If your eyes are super sensitive to wind or heat, and get itchy and irritated easily, there is a high probability that you have developed dry eyes, also referred to as dry eye syndrome or keratoconjunctivitis.
Depending on its cause and severity, it may not be completely curable, but in most cases, dry eyes can be managed successfully, usually resulting in noticeably greater eye comfort, fewer dry eye symptoms, and sometimes sharper vision as well.
If you have developed dry eyes, there are effective home remedies to cure or significantly improve them by replenishing the moisture in your eyes, and restore their proper functioning.
What is Dry Eye?
Dry eye is a condition where an individual is unable to produce enough tears to lubricate or nourish the eyes.
People of both sexes, of all ages, and of all racial backgrounds can experience dry, itchy eyes, ranging from mild to severe. In fact, dry eye is the most common complaint that eye doctors hear from patients.
Dry eye occurs when your tear glands run out of tears or when your tears evaporate too quickly. Your eyes always need a layer of tears coating them to keep them lubricated and avoid the entry of dust and other irritants. A lack of this layer can lead to dry eyes and irritation.
Symptoms of Dry Eye
Symptoms typically include irritation, dryness, burning, grittiness, difficulty reading for long periods of time, and even though it may seem contradictory, excessive watering or tearing as the eyes attempt to solve the problem.
Common Causes of Dry Eye
There are three interrelated layers of the “tear film” – the moisture laden surface of the eye and continuity of that surface and the production of tears relies on the function of three interrelated layers:
- The mucus layer which has some anti-microbial properties.
- The watery layer, which is slightly alkaline, comprises up 90% of the thickness of the tear film.
- The oily layer which slows evaporation of the tear film.
Blinking renews the tear film by bringing material from the watery and oily layers removing debris. While normal blink rate is about 10-12 blinks per minute, when working on the computer our blink rate often slows.
After about 10 seconds the tear film becomes unstable – leading to tired, dry eyes. This is also partially true when the blink is incomplete – not fully covering the cornea.
It’s the cornea that tells the brain to send messages to the body to produce more or less tears and when to blink.
Any disruption in the tear production process, known as aqueous tear-deficient dry eye (where the lacrimal glands don’t produce enough tear fluid) can cause dry eye, such as:
Lasik surgery temporarily disrupts the normal activity of the tear film mechanism. Also, during LASIK, about 60-70% of the superficial nerve fibers in the cornea are cut, which affects both sensing of dryness and production of aqueous tears.
As a result the rate of blinking can slow so much that the tear film deteriorates before the next blink reconstitutes it. The end result may be many months of mild to severe symptoms.
Eventually, this situation usually heals itself.
Tear Evaporation, known as evaporative dry eye, may result from meibomian gland inflammation.
Blepharitis with inflamed eyelids can cause dry itchy eye symptoms.
Computer users tend to blink much less frequently (about 3-4 times per minute verses the normal about 10-15 times per minute). This causes increased tear film instability and evaporation accompanied by eye strain and fatigue that comes of staring at a computer screen.
The position of the monitor should be below eye level allow the upper eyelid to cover more of the eye’s surface protecting the tear film from evaporation.
Other diseases that may be connected to dry eyes are diabetes, (especially with high blood sugar), migraine headaches, rheumatoid arthritis, thyroid disease, asthma, lupus, and possibly glaucoma.
Dry itchy eyes are experienced by 75% of those over 65, by which time you have 40% of the volume of tear film that you had when you were 18.
Women’s Hormonal Changes
Women’s hormonal changes can cause lowered tear production. During the first part of the menstrual cycle, when estrogen production is at its peak, dry eye symptoms increase. Hormonal changes during pregnancy also worsen dry eye conditions.
Post menopause gives rise to a decrease in estrogen production, which has been linked to poor functioning of the meibolian gland, which lies on top of the tear film and protects the tear film from rapid evaporation.
Other causes for dry eyes are smoking, drinking a lot of coffee, wearing contact lenses, being in air-conditioning or heated places with low humidity.
Vitamin D Deficiency
Studies show that vitamin D deficiency is associated with eye pain, inadequate tear film, and unstable tear film. Vitamin D has numerous health benefits, and it can be difficult to get enough through sun exposure. Consider taking a vitamin D supplement.
