Dry eye syndrome - Treatment 

Treating dry eye syndrome 

There is no cure for dry eye syndrome, but there are treatments to control your symptoms.

Once dry eye syndrome develops, some people have recurring episodes for the rest of their lives. The exact treatment for dry eye syndrome depends on whether symptoms are due to:

  • not enough watery tears
  • too much evaporation
  • associated disease

The first thing to consider is whether there are any obvious factors that could be changed, such as minimising any medication that is causing symptoms. If there is an associated disease, this should be treated.

You may also be able to help prevent dry eye syndrome or ease your symptoms by adjusting your environment, keeping your eyes clean and improving your diet.

Read more information about self-treating and preventing dry eye syndrome.

Lubricant treatments

Mild to moderate cases of dry eye syndrome can usually be treated using lubricant eye treatments that consist of a range of drops, gels and ointments. These lubricants aim to replace the missing water in the tear film, but do not contain the antibodies, vitamins and nutrients essential for eye health.

Some lubricants are available without a prescription over-the-counter (OTC) from a pharmacy.

There are many different types of eye drops and gels, so you can switch if your original choice does not work. However, some of the eye drops prescribed by your ophthalmologist if you have severe disease may have certain beneficial properties. It is important you discuss any changes you wish to make to your treatment with your doctor.

Preservative-free drops

Some eye drops contain preservatives to prevent harmful bacteria from growing inside the medicine bottle. If your symptoms mean you need to use these eye drops more than six times a day, it's better to use preservative-free eye drops. 

This is particularly important if your ophthalmologist has told you that you have severe dry eye disease. This is because preservatives in large quantities or after prolonged use (months or years) may damage the delicate cells on the surface of the eye or cause inflammation.

It is safe to use non-preserved eye drops at very high frequencies, including every hour or half-hour.

Most preservative-free preparations come as a package containing single dose units. These might be difficult to open if you have arthritis. Special eye drop delivery devices or tripods are sometimes provided by the suppliers to help the patient put their drops in. Certain non-preserved drops are also manufactured in multi-dose pumps. If you have difficulty putting in your drops, please discuss this with your doctor.

If you wear soft contact lenses, you may also need to use an ocular lubricant that is preservative-free, as preservatives attach to the contact lens and damage the eye. These types of eye drops may be more expensive.

'Oily tear' eye drops

Eye drops that replenish the oily tear and reduce evaporation from the surface of the eye are becoming more popular. These preparations include synthetic guar gums or liposomal sprays.

Liposomal sprays are over-the-counter medications and do not require a prescription. The liposomes are sprayed on the closed eyelid margins. When the eyes open, the liposomes spread across the surface of the eye, creating a new oily film. These are particularly useful if you have blepharitis or evaporative dry eye disease. 

Eye ointment

Eye ointment can also be used to help lubricate your eyes. However, it can often cause blurred vision, so it is probably best to use it last thing at night.

If you wear contact lenses, do not use eye ointments while wearing them. Ask your pharmacist or GP for advice about which ointments may be suitable for you.

Anti-inflammatory treatments

The underlying problem with long-term dry eye disease is inflammation. In such cases it is necessary to give anti-inflammatory treatments.

These include:

  • steroid eye drops and ointments
  • oral tetracyclines
  • ciclosporin eye drops

Steroid eye drops and ointments

Steroids are potent anti-inflammatory drugs which can be given as eye drops or ointments in the severest cases of dry eye disease. They have side effects such as cataract formation and raising intraocular pressure in about 30% of people. This group of treatments should only be used if you are being supervised by an ophthalmologist in an eye clinic.

Oral tetracyclines

Low doses of tetracyclines can be used as anti-inflammatory agents for a minimum of three to four months, sometimes much longer.

The most common drug used is doxycycline, but oxytetracycline and lymecycline are sometimes prescribed.

Ciclosporin eye drops

Ciclosporin is an immunosuppressing agent which has been used in the treatment of dry eye syndrome. These treatments are only available through a hospital eye department.

Autologous serum eye drops

None of the ocular lubricants currently available provide a substitution for the tear film, as they do not contain the vital nutrients required to keep the surface of the eye healthy.

When all treatment options are exhausted, autologous serum eye drops may be required.

This treatment is only available from the National Blood Service through an ophthalmologist and after approval of a funding application.

The patient is assessed for suitability for the blood donation. One unit of blood is taken under sterile conditions (as for regular blood donation). The blood cells are removed from the whole blood and the remaining serum put into eye dropper bottles. Due to quality standards, the process can take several months before the treatment is finally available to use.

Treating underlying medical conditions

If you have an underlying medical condition that is causing dry eye syndrome, your GP will prescribe treatment for it or will refer you to an appropriate specialist.

Complex conditions

If your underlying condition is a complex one, such as Sjögren's syndrome, lupus, rheumatoid arthritis or rheumatic disease, and your symptoms are not settling, you will need to be referred to a specialist for treatment if you are not already receiving treatment for the condition.

To treat your dry eye syndrome, the specialist will address possible triggers, such as medicines or environmental factors, before trying to eliminate them. They will also advise on more complex treatments you might need.

Surgery

If your dry eyes are severe and fail to respond to other forms of treatment, surgery may be an option.

Punctal occlusion

Punctal occlusion involves using small plugs called punctal plugs to seal your tear ducts. This means your tears will not drain into the tear ducts and your eyes should remain moist. 

Temporary plugs made of silicone are normally used first to determine whether the operation has a positive effect. If it does, more permanent plugs can replace the silicone ones.

In more severe cases, the punctal orifices are cauterised (sealed using heat). This permanently seals the drainage hole to increase the amount of tears on the surface.

Salivary gland autotransplantation

Salivary gland autotransplantation is usually only recommended after all other treatment options have been tried.

Salivary gland autotransplantation involves removing some of the glands that produce saliva from your lower lip and placing or grafting them into the side of your eyes. The saliva produced by the glands acts as a substitute for tears.

Page last reviewed: 04/05/2012

Next review due: 04/05/2014

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