Dry Eye Treatment Options
Dr. Jackson’s Dry Eye treatment options include a combination of: lifestyle changes, over-the-counter treatments, prescription treatments and surgical procedures.
The selection of treatment depends largely on the severity of the Dry Eye. Below are many of the ocular surface treatments Dr. Jackson will recommend based on your exam and diagnostic test findings.
- Many of the brand name OTC products, typically the cheapest pricing, have unknown inactive ingredients that can damage the ocular surface long term and can even constrict blood flow to the eye and also cause tachyphylaxis (visious cycle of eye redness)
- Brand name OTC products recommended by Dr. Jackson such as Refresh or Systane products are much more ocular surface friendly; beware that Walgreens/CVS/Walmart/Target “equivalents” are not equivalent to the real brand name products
- There are oil-based and water-based artificial tears and the option chosen by Dr. Jackson will depend on the dry eye diagnosis made at your exam
- Dr. Jackson prefers preservative-free gels and/or ointments at bedtime
- Lacrisert – LACRISERT (hydroxypropyl cellulose ophthalmic insert) is a sterile, translucent, rod-shaped, water soluble, preservative-free, slow-release lubricant which is placed into the inferior cul-de-sac of the eye. It is especially useful in patients who remain symptomatic after an adequate trial of therapy with artificial tear solutions.
- Attached to furnace (feeds entire home) and/or freestanding on the nightstand especially in cold climate environments in the winter
- Inserted pain-free by Dr. Jackson in seconds
- Dissolvable type last 3-6 months and non-dissolvable last until they fall out
- Typically not first line treatment until inflammation is treated initially
- Billable to a patient’s insurance if medically necessary
- Restasis – topical anti-inflammatory eye drop used 2x per day typically needed long term as dry eye disease is progressive and Restasis takes up to 12 weeks to take effect; the only common side effect is burning upon instillation or noncompliance by patients; typically Dr. Jackson will prescribe a topical steroid eye drop to use short term until Restasis takes effect
- Oral/Injectable systemic medications such as Exovac or Plaquenil prescribed by internists and/or rheumatologists
Warm / Hot Compresses
Moist heat can help promote improved oil gland function when used consistently. This can be accomplished by using a simple face cloth soaked in hot tap water, wrung out and rewarmed and reapplied several times over a 5-10 minute period. Alternatively, there are many new products such as the Bruder Mask, which contains tiny moisture beads and can be heated in the microwave for seconds and then placed over closed eyelids for a few minutes to provide effective relief. Dr. Jackson’s office provides access for and prefers the Bruder Mask as his warm compress of choice for patients suffering from Dry Eye Syndrome.
Lid Hygiene / Cleaning Regimens
Blepharitis is accompanied by an accumulation of dead skin cells, dried mucus, bacterial overgrowth and, in many women, impregnation of the delicate lid margin skin with mascara, eyeliner and other make-up residue. The inflamed eyelids must be continuously cleansed of these contaminants which will otherwise exacerbate the problem and lead to its chronicity. There are many products available for this purpose including Ocusoft brand and/or NovaBay brand eyelid wipes and/or lid foams/gels depending on severity. Claridex lid wipes are used for patients diagnosed with Demodex-related blepharitis. An older form of eyelid treatment with baby shampoo is outdated and can even be toxic to the eye. Procedures such as Blephex and/or Lipiflow described below may be needed as well.
Omega Nutritional Supplementation
Generic Omega 3 fish oils have proven to be no benefit for dry eye. High omega gamma linolenic acid (GLA), with its high anti-inflammatory activity which is needed to benefit dry eye, is not normally found in a typical fish diet. Products such as HydroEye formulations have adequate amounts of omega GLA needed to help dry eye. Like Restasis, omega nutraceuticals can take up to 12 weeks to take effect but will provide excellent ancillary long term therapy with minimal to no side effects. Those patients who take oral blood thinners excluding baby aspirin should not take omega supplementation.
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