Drugs Which Can Cause Dry Eye
Drugs which can cause dry eye include:
- Appetite suppressants
- Birth control pills
- Blood pressure medications
- Over-the-counter drugs to “remove red” from eyes
- Ulcer medications
Dry eye can also be triggered by dry windy weather or cold temperatures. Below 30° C (86° F), the outermost layer of the tear film, the oily meibum layer, is stiff and may not adequately cover and protect the tear film. When that happens the tear film evaporates very quickly.
Diagnosing Dry Eye
There are a number of tests used by eye doctors to find the source of problems – which layer of the tear film is involved:
- Schirmer tear test (commonly used in dry eye research)
- Tear film break-up time (10 seconds) (commonly used in dry eye research)
- Conjunctival impression cytology (commonly used in dry eye research)
- Rose Bengal staining pattern
- Tear Osmolarity
- Tear protein levels (lactoferrin and lysozyme)
- Presence of corneal filaments
- Evaluation of debris in tear film
Treatment for Dry Eye
Your eye doctor may recommend only one of these dry eye treatments or a combination of treatments, depending on the cause(s) and severity of your condition.
Also, some eye doctors will have you complete a questionnaire about your symptoms prior to initiating dry eye treatment. Your answers to this survey are then used as a baseline, and the questionnaire may be administered again after several weeks of treatment to evaluate the effectiveness of the chosen treatment approach.
Artificial tears are usually the first step in dry eye treatment. For mild cases of dry eyes caused by computer use, reading, schoolwork and other situational causes, the best dry eye treatment may simply be frequent use of artificial tears or other lubricating eye drops.
There are many brands of artificial tears that are available without a prescription. The challenge with using artificial tears is not lack of product availability — it’s the confusing number of brands and formulations available to choose from.
Artificial tears and other over-the-counter (OTC) lubricating eye drops are available in a wide variety of ingredients and viscosity (“thickness”).
Artificial tears with low viscosity are “light” and watery. They often provide quick relief with little or no blurring of your vision when you apply them. But often their soothing effect is very short-lived, and sometimes you must use these drops very frequently to get adequate dry eye relief.
On the other hand, artificial tears that have a high viscosity are more gel-like and can provide longer-lasting lubrication. But typically these drops cause significant blurring of your vision for several minutes immediately after you apply them. For this reason, these drops often are not a good choice for use during your work day or when you need immediate clear vision for tasks such as driving. Instead, high-viscosity artificial tears are recommended only for bedtime use.
Also, the ingredients in certain brands of artificial tears may determine which type of dry eye condition they are better suited for. For example, one brand might work better for aqueous-deficiency dry eyes, while another brand may be more effective for an evaporative dry eye condition.
Which Artificial Tears are Best?
One thing on which experts agreed is that benzalkonium chloride (BAK), often used as a preservative in eye drops, has the potential to make matters worse.
“BAK is an older chemical preservative that has some serious side effects,” says Dr. Melissa Barnett, a doctor of optometry in Sacramento, California. “If BAK is used daily, it may increase dryness and intensify the inflammation of a previously compromised ocular surface.”
Since inflammation and dryness are both things that you’re hoping to alleviate, it doesn’t make much sense to compound the problem with BAK, especially when a new generation of much gentler preservatives is available.
There are actually two types of lubricating drops:
- Aqueous drops replenish the watery inner layer of your tear film, while
- lipid-based drops fortify the outer layer of oil that keeps the water from evaporating.
- Dryness can occur when there’s too little of either component.
So which type do you need? It depends on the cause of your dryness.
A medical diagnosis can tell whether your dryness is caused mainly by tear evaporation (which requires a lipid drop) or a lack of tear production (for which an aqueous drop is better).
Aqueous drops are the most likely to provide temporary relief, since water will probably be missing in either scenario. But if aqueous drops don’t seem to be helping much, or if you’ve been instructed by your doctor, it might be time to move on to lipid-based drops.
Dr. Surendra Basti, ophthalmologist at Northwestern Memorial Hospital, confirmed this:
“Without knowing the particular cause of the dryness, I would recommend aqueous tears to start. They tend to be absorbed faster and have less clouding and blurring than lipid-based tears.”
