Diseases and Conditions: Diseases Symptoms, Treatment, Signs ...

Dry Eyes: Causes, Treatment And Symptoms

Treatment is key to easing symptoms of dry eye, according to Dr. Massaro-Giordano. "Early on, if you're dry and inflamed, [we'll] get you something that will break the cycle," she explains, emphasizing that appropriate treatments will vary depending on a person's symptoms as well as the severity of their dry eye.

Eye Drops

"The most common treatment is to add lubrication to add moisture to the surface of the eyes consistently throughout the day," says Dr. Saini. This is done through the use of eye drops. These can be over-the-counter artificial tears as well as gels and ointments. Or, for those with more serious dry eye, an eye doctor may suggest prescription eye drops, including anti-inflammatory drops. Eye drops made from your own blood (serum) are another common treatment in severe cases.

Lifestyle Changes and At-Home Remedies

There are a variety of at-home treatments and environmental changes that an eye doctor may suggest as well. This can include:

Avoiding environmental triggers, like air conditioning, wind or cigarette smoke

Using a humidifier

Massaging or placing a warm compress over the eyes

Wearing wrap-around glasses outside to protect the eyes

Adding omega-3 fatty acids to the diet

Limiting screen time and taking breaks

Wearing nighttime goggles to sleep

Eyelid Treatment

If a person's dry eye is due to eyelid inflammation, also known as blepharitis, then the ophthalmologist may focus on treating the eyelids. "This can range from simple warm compresses and eyelid scrubs to in-office intense pulsed light treatment," explains Dr. Saini.

The intense pulsed light therapy involves the use of pulses of light, which help melt blockages and open up the glands to allow for a freer flow of oil.

There are also a number of in-office eyelid treatments to heat and help express the plugged oil glands.

Therapeutic Contact Lenses

If a person's eyes are very dry, "there are specialized contacts that patients can wear," says Dr. Massaro-Giordano. These lenses, which are known as scleral lenses, are designed to keep moisture trapped on the surface of the eye.

Tear Duct Plugs

This treatment, formally referred to as punctal occlusion, addresses the issue of tears draining too rapidly from the eyes. An eye doctor will insert plugs (made of dissolvable material such as collagen or medical plastic such as silicone) into the tear ducts located at the corners of the eyes to block the small tear draining holes. This causes natural tears to remain in the eyes for longer.

Surgery

Surgery may be a treatment option, but only in rare cases if a person's dry eyes are severe. This could entail surgically closing a patient's tear ducts, in a more permanent version of tear duct plugs. Or, the surgery may aim to fix loose lower eyelids if that is causing tears to drain too quickly from the eyes. This type of surgery is not very common, however.

At the end of the day, which treatment option is right for you will depend on your specific symptoms and condition. Dr. Saini also emphasizes that everyone responds to treatment options differently, which may make it necessary to try a few different treatments to find the right one. "However, patients should not feel frustrated," he continues, "there are a growing number of treatments available and an ophthalmologist can help guide you."

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Why You Have Dry Eyes At Night And How To Soothe Them

Dry eyes at night may be caused by too much screen time, taking certain medications, and some health conditions, among others. Treatments may include natural remedies or medications.

Nighttime dry eye can cause significant discomfort. Many people find relief with home treatment. Your doctor can help diagnose any underlying medical causes and start you on a regimen to improve your eye health.

The eye has three layers of tear film: fatty oils, aqueous fluid, and mucus. Dry eye occurs when reduced tear production or increased tear evaporation throws off the balance of these layers, causing inflammation and irritation.

Common causes for tear production problems include:

aging (most people over the age of 65 experience some dry eye)

hormone changes, such as pregnancy, contraception use, or menopause

certain health conditions, such as rheumatoid arthritis, diabetes, and thyroid issues

inflammation of eyelid glands (a condition known as blepharitis)

certain medications

vitamin A deficiency

dry air, wind, or smoke

If you notice your eyes are drier at night, there may be other factors at play. These may include:

Nocturnal lagophthalmos. People with this condition don't fully close their eyelids at night. Sometimes, the eyelids appear to close, but they don't form a seal that holds in moisture.

