Once you’re middle-aged or older, you may assume that it’s normal to have dry, red, irritated eyes much of the time. But it’s not.
Even though more than one-third of American adults endure this common eye complaint, it’s a mistake to just put up with it.
Over time, dry eye can impair your ability to see clearly (usually temporarily but permanently in severe cases)…make it difficult to drive at night…and cause wrinkles on and around the eyelids that add years to your appearance.
Latest developments: The FDA has recently approved new medication for treating dry eye—and another drug is being developed to increase levels of a protein that’s needed for eye lubrication.
Sometimes you can control dry eye with lifestyle changes and the use of artificial tears. But whether you need medication or not, there are ways to largely eliminate these troubling symptoms and keep your eyes healthy.
Our eyes naturally produce about five to 10 ounces of moisture (tears) each day to help prevent the dry, scratchy and/or burning that results from dry eye. When we’re exposed to dust, smoke, excessive sun, dry heat, air-conditioning and even hair dryers, most people produce even more tears.
Unfortunately, some people, for unknown reasons, simply don’t produce enough tears. Tear production also tends to decline with age—particularly in women after menopause, when lower estrogen levels are to blame. Eye dryness is also on the rise among people who spend hours a day squinting at computers and smartphones. People who wear contact lenses while sleeping or use ill-fitting lenses are also subject to dry eye.
Under-recognized causes: Literally dozens of prescription and over-the-counter drugs—including antihistamines…certain high blood pressure drugs such as diuretics…and antidepressants—can cause eye dryness as a side effect.
To find out if one of your medications may be causing dry eye, go to DailyMed.nlm.nih.gov. Enter the name of the medication and scroll down to see what adverse reactions, such as dry eye, have been reported. Dry eye can also be triggered by more serious underlying diseases, including diabetes and Sjögren’s syndrome, an autoimmune disease.
To effectively control dry eye, you need to understand the blinking reflex. This is a natural process that stimulates the secretion of oil from approximately 50 tiny glands (the meibomian glands) in the lower and upper eyelids. The oil slows the evaporation of tears and improves their ability to cling to the surfaces of the eyes. At the same time, blinking spreads moisture across the eyes and removes dust and other contaminants.
Important: The size of your eyes, along with their tear-producing capacity, can have a lot to do with dryness. Normally, the upper and lower eyelids come together at the conclusion of a blink. If your eyes are larger than normal—because of diseases such as overactive thyroid (hyperthyroidism), for example, or because they’re just made that way—the lids don’t completely close. This causes dryness in the lower half of the eyes.
What most people don’t realize is that the frequency of blinking is highly individual—and it varies depending on what you’re doing at any particular moment.
A study that looked at blink rates in healthy people found that the frequency was as low as 4.5 blinks a minute while reading or doing other engrossing tasks…or as high as 26 blinks per minute during lively conversations. One blink every four or five seconds is about average.
Even though blinking is among the most effective ways to prevent dryness, it isn’t practical to spend your time willing yourself to blink. What works better: Break up your TV, computer or smartphone sessions by closing your eyes for 10 seconds or so a few times every hour.
The first line of defense against dry eye is over-the-counter (OTC) artificial tears. There are many generic versions, including brands from major pharmacies, that work quickly. Popular brands: Refresh and Systane.
My advice: Liquid drops are fine if you have only mild/intermittent dryness. Refrigerating the drops will make them feel more soothing. Preservative-free drops are more expensive, but they tend to be more soothing because the preservative can be irritating for some people. When eye dryness is persistent, use gel-containing drops—the gel keeps the eyes lubricated for longer periods. Popular gel brands: Refresh, Systane and GenTeal.
If you need a product that’s even longer-lasting than liquid drops or gel, consider OTC lubricating ointments (such as Refresh PM). Many dry eye sufferers use an ointment every few hours instead of one or more times an hour for the liquid products. However, some people report blurry vision when using ointments. To avoid this, try the product at bedtime—especially if you wake up with dry eyes. Drinking lots of water and/or using a humidifier at night—or even near one’s computer station during the day—helps, too.
Also: Try omega-3 fatty acid supplements…or simply eat more fatty fish. A Harvard study that looked at more than 32,000 women found that those who ate fish more than five times a week were 68% less likely to develop dry eye than those who didn’t. And patients who did have dry eye tended to have fewer symptoms.
The omega-3s in fish reduce inflammation and increase tear production. Fish-oil supplements probably have similar effects. Typical dose: 1,000 mg daily.
If you follow these steps but your eye dryness doesn’t improve within a month or two, it’s wise to consult an ophthalmologist. He/she can offer additional advice and may prescribe medication. For example…
• Lifitegrast ophthalmic solution (Xiidra), which was approved by the FDA in 2016, is an anti-inflammatory drop that’s applied twice daily to each eye. Reducing inflammation can increase tear production. Like other drops, it may cause irritation/blurred vision that typically lasts for minutes at a time.
• Cyclosporine ophthalmic emulsion (Restasis) was approved by the FDA in 2002 for increasing tear production. The downside is that it takes four to six months to reach its full effectiveness—and like Xiidra, it may cause irritation initially. The irritation usually fades after using it for about a month.
• Lacripep is the newest eye drop for treating dry eye. It’s still in the early stages of testing. A large-scale clinical trial involving more than 200 patients will soon be under way. The drug contains a fragment of the protein lacritin, which is deficient in patients with dry eye. The protein is important for promoting healthy tears and maintaining the health of eye nerves involved in tear production. Unlike other drops, the drug isn’t washed out by tears—it can still be detected 24 hours later. This means that it could potentially be used just once a day.
If your dry eye is severe and does not improve with the approaches above, your doctor might recommend a simple office procedure that plugs the small openings (tear ducts) that drain tears away from the eyes. Blocking these openings with punctal plugs keeps tears in place longer.
Most people start with temporary plugs made from collagen or dissolvable suture material. The plugs break down on their own in about three months—long enough to see if this approach is helpful. If you’re satisfied, the plugs can be replaced with permanent silicone plugs. Side effects, such as infection, are rare. Most health insurance covers the cost of this procedure.
