How to Treat Dry Eyes


There are various types of dry eye syndrome, and between 10 and 15 percent of people in the United States have dry eye problems, said Kenneth Goins, MD, associate professor of ophthalmology and visual sciences in the University of Iowa Roy J. and Lucille A. Carver College of Medicine.

"Many different factors can affect the tear film quality and amount, which leads to secondary changes in the eye and loss of vision," said Goins, who specializes in treating patients with corneal, external and refractive eye diseases at UI Hospitals and Clinics.

The amount of lubricating tears produced by the eyes can vary depending on whether the eye is at rest or under stress, such as while reading. People with severe dry eyes usually complain of pain, redness, decreased vision and foreign body sensation.

Causes of dry eyes include wind and sunlight; exposure to dirt and grit; decreased tear production as a person ages; eyelid abnormalities that affect the blink mechanism; and naturally and artificially dry environments. In addition, major causes of dry eyes are the side effects of medications or associated systemic (whole body) diseases such as rheumatoid arthritis or lupus, Goins said.

The list of medications that cause dry eyes is extensive and includes certain blood pressure medications (beta-blockers), antidepressants, heart anti-arrhythmia drugs and Parkinson's medications. However, people should not stop taking their medications despite dry eye problems. Instead, Goins emphasizes, patients should work with their doctors to address the concern.

"Your doctor has to take a good history to elucidate the dry eye problem and determine whether it is related to an existing condition," Goins said.

Dry eye management depends on the cause of the problem. Goins recommends that patients wear sunglasses to protect the eyes from wind and excess light. People also can use artificial tears (also known as tear substitutes) four times a day or more, if needed, and a lubricating ointment at bedtime. It is important to recognize the difference between artificial tears that provide moisture and eye drops that only remove redness from the eyes.

Goins explained that artificial tears come in preservative-free and preservative-containing forms. Those that contain preservatives generally are easier to use "on the go" by patients who need them only a few times a day.

"There are many over-the-counter artificial tear brands to choose from, so individuals may need to do some trial-and-error to see what works for them," Goins said.

People with severely dry eyes who need drops four to eight times a day should use preservative-free artificial tears to avoid developing an allergy to preservatives. "Preservative-free drops are packaged in separate vials that each contain one dose," Goins explained.

He added that a number of his patients say that flax seed oil tablets can reduce dry eye symptoms, but he knows of no research studies supporting these claims.

Some people have dry eye problems related to dry heat or overly air-conditioned rooms.

"Given the fact that it's winter and many homes have dry heating systems, it might be a good idea to get a humidifier for the home," Goins said. "It's important, however, to keep the filter clean."

People with significantly dry eyes who feel pain or foreign body sensation that begins to affect their daily activities should make a vision examination appointment with an ophthalmologist. A person with dry eyes and a dry mouth that is associated with difficulty eating or drinking or other symptoms, such as arthritis, should seek eye care. Goins and colleagues use a series of tests to determine quality and quantity of tear production in a person's eye. The tests involve harmless staining of the corneal surface.

If tear substitutes and other measures fail, an individual may opt for a procedure called a punctal occlusion. Goins explained that each eyelid has one punctum, a tiny opening that drains tears away from the eye. Doctors can fill this opening with a silicone plug to help preserve existing tears. If the procedure is not successful, additional or alternative treatments may be considered, including Restasis (cyclosporin A containing eye drops which have been shown to increase tear production) or hormone replacement therapy in women.

University of Iowa Health Science Relations and Kenneth Goins, MD

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