Effective Treatments for Dry Eye Syndrome: Beyond Artificial Tears

Vision problems

I am experiencing stinging in my eyes, tearing, and blurred vision.
After an examination, the doctor diagnosed me with dry eye syndrome and prescribed artificial tears and a moisturizing solution, but I still experience stinging and tearing.
Are there any better treatment options available?

Ms. Chen, 30~39 year old female. Ask Date: 2005/02/25

Dr. Lin Zhengyi reply Ophthalmology

Hello! The tear film on the surface of the eye is primarily composed of three layers: the outermost lipid layer, the middle aqueous layer, and the innermost mucin layer.
Generally, dry eye syndrome refers to insufficient secretion of the aqueous layer.
Tear secretion includes both basal secretion and reflex secretion; the former refers to the normal amount of tear production under resting conditions, while the latter refers to the amount produced in response to irritation of the eye.
Most cases of dry eye syndrome are due to insufficient basal secretion, while reflex secretion remains normal.
Therefore, patients with dry eye syndrome may still experience mild tearing in response to eye irritation.
For these patients, using artificial tears or ointments can alleviate symptoms.
In more severe cases of dry eye syndrome, the use of punctal plugs may be considered to reduce tear loss, protect the eyes from wind exposure, and maintain indoor humidity.
Patients with dietary habits that lead to deficiencies may benefit from vitamin A supplementation (such as cod liver oil or dark vegetables and fruits).
Additionally, it is important to check for other ocular conditions such as entropion, corneal disease, or blepharitis and provide appropriate treatment.
Thank you!

Reply Date: 2005/02/25

More Info

Dry Eye Syndrome (DES) is a common condition that can significantly impact a person's quality of life. It occurs when the eyes do not produce enough tears or when the tears evaporate too quickly. Symptoms can include dryness, irritation, burning sensations, and blurred vision. While artificial tears are often the first line of treatment, there are several other effective options to consider if artificial tears are not providing sufficient relief.

1. Punctal Plugs: These are small devices inserted into the tear ducts to block drainage, thereby keeping tears on the surface of the eye longer. This can be particularly beneficial for individuals with moderate to severe dry eye symptoms. The procedure is minimally invasive and can be performed in a doctor's office. There are both temporary and permanent options available.

2. Prescription Medications: If over-the-counter artificial tears are not effective, your doctor may prescribe medications to help manage dry eye symptoms. One common medication is cyclosporine A (Restasis), which helps increase tear production. Another option is lifitegrast (Xiidra), which reduces inflammation and may also improve tear production.

3. Anti-inflammatory Treatments: Inflammation of the ocular surface can contribute to dry eye symptoms. Corticosteroid eye drops may be prescribed for short-term use to reduce inflammation. However, long-term use of steroids is generally not recommended due to potential side effects.

4. Scleral Lenses: As you mentioned, scleral lenses, such as the PROSE lens developed by the Boston Foundation for Sight, can provide significant relief for patients with severe dry eye. These lenses vault over the cornea and create a reservoir of fluid that keeps the eye moist. They can be particularly beneficial for individuals who have not found relief with traditional treatments.

5. Environmental Modifications: Simple changes in your environment can help alleviate dry eye symptoms. Using a humidifier, avoiding direct airflow from fans or air conditioning, and taking regular breaks from screens can help reduce dryness. Additionally, wearing sunglasses or goggles outdoors can protect your eyes from wind and sun exposure.

6. Dietary Supplements: Omega-3 fatty acids, found in fish oil and flaxseed oil, have been shown to improve dry eye symptoms in some patients. These supplements can help improve the quality of tears and reduce inflammation. It’s advisable to consult with a healthcare provider before starting any new supplements.

7. Warm Compresses and Eyelid Hygiene: Regularly applying warm compresses can help unclog blocked meibomian glands, which are responsible for producing the oily layer of tears. This can improve the overall quality of tears and reduce evaporation. Additionally, maintaining eyelid hygiene by cleaning the eyelids with specialized wipes or diluted baby shampoo can help manage symptoms.

8. Neurological Evaluation: As suggested by your doctor, if your symptoms are severe and do not correlate with the observed signs of dry eye, it may be beneficial to consult a neurologist. Some patients experience dry eye symptoms due to neurological issues that affect tear production or sensation in the eye.

In summary, while artificial tears are a common treatment for dry eye syndrome, there are numerous other options available that can provide relief. It is essential to work closely with your eye care provider to determine the most appropriate treatment plan based on the severity of your symptoms and any underlying conditions. By exploring these various options, you can find a more effective strategy to manage your dry eye symptoms and improve your overall eye health.

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