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DRY EYE SYNDROME Treatment information HEALTHCARE PROFESSIONALS - FACT SHEET Lifestyle and environment factors Mild or moderate dry eye symptoms Treatment should initially focus on identifying and • Artificial tears alone are usually sufficient to addressing lifestyle / environmental factors that may provide relief cause or exacerbate dry eye syndrome. These include: • Hypromellose is the most commonly used product, • Smoky or dusty environments and can be administered frequently • Air conditioning / heaters in the home or car • Products containing carbomers or polyvinyl alcohol • Prolonged viewing of computer screens are longer-acting • Contact lens wear • Sodium chloride is short acting and suitable as • Over-rinsing with water or saline ‘comfort drops’ or for use with contact lenses • Use of redness-relieving eye drops – Some eye drops contain preservatives and can cause e.g. naphazoline, tetrahydrozoline, phenylephrine irritation. If someone is sensitive to preservatives or herbals such as witch hazel or uses soft contact lenses, consider switching to The patient’s medication history should also be reviewed, one that is preservative-free. Carmellose sodium, as topical and systemic antihistamines have been hydroxyethylcellulose, hypromellose and povidone are associated with dry eye syndrome. Similarly, hormone all available without preservatives. replacement therapy (HRT), tricyclic antidepressants (TCAs) and selective serotonin re-uptake inhibitors Severe dry eye symptoms (SSRIs) can aggravate ocular symptoms. Diuretic • Preservative-free artificial tears are suitable, but therapy should additionally be taken into account. consider adding an ocular lubricant ointment to use at night A good level of daily water intake should be encouraged • Eye ointments - such as paraffins - physically to aid hydration. As omega-3 fatty acids may reduce tear lubricate and protect the eye surface from epithelial evaporation and inflammation, oral supplements or dietary erosion and are particularly useful when the eye is intake via fish or flaxseed oil is often recommended. closed during sleep • As eye ointments containing paraffin may be Artificial tears and lubricants uncomfortable and blur vision, they should only The term ‘artificial tears’ is commonly used to describe be used at night and never with contact lenses drops, solutions and liquid gels applied directly into • Bicarbonate containing artificial tears have been the eye. Artificial tears don’t have all the component shown to promote healing in severe dry eyes of real tears - they mainly just act as a lubricant. The term ‘ocular lubricants’ generally refers to more viscous products such as ointments. of Sjögren’s disease Additional nonsurgical interventions Corticosteroids Moisture chambers Topical corticosteroids can be used to reduce These are used to prevent the eyes from drying out- inflammation, a key component of dry eye syndrome. during sleep, for example. They cannot be used for more than 4 weeks, however, due to a rise in intraocular pressure and risk of cataracts. Methylcellulose inserts Hydroxypropyl methylcellulose inserts (lacriserts) are Surgical interventions small pellets that contain artificial tears and are inserted Punctual occlusion surgery under the eyelid once-daily, to help keep the surface of This may be an option for patients whose symptoms the eye moist. As a sustained-release formulation for of dry eye cannot be adequately controlled with artificial tears, the effect can last anywhere from 6 to 12 conservative measures. The goal of this surgery is to hours. Lacriserts are usually used in patients with dry occlude (block) the tear ducts that drain tears from the eye whose symptoms cannot be controlled by frequent eye. Temporary punctual occlusion involves surgically instillation of artificial tears. inserting collagen or silicone plugs into the tear ducts. Permanent punctual occlusion involves using a laser or Tetracycline analogues electrocautery device to permanently seal shut the tear Doxycycline and minocycline have been shown to be ducts. This enables the tears to pool, thus delivering effective for treating meibomian gland dysfunction. moisture to the eyes Ciclosporin Salivary gland autotransplantation This may act as a partial immunomodulator, although This procedure is normally only recommended after all its exact mechanism of action is unknown. It is used to other treatment options have been tried. The glands relieve dry eyes caused by suppressed tear production that produce saliva are removed from the lower lip and secondary to ocular inflammation, as well as meibomian grafted into the side of the eyes. The saliva produced by gland dysfunction. the glands acts as a tear substitute. Autologous serum eye drops For information on causes, symptoms • Are unpreserved and non-antigenic and diagnosis, please see our fact sheet • Contain growth factors, fibronectin, immunoglobulins ‘About dry eye syndrome.’ and vitamins in a similar or higher concentration to natural tears • Are used for severe dry eye with punctate epithelial defects and corneal damage, to promote re-epithelialisation Tear secretagogues (muscarinic agonists) These increase the volume of tears produced by the lacrimal gland and are used for the treatment