, if you need the drop more often than four times a day, ask us, your eye doctors, about what other treatment options are available.

THE BASIC TREATMENT DOESN'T WORK FOR ME; WHAT ADDITIONAL TREATMENTS ARE THERE FOR DRY EYE?

We eye doctors have many tricks up our sleeves to help dry eyes. Additional treatments include eyelid cleaning, prescription medicine, or in-office treatments such as intense pulsed light (IPL)(6) and radiofrequency (RF).


The old school recommends diluted baby shampoo, 1 part shampoo in 10 parts water and scrubbing the lids and lashes with that solution. Nowadays, we have many more effective and gentler products that can help dry eye sufferers with blepharitis. We have pre-moistened eyelid hygiene products (think wet naps but safe for your eyes). Your eye doctor will recommend specific formulas based on what we see when we look at your eyes under the microscope. Stay tuned for future posts about the different eyelid cleaning products currently available.

Several prescription medicines can be used. They range from medicated eye drops to skin creams to oral medicines (pills) that all help get the dry eye inflammation on the surface of the eye under control. If you have been suffering from very severe eye dryness, we can get eye drops made from your own blood, which works really well to heal the surface of your eye.


Lately, eye doctors have learned from other doctors who noticed cosmetic skin treatments have massive benefits if you suffer from dry eyes. Those are intense-pulsed light (IPL) and radiofrequency (RF). So far, these treatments have been proven to be very effective at helping your dry eye symptoms. IPL and RF also have the added benefit of reducing the fine lines and blemishes around the eyes.


If you're interested in exploring these and other advanced dry eye treatments, book a consultation with us to get the conversation started.

DOES DRINKING WATER HELP DRY EYES?

Drinking water and improving your overall hydration might help dry eyes, but we're not 100% sure. This study found that drinking water improved the situation in your tears (4). Other researchers found that dry eye sufferers were more likely to be dehydrated (5). However, there isn't much evidence that proves drinking water will improve your dry eyes. That being said, couldn't we all stand to drink a little more water?


We hope you found this information helpful to jump start your dry eye treatment on the right track. Stay tuned for more information, updates, and product reviews for your dry eyes.


References:

  1. Craig JP, Nelson JD, Azar DT, et al. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017;15(4):802-812. doi:10.1016/j.jtos.2017.08.003

  2. Ton J, Korownyk C. Omega-3 Supplements for Dry Eye: Fishy Evidence or a Big Catch. Edmonton, Canada: Alberta College of Family Physicians; 2018.

  3. Hosten LO, Snyder C. Over-the-Counter Ocular Decongestants in the United States - Mechanisms of Action and Clinical Utility for Management of Ocular Redness. Clin Optom (Auckl). 2020;12:95-105. Published 2020 Jul 23. doi:10.2147/OPTO.S259398

  4. Fortes M.B., Diment B.C., Di Felice U., Gunn A.E., Kendall J.L., Esmaeelpour M., et al.: Tear fluid osmolarity as a potential marker of hydration status. Med Sci Sports Exerc 2011; 43: pp. 1590-1597.

  5. Walsh N.P., Fortes M.B., Raymond-Barker P., Bishop C., Owen J., Tye E., et al.: Is whole-body hydration an important consideration in dry eye?. Invest Ophthalmol Vis Sci 2012; 53: pp. 6622-6627.

  6. Leng X, Shi M, Liu X, Cui J, Sun H, Lu X. Intense pulsed light for meibomian gland dysfunction: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2021;259(1):1-10. doi:10.1007/s00417-020-04834-1