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Dry Eye Syndrome – Part II – Treatments

I like to approach the treatment of Dry Eye Syndrome in a stepwise process.

PREVENTION

The first thing to do for your eyes is give them a healthy environment.  In Colorado, this can be difficult due to the low humidity and use of heaters when the weather gets colder.  Humidifiers do a good job in increasing the relative humidity in the house.  Some houses have central humidifiers, which are ideal, but having portable humidifiers in the rooms you spend the most time help as well.  Also, in the summertime, evaporative coolers are preferred, as they add moisture to the air.  Air conditioners actually remove moisture from the air, and make for a much drier environment.  Your eyes will also benefit from avoiding smoking and other pollutants.  Additionally, wearing sunglasses when outside can help to protect your eyes, and wearing goggles while skiing dramatically decreases the amount of drying from the cold wind.

INITIAL TREATMENT

Lubricating eye drops are the initial treatment for dry eyes.  I like to think of eye drops like hand lotion.  They work best if you use them regularly, and before the eyes are severely dry.  There are many types available, and I haven’t found a drop that works great for everyone.  I usually prefer those with thicker viscosity that stay in the eye longer, or drops that aim to replace the oil component of your tears (Soothe XP or Refresh Advanced).  Also, lubricating ointments work well at nighttime.  I recommend avoiding drops that “get the red out” (Visine, Clear Eyes, and many allergy drops), as these can be addicting to the eye, and cause more long-term trouble.  Other secondary factors may add to dry eyes, such as blepharitis and seasonal allergies.  Hot compresses can help with blepharitis, and mast cell stabilizers, such as ketotifen eye drops, can help with the itching caused by allergies.

SECONDARY TREATMENT

If lubricating drops do not provide enough relief, the next step that I recommend is tear duct plugs.  These block the drainage of the tears from your eyes to your nose, so that normal tears stay in the eye longer, and keep the eye lubricated.  I usually recommend collagen plugs that last about one week, and then dissolve.  If they help, then plugs made of caprolactone are placed in the tear ducts, which dissolve after about six months.  Permanent silicone plugs are also available, but they stick out of the tear ducts slightly.  Some patients can feel them and also notice that they often fall out.  Most of my patients prefer the six month plugs.

TERTIARY TREATMENT

If the lubricating drops and punctal plugs still do not resolve the issues, I then recommend Restasis (cyclosporine) eye drops.  These drops work by decreasing the inflammation in the lacrimal gland to increase the amount of aqueous tear production.  Many patients find them to be very helpful.  The drawbacks include cost and the slow onset of improvement (usually 3-4 months).

CONCLUSION

Dry Eye Syndrome is a very common condition, especially in Colorado.  Many techniques for prevention and treatment are available to make the symptoms more tolerable.  Please call us to make an appointment for evaluation and treatment – 303-440-3049.

Ken Kreidl, MD

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