What are the treatment options for dry eye syndrome?

From the Guidelines

Treatment options for dry eye syndrome range from simple lifestyle changes to medical interventions depending on severity, with the goal of improving morbidity, mortality, and quality of life by increasing tear production, reducing tear evaporation, or decreasing inflammation on the ocular surface. For mild cases, artificial tears like Systane Ultra or Refresh Tears used 4-6 times daily provide immediate relief by supplementing natural tear production, as recommended by the most recent study 1. Preservative-free formulations are recommended for frequent users to avoid irritation. Environmental modifications help significantly—using a humidifier, taking regular screen breaks with the 20-20-20 rule (looking 20 feet away every 20 minutes for 20 seconds), and avoiding direct air flow to the eyes.

Some key considerations for treatment include:

• For moderate cases, prescription medications like cyclosporine (Restasis) or lifitegrast (Xiidra) applied twice daily reduce inflammation and increase tear production, though they may take several weeks to show full effect, as shown in a study 1.
• Punctal plugs, tiny silicone or collagen devices inserted into tear ducts, prevent drainage and retain moisture on the eye surface.
• For severe cases, autologous serum tears (made from the patient's own blood) or scleral contact lenses may be necessary.
• Treating underlying conditions like blepharitis with warm compresses and lid scrubs twice daily is essential, as is addressing any contributing medications or systemic diseases.
• Omega-3 fatty acid supplements (1000-2000mg daily) may improve oil gland function and tear quality, although their effectiveness is still being researched, with some studies showing no benefit 1.

It's also important to consider the potential benefits and drawbacks of different treatments, such as the use of corticosteroids, which can decrease ocular irritation symptoms but may have adverse effects like increased intraocular pressure and cataract formation 1. Additionally, new treatments like varenicline nasal spray and perfluorohexyloctane ophthalmic drops have shown promise in clinical trials 1.

Overall, the most effective treatment plan will depend on the individual patient's needs and circumstances, and may involve a combination of lifestyle changes, medications, and other interventions. The key is to prioritize treatments that have been shown to improve morbidity, mortality, and quality of life, while minimizing potential risks and side effects.

From the FDA Drug Label

Instill one drop of RESTASIS® ophthalmic emulsion twice a day in each eye approximately 12 hours apart. RESTASIS® can be used concomitantly with artificial tears, allowing a 15 minute interval between products. One of the treatment options for dry eye syndrome is the use of cyclosporine ophthalmic emulsion (RESTASIS®), which can be used twice a day in each eye. Additionally, artificial tears can be used concomitantly with RESTASIS®, with a 15 minute interval between products 2.

From the Research

Dry Eye Treatment Options

• The most widely used therapy for dry eye disease is tear replacement by topical artificial tears 3
• Punctal occlusion to prevent the drainage of natural or artificial tears is the most common non-pharmacological treatment 3
• Topical anti-inflammatory and immunomodulatory agents, such as cyclosporin A, are under investigation in the treatment of dry eye 3
• Artificial tears of various kinds are recommended if the symptoms are mild 4
• Lid hygiene is helpful in the treatment of hyperevaporative dry eye, while collagen or silicon plugs can be used for partial occlusion of the efferent lacrimal ducts to treat severe hyposecretory dry eye 4
• The benefit of long-term topical anti-inflammatory treatment of moderate or severe dry eye disease with corticosteroids or cyclosporine A eye drops has been documented in clinical trials on a high evidence level 4
• Orally administered tetraycycline derivatives and omega-3 or omega-6 fatty acids are also used 4

Specific Treatment Products

• Systane Ultra (polyethylene glycol/propylene glycol with hydroxypropyl guar) lubricant eye drops have been shown to be effective in managing dry eye disease 5
• Propylene glycol and hydroxypropyl guar nanoemulsion lubricant eye drops have been found to be safe and effective in providing temporary relief of symptoms of dry eye disease 6
• Over-the-counter (OTC) artificial tear drops, such as 0.2% polyacrylic acid-based artificial tears, have been found to be effective in treating dry eye symptoms 7

Treatment Considerations

• The treatment of dry eye disease should be based on the severity of symptoms and signs 4
• The use of artificial tear products that replace or supplement the deficient natural tear film is the mainstay treatment option 5
• The effectiveness and safety of individual OTC artificial tear formulations are not well established due to inconsistencies in study designs and reporting trial results 7