But he notes, “that doesn’t necessarily mean they’ll be sufficient in the long term.”
Blink Tears (Aqueous Drops)
If you’re looking for a gentle way to treat dryness, Blink Tears is a safe bet: aqueous artificial tears whose main active ingredient, polyethylene glycol, mimics your eyes’ natural mucous membranes to relieve irritation.
Users say they absorb rapidly without any cloudiness or irritation.
Blink Tears really stands out because it contains sodium hyaluronate, a lubricant that’s produced naturally by our eyes in response to ocular surface damage.
Sodium hyaluronate helps control inflammation, retain water, and lower viscosity when you blink — which decreases the sensation of having “something in your eye.”
The preservative in Blink Tears’ multi-dose bottle is also one of the gentlest on the market.
Manufactured under the brand name OcuPure, it’s what’s known as an oxidative preservative. Unlike more common chemical preservatives, oxidative preservatives break down into natural tear components when exposed to light, which means they don’t linger in the eye.
By contrast, Bausch & Lomb’s Soothe Hydration Lubricant Eye Drops — another aqueous drop — uses the chemical preservative edetate disodium, which has been shown to be at least mildly toxic to eye cells.
Dr. Whitney Hauser, doctor of optometry at the Southern College of Optometry, points out that
“while oxidative preservatives tend to be more gentle than chemical ones, both are still preservatives, and preservative-free is the most gentle to the ocular surface.”
Fortunately, Blink Tears also offers a preservative-free formula that has the exact same active ingredients, though it is a little pricier.
Both versions of Blink Tears are easy to apply: the multi-dose bottle squeezed out individual drops with no squirting or leaking, and the preservative-free vials had caps that twisted off easily, creating a tiny “bottle” that dispensed its tears evenly.
Bausch & Lomb Sooth Preservative-Free Lubricant Eye Drops (Lipid Drops)
Another excellent choice is Bausch+ Lomb Sooth Preservative-Free Eye Drops. The lipids in these drops help thicken the outer layer of your tear film to keep moisture from escaping, which is sometimes the underlying problem.
You typically don’t need to use lipid-based drops quite as often as aqueous drops since they don’t evaporate as rapidly. But because B+L Soothe is preservative-free, it’s gentle enough to be used on a regular basis — and despite being preservative-free, it’s around the same price as many of the preserved drops.
Instead of OTC artificial tears (or in addition to them), your eye doctor might recommend daily use of a prescription eye drop called Restasis (Allergan) for your dry eye treatment.
Restasis does more than simply lubricate the surface of your eye. It includes an agent that reduces inflammation associated with dry eye syndrome and helps your body produce more natural tears to keep your eyes moist, comfortable and healthy.
It’s important to know, however, that the therapeutic effect of Restasis is not immediate. You must use the drops daily for a minimum of 90 days to experience the full benefits of this dry eye treatment.
A significant percentage of people who try Restasis will experience burning eyes early during the first few weeks of treatment.
In July 2016, Shire announced it received FDA approval to market its new Xiidra (ZYE-druh) prescription eye drops for the treatment of dry eye in the United States.
Xiidra, like Restasis, is aimed at reducing inflammation that is associated with the signs and symptoms of dry eyes.
The safety and efficacy of Xiidra was studied in four placebo-controlled, 12-week clinical trials that included 1,181 people with dry eyes. Participants were evaluated for dry eye signs and symptoms just prior to starting use of the drops, then after two weeks, six weeks and 12 weeks of Xiidra use.
In two of the four studies, participants noticed a significant reduction in dry eye symptoms after using Xiidra for two weeks. In all four studies, participants noticed a larger reduction in dryness symptoms after six weeks and 12 weeks of Xiidra use.
Also, at 12 weeks, a statistically significant reduction in signs of dry eyes was found among Xiidra users compared with participants given a placebo in two of the four studies.
The most common side effects of Xiidra reported in the studies were eye irritation, altered taste sensation and reduced visual acuity, which occurred in 5 to 25 percent of participants.
The recommended dosage for Xiidra, like Restasis, is two applications in each eye per day, approximately 12 hours apart.
Steroid Eye Drops
Over the past several years, doctors have discovered the importance of inflammation as a cause of dry eyes. Inflammation frequently causes the redness and burning associated with dry eye disease; but in many cases, it may be present without any visible signs or symptoms at all.
