DMSO Does Not Have an Established Role in Standard Dry Eye Treatment
DMSO (dimethyl sulfoxide) is not recommended as a standard treatment for dry eye disease and does not appear in current evidence-based guidelines for dry eye management. 1, 2, 3
Why DMSO Is Not Part of Standard Dry Eye Care
The most recent and comprehensive dry eye treatment guidelines from the American Academy of Ophthalmology (2024,2019) make no mention of DMSO as a therapeutic option for dry eye syndrome. 1 The established treatment algorithm progresses from:
- First-line: Preservative-free artificial tears, environmental modifications, and treatment of underlying blepharitis or meibomian gland dysfunction 2, 3
- Second-line: Topical cyclosporine 0.05% or lifitegrast 5% for moderate disease 2, 3
- Advanced therapies: Punctal occlusion, autologous serum drops, or oral secretagogues for severe disease 1, 2
Limited and Contradictory Research Evidence
The available research on DMSO for ocular inflammation is sparse, outdated, and shows conflicting results:
Potential Mechanisms (Experimental Only)
One recent animal study (2020) investigated a zileuton formulation dissolved in DMSO for anesthesia-induced dry eye in mice. 4 The study suggested that:
- DMSO itself may have "general healing activity" by suppressing prostaglandins 4
- The therapeutic effect appeared to result from synergistic action between DMSO and zileuton (a 5-lipoxygenase inhibitor), not DMSO alone 4
- The formulation reduced inflammatory cytokines and oxylipins without affecting tear production rates 4
Critical limitation: This was an animal model study using DMSO as a vehicle for another active drug, not as a standalone dry eye treatment. 4
Historical Safety Concerns
A 1977 study examining topical ocular DMSO found concerning results: 5
- High concentrations (90-100%) aggravated inflammatory responses 5
- Moderate concentrations (50-70%) showed no benefit over controls 5
- Only 30% DMSO demonstrated anti-inflammatory properties, but was inferior to dexamethasone 0.1% 5
- Side effects included skin irritation and breath odor 5
FDA Safety Data
The FDA drug label for DMSO-containing veterinary products warns that: 6
- Lens changes and nuclear cataracts were observed in animals receiving oral DMSO at high doses or with prolonged therapy 6
- DMSO may facilitate systemic absorption of other topically-applied drugs and potentiate systemically administered medications 6
- These ocular effects were slowly reversible but showed species-dependent recovery rates 6
Common Pitfalls to Avoid
- Do not use DMSO as a substitute for evidence-based dry eye treatments that have demonstrated efficacy in reducing morbidity and improving quality of life 1, 2
- Do not delay appropriate anti-inflammatory therapy (cyclosporine, lifitegrast, or short-term corticosteroids) in patients with moderate to severe dry eye by attempting unproven treatments 2, 3
- Recognize that the 2020 animal study used DMSO as a vehicle for zileuton, not as monotherapy, making it impossible to attribute benefits to DMSO alone 4
Evidence-Based Alternative Approach
For patients seeking anti-inflammatory dry eye treatment beyond artificial tears:
- Topical cyclosporine 0.05% twice daily prevents T-cell activation with success rates of 74% in mild, 72% in moderate, and 67% in severe dry eye 2
- Short-term topical corticosteroids (2-4 weeks maximum) provide small to moderate symptom relief and reduce corneal staining 1, 7
- Lifitegrast 5% blocks LFA-1/ICAM-1 interaction and improves both signs and symptoms 2
The absence of DMSO from all major dry eye treatment guidelines, combined with limited and contradictory evidence, indicates it should not be used for dry eye management in clinical practice. 1, 2, 3