Screen time. Spending lots of time in front of your computer or smartphone reduces your blink rate. This can cause eye strain and dry eye, which may feel worse in the evening after a long day of work.

Prolonged contact lens use. Wearing lenses for too long during the day can make dry eye more pronounced at night.

Taking care of your health can help relieve nighttime dry eyes. There are also specific steps you can take to reduce symptoms.

Apply a warm washcloth to your eyes. After a few minutes, gently rub the eyelids to remove dirt and irritants.

Clean the eyelids. If you have blepharitis, you may benefit from regularly washing your eyelids with baby shampoo or mild soap. Apply a small amount to your fingertips and wash around the base of the eyelashes while your eyes are closed.

Get more omega-3 fatty acids. Eating more foods that are high in omega-3 fatty acids, such as flax seed and fatty fish, may help ease dry eye symptoms. Or talk to your doctor about taking omega-3 supplements.

Use castor oil drops. These drops may help reduce tear evaporation.

Try acupuncture therapy. Some people have found that acupuncture helps reduce dry eye symptoms.

If you have nighttime or early morning dry eye symptoms, talk with your doctor about other over-the-counter (OTC) or prescription remedies, such as:

Artificial tears. Many people find that using OTC eye drops throughout the day helps to prevent dry eye. If you need to use drops more than four times a day, choose an option that doesn't contain preservatives.

Ointment or artificial tear gels. These help promote eye moisture and can offer longer relief than drops, but they may cause blurry vision. Use only a small amount of ointment at night to minimize this blurry effect.

Prescription medications. If your doctor diagnoses you with dry eyes, they may prescribe a medication that reduces inflammation or increases tear production, such as:

antibiotics

cyclosporine (Restasis, Cequa)

corticosteroids

hydroxypropyl cellulose eye inserts (Lacrisert)

lifitegrast (Xiidra)

cholinergics (pilocarpine, cevimeline)

An underlying medical cause or environmental factor can lead to the discomfort of morning dry eye. Take note if this happens regularly, and make an appointment with your eye doctor.

While you're waiting for your appointment, assess whether any factors may be contributing to your dry eyes, such as screen time or contact lens use. You might also try using artificial tears during the day and warm compresses on your eyes at night.

There are some simple things you can do to help prevent nighttime dry eye.

Use a humidifier. Adding moisture to the air in your bedroom may help with nighttime dry eye, especially if your air is very dry.

Reduce the impact of screens. If you spend a lot of time working in front of a computer, take frequent breaks and remember to blink often. It also helps to place your screen slightly below your line of vision.

Change your eyewear. If you wear contacts, try switching to glasses.

Wash bedding regularly. This removes allergens like dust and pet hair that might irritate your eyes.

Stay hydrated. This helps your body have enough water to function properly and promote tear film.

Nighttime dry eye can signal a more serious condition. Talk with your doctor if you regularly experience dry eye, especially if lifestyle changes and artificial tears don't help.

Your doctor may recommend other OTC treatments, prescribe medication, suggest further testing, or refer you to an optometrist for a more in-depth assessment.

Nighttime dry eye has many causes. Your doctor can help find the reason behind your symptoms. Taking breaks from your screen, wearing glasses instead of contacts, and using artificial tears may help reduce dry eye symptoms.

If you continue to have dry eyes after making these lifestyle changes, talk with your doctor. Medications may be necessary to provide long-term relief.

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How Can Amniotic Membranes Treat Dry Eye?

If dry eye disease is severe and doesn't respond to medications, surgery or other procedures may be needed. One option includes amniotic membrane grafting.

Dry eye is a common condition where your eyes don't get enough tears to stay adequately moist. This may be caused by a general lack of tears or difficulties with tear production or evaporation.

Treatment for dry eye depends on the severity, with artificial tears or prescription eye products being used first.

Amniotic membranes consist of tissues that are implanted directly over the surface of your eyes. These grafts may help treat and prevent damage caused by dry eye.