Artificial tears usually do not adequately address these inflammatory changes, and your doctor may recommend prescription steroid eye drops to better manage the underlying inflammation associated with dry eyes.
Steroid eye drops are generally used short-term to quickly manage symptoms. They are often used in conjunction with artificial tears and Restasis, as a complement to these more long-term treatment strategies.
While a small amount of the steroid may get absorbed systemically, in the right candidate, the effects of steroid eye drops are generally not noticed beyond the eye. Still, it’s important to discuss your medical history with your eye doctor before starting steroid eye drops.
Many different types of steroid drops are available and differ in their potency. Most doctors prefer to start with mild steroids that are quickly degraded inside the eye. In some cases, however, more potent drops are required to address more severe symptoms.
Steroid eye drops can increase the risk of developing high eye pressure or even cataracts if used for extended periods of time. But these risks are low when the drops are used only on a short-term basis for dry eye treatment.
Lacrisert (Bausch + Lomb) is a sterile, slow-release lubricant that is placed under the lower eye where the conjunctiva of the inside of the eyelid meets the conjunctiva of the eyeball (this location is called the inferior cul-de-sac of the eye).
Lacrisert is a solid insert composed of a preservative-free lubricating agent (hydroxypropyl cellulose) that slowly liquefies over time, providing an all-day moistening effect.
For most people with dry eyes, a single Lacrisert is applied once a day. The device has been proven to relieve dryness, burning, watery eyes, foreign body sensation, itching, light sensitivity and blurred vision, according to the company.
Lacrisert typically is recommended for patients with moderate to severe dry eye symptoms, especially if dry eye treatment with artificial tears alone proves unsuccessful.
If improperly placed in the inferior cul-de-sac of the eye, it’s possible Lacrisert could cause a corneal abrasion. Also, Lacrisert may cause transient blurred vision, eye discomfort or irritation, matting or stickiness of eyelashes, red eyes and sensitivity to light.
Punctal plugs are sometimes used in dry eye treatment to help tears remain on the surface of the eye longer.
A punctal plug is a small, sterile device that is inserted into one of the small openings (puncta) of tear drainage ducts that are located in the inner corner of the upper and lower eyelids.
After these openings have been plugged, tears can no longer drain away from the eye through these ducts. In this way the tear film stays intact longer on the surface of the eye, relieving dry eye symptoms.
So where do the tears go? Usually they will simply evaporate from the eye surface without symptoms. But if insertion of punctal plugs causes the eyes to “water,” one or more of the plugs can be removed.
Meibomian Gland Expression
A very significant percentage of dry eye cases are caused by inadequate oil (meibum) being secreted from meibomian glands located along the margin of the eyelids.
The openings of these glands are near the base of the eyelashes, and if these openings get clogged, the oil that is critical to keeping the tear film from evaporating too quickly cannot do its job. This is called meibomian gland dysfunction (MGD), which leads to a condition called evaporative dry eye.
To treat MGD and evaporative dry eye, your eye doctor may perform an in-office procedure called meibomian gland expression.
In this procedure, warm compresses may or may not first be applied to your eyelids; then a forceps-type device is used to squeeze the clogged contents (hardened meibum and possibly other substances) from the meibomian glands.
To fully express the contents of the meibomian glands and get them functioning properly, significant pressure must be applied to the eyelids, which can be uncomfortable. But the results usually are worth putting up with the short-term discomfort of the procedure.
An alternative (and potentially more comfortable) way to help open clogged meibomian glands to treat dry eyes is to simply apply warm compresses to the closed eyelids to soften the hardened meibum.
Unfortunately, for warm compresses to work well, some researchers say you have to use a compress that can maintain a temperature of 108 degrees Fahrenheit for more than 10 minutes, and the compresses have to be applied for this length of time at least twice a day.
Most people are unable or unwilling to perform this type of dry eye treatment correctly, and shorter and less frequent use of variable-temperature warm compresses typically is ineffective.
The LipiFlow Thermal Pulsation System (TearScience) is an automated, in-office dry eye treatment that combines the best features of warm compress therapy and meibomian gland expression.
The patented device fits onto the eye and also over the eyelids and applies precisely controlled heat to the lids to soften hardened meibum.
