This Guide is based on the Dry Eye Syndrome Preferred Practice Pattern 2018 from the American Academy of Ophthalmology.
Dry eye is a common condition where defects in the production or composition of tears cause irritation and potential damage to the surface of the eye.
Patients with dry eye symptoms often have many contributory factors. It is imperative to treat any causative factors that are amenable to treatment. Tear replacement alone is frequently unsuccessful if additional causative factors are not concomitantly addressed.
Modifiable risk factors such as antihistamine or diuretic use (do not discontinue without consulting your doctor), cigarette smoking and exposure to second-hand smoke, environmental factors such ceiling fans and low-humidity environments should be addressed.
First-line recommendations:
Artificial Tears: Lubricates and hydrates eyes for mild to moderate dryness. Preservative-free tears are favored for prolonged or frequent use. Dose: Apply 1-2 drops in each eye as needed. Refresh Tears PF Preservative-Free Artificial Tears (FDA M018).
Managing modifiable risk factors: Strategies to alleviate symptoms include humidifying the surrounding air with a humidifier, avoiding cigarette smoke exposure, reducing air drafts with side shields on glasses, and modifying airflow patterns at work, home, and in vehicles. Additional measures, such as lowering computer screens below eye level to reduce lid aperture, taking regular breaks, and consciously increasing the frequency of blinking, may help minimize discomfort during activities like reading and using a computer.
Supplementary recommendations:
Omega-3 supplements: Use of essential fatty acid supplements for dry eye treatment has been reported to be beneficial though evidence is not conclusive. Omega 3 Fish Oil supplement (FDA GRAS).
Second-line recommendations:
Nighttime ocular lubricant: Use as needed for nighttime relief of dry eye symptoms. Recommended product. Systane Nighttime Lubricant Eye Ointment (FDA M018).
Prescription medications:
Cyclosporine: Reduces inflammation and stimulates tear production. Requires prolonged use for effect.
Lifitegrast (Xiidra): Targets inflammation associated with dry eye.
Corticosteroids have been reported to decrease ocular irritation symptoms.
Citations
Akpek EK, et al. Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology. 2019; 126(1): p.P286-P334. doi: 10.1016/j.ophtha.2018.10.023
