Therapies for Dry Eye Syndrome

Dry Eye Syndrome (DES), also known as keratoconjunctivitis sicca, is a common condition that occurs when the eyes do not produce enough tears or when the tears evaporate too quickly. This leads to symptoms such as irritation, redness, a gritty sensation, and even blurred vision. If left untreated, chronic dry eye can cause damage to the cornea and significantly impact the quality of life. Fortunately, various therapies are available to manage and alleviate symptoms.

Understanding Dry Eye Syndrome

Before delving into treatment options, it is essential to understand the underlying causes of dry eye syndrome. These may include:

• Aging: Tear production decreases with age.
  

• Medical conditions: Autoimmune disorders such as Sjögren’s syndrome, rheumatoid arthritis, and diabetes can contribute to dry eyes.
  

• Environmental factors: Exposure to wind, smoke, or dry air can lead to tear evaporation.
  

• Medications: Certain antihistamines, decongestants, antidepressants, and diuretics can reduce tear production.
  

• Screen time: Prolonged use of digital screens can decrease blink rates, exacerbating dry eyes.
  

Contact lens wear: Long-term use of contact lenses may contribute to dry eye symptoms.

Therapies for Dry Eye Syndrome

1. Artificial Tears and Lubricants

Artificial tear drops are the first line of defence against mild to moderate dry eye symptoms. They help to maintain eye moisture and reduce irritation. There are several types available:

• Preservative-based drops: Suitable for occasional use but may cause irritation with frequent application.

• Preservative-free drops: Recommended for frequent users to minimise irritation.

• Gel and ointments: Provide longer-lasting relief, especially for night-time use.

2. Prescription Eye Drops

For patients with moderate to severe dry eye, prescription eye drops can help manage inflammation and stimulate tear production.

• Cyclosporine (Ikervis): Helps increase tear production by reducing inflammation in the tear glands.

• Lifitegrast (Xiidra): Targets inflammation associated with dry eye disease and improves symptoms.

• Corticosteroid eye drops: Used for short-term relief of severe inflammation but not suitable for long-term use due to potential side effects.

3. Punctal Plugs

Punctal plugs are tiny, biocompatible devices inserted into the tear ducts to block drainage, allowing tears to remain on the eye surface for longer periods. They are available in temporary (dissolvable) and permanent (silicone) forms. This therapy is particularly beneficial for individuals with severe tear evaporation.

4. Lifestyle and Environmental Modifications

Making small changes in daily habits and environment can significantly improve dry eye symptoms:

• Hydration: Drinking plenty of water helps maintain overall moisture balance.

• Blinking exercises: Taking regular breaks from screens and practicing conscious blinking can help distribute tears evenly.

• Humidifiers: Adding moisture to indoor air can prevent tear evaporation.

• Wearing protective eyewear: Sunglasses and wraparound glasses can shield eyes from wind and harsh weather conditions.

5. Nutritional Supplements

Diet plays a vital role in eye health. Omega-3 fatty acids, found in fish oil and flaxseed, have been shown to reduce dry eye symptoms by improving tear quality and reducing inflammation. Supplements such as vitamin A and vitamin D may also contribute to better eye hydration.

6. Warm Compresses and Eyelid Hygiene

Applying warm compresses to the eyelids followed by lid massage can help unclog meibomian glands. These glands produce the outer oily layer of tear film. Using lid wipes or cleansing gels to clean the eyelids can reduce bacterial buildup and improve tear quality.

7. Intense Pulsed Light (IPL) Therapy

IPL therapy is a newer treatment that targets the meibomian glands using pulses of light. It helps reduce inflammation and improves the function of these oil-producing glands, reducing tear evaporation.

8. Autologous Serum Eye Drops

For severe cases, autologous serum eye drops (ASEDs) are made from a patient’s own blood serum. These drops contain growth factors and essential nutrients that promote healing and provide relief for chronic dry eye patients.

9. Scleral Contact Lenses

Scleral lenses are specialised contact lenses that create a protective reservoir of fluid over the cornea, providing continuous moisture for individuals with severe dry eye disease. These lenses are custom-fitted and can be particularly beneficial for patients with conditions such as Sjögren’s syndrome or corneal abnormalities.

10. Amniotic Membranes

Amniotic membranes (AMs) are an emerging and effective treatment for dry eye syndrome, especially in moderate to severe cases that do not respond well to conventional treatments like artificial tears, anti-inflammatory drops, or punctal plugs. The amniotic membrane is the innermost layer of the placenta, with anti-scarring, anti-inflammatory, and regenerative properties, making it a valuable tool in ophthalmology for treating ocular surface diseases. The amniotic membrane is placed on the eye, typically using a ring like a contact lens. The patient then wears it for several days to heal the cornea.

When to Consult a Professional

Dry Eye Syndrome is a multifactorial condition that requires a tailored approach for effective management. From over-the-counter artificial tears to advanced therapies like IPL and scleral lenses, various treatments can provide relief based on the severity of the condition. Patients experiencing persistent dry eye symptoms should consult an eye care professional to determine the most suitable therapy for their specific needs. With proper treatment and lifestyle adjustments, individuals can significantly improve their eye comfort and overall quality of life.