At the same time, the LipiFlow system applies pulsed pressure to the eyelids to open and express clogged meibomian glands, thereby restoring the correct balance of oils in the tear film to relieve dry eye syndrome.
Lipiflow treatment takes approximately 12 minutes per eye. In a clinical study of the effectiveness of the procedure, most patients (76 percent) reported improvement of their dry eye symptoms within two weeks, and patients also showed improvement in the quality and quantity of meibomian gland secretions and the duration of time their tear film remained on the eye before evaporating. In some cases, however, it can take a few months for improvements to become apparent.
Typically, the beneficial effects of the LipiFlow procedure last one to three years or longer.
Potential side effects from LipiFlow dry eye treatment include corneal abrasion, eye pain, swollen eyelids, eyelid irritation or inflammation, chalazion, transient blurred vision, itching, and red eyes.
LipiFlow dry eye treatment typically is not covered by health insurance. Fees for the procedure can vary from one practitioner to another and tend to range from $700 to $900 per eye.
Intense Pulsed Light
For well over a decade, the FDA has approved the use of intense pulsed light (IPL) to treat rosacea on the skin. Rosacea on the skin and eyelid often occur together.
Ocular rosacea presents with dilated small blood vessels coursing along the eyelash margin in patients suffering from blepharitis and may contribute to dry eye symptoms.
In IPL treatment, a hand-held device flashes bright light onto the skin. The light is filtered to allow only wavelengths that can be absorbed by the dilated blood vessels. The effect of this treatment may be the resolution of the dilated vessels and associated inflammation.
Many patients experience relief from their dry eye symptoms and become less dependent on artificial tears and other eye drops to control dry eye symptoms after IPL therapy. For this reason, IPL treatment may be well-suited for dry eye patients who don’t want to be troubled by the inconvenience of frequent eye drop use.
Patients usually require four to six intense pulsed light treatments, with about one month between each treatment.
Typically, the treatments are well-tolerated and are not associated with any down-time. However, prior to the treatment it’s important to discuss with your doctor how much time you spend in the sun.
IPL treatment generally is not covered by health insurance or vision insurance and it may not be appropriate for patients with certain skin pigmentations.
Home Remedies for Dry Eyes
If you have mild dry eye symptoms, there are several things you can try to get relief before going to the eye doctor:
Doctors sometimes recommend nutritional supplements as part of a holistic dry eye treatment plan. Studies have found that supplements containing omega-3 fatty acids can decrease dry eye symptoms.
The National Eye Institute notes that in some patients with dry eye, supplements or dietary sources of omega-3 fatty acids (such as tuna fish) may decrease symptoms of irritation.
Stephanie Marioneaux, MD, a spokesperson for the American Academy of Ophthalmology, told The New York Times that the omega-3s in fish oil are believed to reduce inflammation.
If inflammation of the eyelids or surfaces of the eye worsens dry eye, it makes sense that a supplement could help the problem. “Dry eye is pretty complex, and there is no cure,” she said. “Treating the inflammation, however, can improve some of the symptoms.”
A study of more than 32,000 women from the Women’s Health Study published in 2005 found those who consumed the most omega-3 fish oil had a 17 percent lower risk of dry eye, compared with women who ate little or no seafood. More recently, a study in the International Journal of Ophthalmology concluded omega-3 fatty acids “have a definite role for dry eye syndrome.”
Omega-3 oils may also help in the treatment of other eye diseases. The oils may reduce growth of abnormal blood vessels that occur in age-related macular degeneration and other retinal vascularization diseases.
Good dietary sources of omega-3s include cold-water fish such as salmon, sardines, herring and cod. For a vegetarian source of omega-3s, some eye doctors recommend flaxseed oil to relieve dry eye.
As mentioned earlier, studies show that vitamin D deficiency is associated with an unstable tear film. I think everyone should take a vitamin D supplement, especially if you live in a northern climate, and don’t get much sun.
Of course, drinking more water can help, too. Mild dehydration often makes dry eye problems worse. This is especially true during hot, dry and windy weather.
Blink More Frequently
When using a computer, smartphone or other digital device, we tend to blink our eyes less frequently than normal, which can cause or worsen dry eye symptoms.
