Dry Eye Remedies

[IonaS]

I am seeking your advice regarding what more I might do to relieve my suffering from dry eyes, which has been plaguing me for more than 8 years. Diagnosed in 2002 with Sjogren's Syndrome, punctal eye plugs were installed by my opthomologist originally with limited success, and then removed when I began using Restasis twice a day 3 or 4 years ago, also with only limited relief. My eyes have become even dryer this past year, feeling like gravel is in them most of the time, and my eyelids (particularly the right eye) stick to the eyeball and are difficult to open after sleeping or napping. Since January 2008, I have been using a steroid drop, Lotemax, twice a day, but continue to have periods of painful blinking. Is there anything else that I might do to relieve my suffering?

[John C Hagan III, MD, FACS]

a Schirmer test of zero indicates that you have severe dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical compies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops. Eye drops for dryness are classified as preserved drops (individual vials that must be used within 24 hrs), preserved drops, gels and ointments. The preserved drops are more expensive and usually only help the small percentage of people that are really allergic to preservatives. Gels and ointments are normally used at night since regular tears won’t last all night.   There is also an over the counter spray for dry eyes called “Tears Again”.  Tears may need to be used as often as 6 times/day.

If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 8 weeks of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes two months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. If you did not take for 8 weeks you need to restart therapy. Improvement often continues for up to 6 months.

If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.

Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.

In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.

If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.

If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise. A final new treatment that they can often do is “Autologist Platelete-rich plasma” therapy. This uses eyedrops made out of your blood products. (reference Ocular Surgery News: November 1, 2007 page 46  lead author Jorge Alio MD.

Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.

JCH III MD