DMSO Eye Drops Are Not Recommended for Dry Eye Disease
DMSO eye drops are not part of standard, evidence-based treatment for dry eye disease and should not be used as a therapeutic option. While DMSO has theoretical properties as an anti-inflammatory and membrane-penetrating agent, it is not included in any major ophthalmology guidelines for dry eye management, and there is insufficient clinical evidence supporting its safety or efficacy for this indication 1.
Why DMSO Is Not Recommended
Absence from Clinical Guidelines
- The American Academy of Ophthalmology's Dry Eye Syndrome Preferred Practice Pattern (2024) does not list DMSO as a treatment option for any severity of dry eye disease 1.
- Established treatments for severe dry eye include autologous serum drops, cyclosporine, lifitegrast, punctal occlusion, and scleral lenses—but not DMSO 1.
Limited Clinical Evidence
- While one review article discusses DMSO's theoretical properties (anti-inflammatory, analgesic, membrane penetration enhancement), it acknowledges that DMSO "remains underexplored and ignored by pharmaceutical developers and ophthalmologists" 2.
- The same review notes that DMSO is "nonpatentable" and lacks the rigorous clinical trial data required for standard ophthalmologic practice 2.
- No randomized controlled trials demonstrate DMSO's efficacy specifically for dry eye disease compared to established treatments 2.
Evidence-Based Alternatives for Severe Dry Eye
First-Line Treatments
- Preservative-free artificial tears should be used at least twice daily, increasing to hourly based on severity 3.
- Lid hygiene regimen with warm compresses for 5-10 minutes twice daily is essential, particularly when crusting suggests meibomian gland dysfunction 3.
Second-Line Anti-Inflammatory Therapy
- Topical cyclosporine 0.05% twice daily has demonstrated success rates of 74% in mild, 72% in moderate, and 67% in severe dry eye 3.
- Lifitegrast 5% has FDA approval and shows benefit in both signs and symptoms over 3 months 1.
Advanced Treatments for Refractory Cases
- Autologous serum eye drops (20-50%) improve symptoms and corneal staining in severe cases, particularly with Sjögren's syndrome and graft-versus-host disease 1, 4, 5.
- Permanent punctal occlusion via thermal cautery can be performed after trial with temporary plugs 1.
- Scleral lenses have been used successfully for years in severe dry eye 1.
Critical Safety Considerations
When to Refer to Ophthalmology
Patients should be referred promptly if they experience 1, 3:
- Moderate or severe eye pain
- Lack of response to initial therapy after 2-4 weeks
- Corneal infiltration or ulceration
- Vision loss or blurred vision
- Progressive conjunctival scarring
Pitfalls to Avoid
- Do not use unproven treatments like DMSO when evidence-based options exist 1.
- Avoid topical corticosteroids for more than 2-4 weeks due to risks of increased intraocular pressure, cataracts, and infections 3.
- Never attribute severe symptoms to "simple dry eye" alone without ruling out systemic autoimmune disease (approximately 1 in 10 patients with significant dry eye have underlying Sjögren's syndrome) 1.