Treating dry eye syndrome

Treatment for dry eye syndrome helps to control the symptoms, but there's no cure. Some people may have recurring episodes for the rest of their lives.

The exact treatment for dry eye syndrome depends on whether symptoms are caused by:

• decreased production of tears
• tears that evaporate too quickly
• an underlying condition

The first thing to consider is whether there are any obvious factors, such asa medication, causing thesymptoms.

If your dry eye syndrome is caused by an underlying condition,your GPcan prescribe treatment or refer you to an appropriate specialist.

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

However, they don't contain the antibodies, vitamins and nutrients found in normal tears that are essential for eye health.

Mostlubricantsare available without a prescription over the counter from a chemist.

There are many different types of eye drops and gels, and it's often worth tryinga number of different ones to find one that suits you.

Sometimesyou may have to use two or three different compounds to have the best effect. However,it's important you discuss any changes you wish to make to your treatment with your optometrist or doctor.

Preservative-free drops

Some eye drops contain preservatives to prevent harmful bacteria growing inside the medicine bottle. If your symptomsmeanyou 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 youthat you have severe dry eye disease. Preservatives used in large quantities or over a prolonged period of time months or yearsmay damage the delicate cells on the surface of the eye or cause inflammation.

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

If you have anydifficulty putting in your drops, please discuss this with your doctor or optometrist. There are mechanical devices to help squeeze bottles, multi-dose bottles with valves, and single dose containersthat may be easier for you.

'Oily' tear eye drops

Eye drops that replenish the oily part of the tear film and reduce evaporation from the surface of the eye are also increasingly being used. These preparations include synthetic guar gums or liposomal sprays.

Liposomal sprays areover-the-counter medications that aren't available on a prescription. They are sprayed on to the edges of your eyelids when your eyes are closed.

Whenyou open your eyes, the solution spreads across the surface of the eye, creating a new oily film.

Oily tear dropsare particularly useful if you have Blepharitis ordry eye syndrome caused by your tears evaporating too quickly.

Eye ointments

Eye ointments can also be used to help lubricate your eyes and keep them moist overnight, as your tears can evaporate while you sleep if your eyes aren't fully closed.

These ointments tend to be used overnight because they can cause blurred vision.

If you wear contact lenses, don't use eye ointments while wearing them. Ask your pharmacist or GP for advice about alternative treatments that may be suitable for you.

Anti-inflammatory treatments

The underlying problem with long-term dry eye syndrome is inflammation in and around the eye. One of the anti-inflammatory treatments mentioned below may also be recommended, but these can only be obtained after you've seen an ophthalmologist.

Corticosteroid eye drops and ointments

Corticosteroids arepowerful anti-inflammatory medications that can be given as eye drops or ointments in severe cases of dry eye syndrome.

They have side effects in around one in every three people, which may include:

• cataracts
• raising the pressurewithin the eye

This group of treatments shouldonly be used if you're being reviewed by an ophthalmologistat an eye clinic. You shouldn'tuse these treatments if you have no follow-up at an eye clinic.

Oral tetracyclines

Low doses of medications called tetracyclinescan beused as anti-inflammatory agents for a minimum ofthree to four months, and sometimes for much longer.

The most commontetracyclineused is doxycycline, but others, such as oxytetracycline and lymecycline, are sometimes alsoprescribed.

Ciclosporin eye drops

Ciclosporin is a medication that suppresses the activity of your immune system. It is sometimes usedin the treatment of severe dry eye syndromethat doesn't respond to lubricants.

This treatment is only available through a specialist in dry eye syndrome at a hospital eye department.

Serum eye drops

Serum eye drops may be required in very rare cases where all other medications haven't worked. These are special eye dropsmade using components of your own blood or blood from a donor.

The treatment isonly available from the NHS Blood and Transplant TissueService through an ophthalmologist and after funding is approved.

To makeserum eye drops, one unit of blood is taken under sterile conditions, as for regular blood donation . The blood cells are then removed and the remaining serum is diluted and putinto eye drop bottles.

Because of quality standards, this 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's causing dry eye syndrome, your GP will prescribe treatment for it or refer you to an appropriate specialist.

Surgery

If your dry eyes are severe andfail to respond to other forms of treatment, surgery may be an option. Two types of surgery sometimes used to treat dry eye syndrome are described below.

Punctal occlusion

Punctal occlusion involves using small plugs called punctal plugs to seal your tear ducts. This means your tears won't drain into the tear ducts and your eyesshould remain moist.

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

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

Salivary gland autotransplantation

Salivary gland autotransplantation is an uncommon procedure that's usually only recommended after all other treatment options have been tried.

This procedure involves removingsome of the glands that produce saliva from your lower lip and placing themunder the skin around your eyes. The saliva produced by the glands acts as a substitute for tears.