Make a conscious effort to be aware of this, and blink more often when using these devices. Also, perform full blinks, gently squeezing your eyelids together to wash your eyes fully with a fresh layer of tears.
Wear Wraparound-style Sunglasses and Eyewear with Side Shields
Take Frequent Breaks During Computer Use
A good rule of thumb here is to look away from your screen at least every 20 minutes and look at something that is at least 20 feet from your eyes for at least 20 seconds.
Some eye care practitioners call this the “20-20-20 rule,” and abiding by it can help relieve both dry eyes and computer eye strain.
Use a Humidifier
Using a humidifier at home and/or at work to keep the air from drying out in the winter. A humidifier puts more moisture in the air. With more moisture in the air, tears evaporate more slowly, keeping your eyes more comfortable.
Also, both furnaces and air conditioners decrease humidity in the air, so a humidifier can replenish a comfortable level of moisture all year round.
Remove Eye Makeup Thoroughly
At the end of the day, be diligent about remove all traces of makeup from your lids and lashes. Use an effective makeup remover which is formulated for sensitive eyes.
I like Marcelle Micellar Solution; it’s a 3-in-1 solution that gently cleanses, smooths skin, and effectively removes makeup from both the face and the eyes.
It’s rinse-free formula is:
- Effective, even on long-wearing and waterproof makeup, the skin is left exceptionally clean, fresh and soothed.
- Hypoallergenic,free of fragrance, parabens, oil, soap, and alcohol
- Tested under ophthalmological control on sensitive skin.
- Suitable for sensitive eyes and contact lens wearers.
Clean Your Eyelids
When washing your face before bedtime, gently wash your eyelids to remove bacteria that can cause blepharitis and meibomian gland problems that lead to dry eye symptoms.
Apply a warm, moist washcloth to your closed lids for a minute or two, then gently scrub your lids and lashes with a mild cleanser, such as diluted baby shampoo or an eyelid cleanser.
Wear Quality Sunglasses
When outdoors during the day, always wear sunglasses that block 100 percent of the sun’s UV rays.
It’s best if they feature a wrap-style frame to protect your eyes from wind, dust and other irritants that can cause or worsen dry eye symptoms.
In addition to the dry eye treatments listed above, your eye doctor may recommend one or more of the following supplemental measures if any of the conditions below apply to you:
Many medicines — including antihistamines, antidepressants, birth control pills, certain blood pressure medications and more — can cause or worsen dry eye symptoms.
Even over-the-counter (nonprescription) medications for allergies and other conditions can cause dry eyes.
Be sure to discuss all medications you are taking with your eye doctor if you are experiencing dry eye problems.
In some cases, adjusting the type and number of medications you are taking may help reduce dry eye symptoms without causing adverse health effects.
However, never discontinue a prescription medication without first discussing the matter with your physician.
If your eye doctor feels an adjustment to one of your medications may help relieve dry eye symptoms, he or she can discuss it with your physician (or have you discuss it with your doctor) to see if such a change is possible.
Treating Eyelid Conditions
If you have blepharitis, meibomian gland dysfunction or other eyelid conditions, these often are associated with dry eye disease and should be addressed as part of your overall dry eye treatment regimen.
For example, if you have blepharitis, your eye doctor may recommend use of an antibiotic and/or steroid ointment or eye drop in addition to daily eyelid cleansing with a non-irritating shampoo.
Discontinuing or Reducing Contact Lens Wear
If you wear contact lenses, it can be difficult to tell if an underlying dry eye condition is causing contact lens discomfort or if your contact lenses are causing dry eye symptoms.
If you wear contacts, it’s often best to discontinue wearing them (or perhaps switch to daily disposable contact lenses for part-time wear only) while your dry eye treatment is in progress.
If you have dry eye, try the home and lifestyle remedies discussed, which are known to help.
- avoiding long episodes of staring at computers/TV screens
- blinking regularly
- using eye drops
- increasing air humidity in work and home environment using humidifiers
- protecting eyes by wearing sunglasses to avoid exposure to sun
- increasing your intake of nutritious food rich in fatty acids, as well as staying hydrated.
If your symptoms of dry eye continue, make an appointment with an eye doctor for a diagnosis and other treatment options.
Did I miss anything? Share your dry eye tips!
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