The ocular surface disease commonly known as dry eye affects millions and millions of people in the United States and worldwide. To date, there has been no simple solution for this very vexing problem. There are a variety of artificial tear products on the market which differs in composition and complexity. Different tear products may offer an advantage for your specific problem.
Some patients develop dryness due to a decrease in their normal corneal sensation. This form of dry eye is often called neuropathic dry eye and may be related to the severing of the corneal nerve endings during a variety of corneal procedures. As a result, these patients blink less frequently and less completely than normal patients thus developing a secondary dry eye problem. Some of these patients develop lagophthalmos which are incomplete lid closure when sleeping. These patients note foreign body sensation upon awakening as well as burning or pain. Such patients will often benefit from an ointment or gel at bedtime to coat the ocular surface. Products such as Refresh PM, Lacrilube, Duolube, or Genteal Gel may provide some comfort.
Many patients develop dry eye related to decreased blink frequency while performing prolonged reading or computer work or other near vision tasks. The patients often complain of ocular fatigue or tired eyes and benefit from the use of an artificial tear while doing their prolonged close work. Alternatively, giving your eyes a break by looking off in the distance and focusing outside a window or across the office, often provides the necessary break that allows the accommodation mechanism or near focusing muscles in the eyes the opportunity to relax and recover leading to less burning and tiredness of the eyes.
Many patients are concerned about red eyes and look for a drop that “gets the red out” such as Visine. I strongly advise against the use of these “ocular decongestants” for a variety of reasons. First, most of these products contain vasoconstrictors. They “get the red out” by using a pharmacologic agent that constricts the blood vessels. Thus, the eye looks whiter. However, as the medication wears off, rebound dilation of the vessels takes place and the eye then looks even redder. This prompts the patient to reinstill the eye drop creating more whiteness, further rebound dilation and increased reddening. Over time this can result in permanently increased redness due to increased vascularity associated with the rebound dilation of the vessels.
May medications taken orally may also provoke increased dry eye. Some of these include antihistamines for allergies, medications used to treat Parkinson’s Disease, some medicines taken for depression and medicines used to relieve anxiety. Patients who require such oral medications will often benefit from artificial tear supplements. Some of my favorites are Theratears, Blink, Refresh, and Systane Ultra.
Artificial tears have a variety of components including carboxymethylcellulose, hydroxypropyl methylcellulose, polyethylene glycol, propylene glycol and hyaluronic acid all of which act as lubricants in the drop. No drop is necessarily better than another. Whichever drop provides an individual patient the most comfort is the drop the patient should continue to use.
Finally, there are now two prescription agents on the market which may be beneficial to dry eye patients. These include Restasis and Xiidra both of which work by suppressing immune-mediated infiltration of the lacrimal gland. Each has their pros and cons, and both are very expensive.
In our office prior to using either Restasis or Xiidra, I prefer to first try collagen punctal plugs. These are inserted into the canalicular system which is the gutter pipe into which your tears drain. They collagen plugs last up to six months and can easily be replaced twice yearly during a two-minute office procedure right in the exam chair at the slit lamp. By plugging the drain or gutter pipe into which your tears flow and keeping your own tears around longer, this often results in significant improvement in comfort at substantially less cost. I am happy to discuss any aspect of ocular surface disease with you at your office visit!