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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.