If you have severe dry eye that hasn't responded to prior treatment, consider speaking with an eye doctor about amniotic membranes, including their possible benefits and risks, and whether this is a viable treatment option for you.

You can think of amniotic membranes as tissue-based bandages for your eyes. These allow healing to take place while also offering your eyes protection.

While amniotic membranes have been used by doctors for the last century to treat chronic wounds, this treatment method is relatively new in eye care.

In general, amniotic membranes can help heal tissue damage while also providing anti-inflammatory benefits. It may be used in severe cases of dry eye, where a chronic lack of tears has caused corneal damage (keratitis).

For dry eye treatment more specifically, amniotic membranes are used to:

help repair surface damage to your eyes

protect your eyes while on your eye

lower eye inflammation

protect from infections

help prevent scars that might otherwise cause vision difficulties

In one major 2018 study, titled the Dry Eye Amniotic Membrane study, researchers found that this treatment was helpful for most of the participants. The authors noted that 88% of the study participants experienced improved eye surface.

Amniotic membrane grafting is considered a noninvasive procedure, and few risks have been noted.

The 2018 study found that while 10% of participants needed to repeat their treatment, there were no adverse effects from amniotic membrane placement.

Possible risks to discuss with an eye doctor include discomfort, infections, or intolerance of the graft.

To perform an amniotic membrane graft for dry eye, a doctor will use tissues from a donor.

Amniotic membranes are derived from the placentas of fetuses who are delivered via elected cesarean birth. The tissue is then screened for possible infectious diseases and treated with antibiotics.

An eye doctor will consider one of the following two types of amniotic membranes:

Cryopreserved amniotic membrane: This type is kept frozen to help preserve the tissues before being brought to room temperature before your treatment. Cryopreserved versions are the most common types used and are inserted with a contact-lens-like ring.

Dehydrated amniotic membrane: While this type is kept at room temperature, it's vacuum-sealed before storage and is rehydrated before use.

This is what you can expect from an amniotic membrane dry eye procedure:

First, you'll lie down while an eye doctor will place small devices over your eyelids to keep your eyes open.

Next, the amniotic membrane graft is placed over the cornea and ocular surface of your eye. It's placed sticky-side down to help it stay in place.

Last, sutures or fibrin glue are used to keep the membrane in place. If using a dehydrated amniotic membrane, an eye doctor will place a bandage contact lens on top.

Little recovery time is needed for amniotic membrane grafting. The membranes dissolve in your eye within about a week. During this time, you may experience blurry vision. You may need to refrain from driving and other activities until your vision has been completely restored.

An eye doctor will also recommend that you avoid rubbing your eyes, as this can cause unintentional injuries.

In addition to speaking with an eye doctor about amniotic membrane treatment for dry eye, the following information may help you make an informed decision.

How long does amniotic membrane last on eyes?

After application, an amniotic membrane is dissolved into your eye within about a week. An eye doctor will check for the dissolution of the membrane and also determine whether you need a follow-up procedure in the future.

How much does amniotic membrane treatment cost?

The exact cost of amniotic membrane grafting varies based on the type you're seeking, as well as where you live. It may be covered by private and government-based health insurance programs, but it's important to check with a healthcare professional in advance.

Individual device costs may range between $300–$900 each. But according to a cost effectiveness study published in 2020, the total average cryopreserved amniotic membrane procedure for dry eye was $10,300.

The analysis also found that, when compared with topical immunosuppressants in a 1-year timeframe, amniotic membrane grafting was less expensive despite the higher initial price tag.

What does an amniotic membrane do for the eye?

Amniotic membranes are akin to bandages that help promote tissue healing when other treatments don't work. If you have eye damage from dry eye or other eye health issues, amniotic membranes can provide a layer of protection to allow them to heal.

Thin-like contact lenses, these implants can also help heal and smooth the eye surface.

Amniotic membranes add a layer of protection to your eyes that may be damaged from a number of underlying causes. This includes severe cases of dry eye.

If you've been dealing with dry eye symptoms that aren't improving with other treatments, or your eye doctor has detected damage in your cornea, you may consider discussing amniotic membranes as a possible treatment option.

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