Care for Dry Eyes

There are many possible causes for consistently itchy, burning or irritated "dry" eyes. As such, your treatment options will depend entirely on the underlying cause. To care for dry eyes, you need to understand both the cause of your dryness and the treatment for that cause.

Steps

Determining the Cause of Your Dry Eyes

1. Rest your eyes from contact lenses. Many contact lens wearers think of them as a replacement for glasses, but this is not at all the case. Contacts should only be worn in conjunction with glasses, but you should not be wearing contacts from the time you wake to the time to go to sleep. Over-using your contacts could contribute to dry eye. Cut back on the amount of time you spend in contacts, wearing them only when necessary. You can also take a two week break if your eyes are dry and irritated.
2. Improve your hygiene practices. Do you clean your contact lenses as directed? Do you wash your hands with soap before touching your eyes? Poor eye hygiene can lead to inflammation of the eyelids or possible infection, which can lead to dry eye.
   • Always wash your hands with before touching your eyes or contact lenses.
   • Rub the contact lens with an appropriate cleaning solution, then rinse them off with fresh solution.
   • Don’t be fooled by “no-rub” solutions — rubbing your contacts is the best way to ensure ocular hygiene.
   • Rinse your contacts case with fresh solution (not water) every time you put your contacts in, and turn it over to let it dry.
   • Replace your contacts as recommended. If your lenses are only designed for 2-week wear, don’t wear them for a month.
   • Never sleep in your contact lenses.
3. Take your local environment into consideration. If you live somewhere with a particularly dry climate — the Midwest and Southwest United States, for example — that might be the cause of your unusually dry eyes. Areas that experience large seasonal changes, like the American Northwest, can also contribute to dry eyes. The chances of your eyes being affected are greater in the dryer winter months. Unfortunately, there’s nothing you can do to solve a geographical problem, short of moving. You just need to take extra care to protect your eyes.
4. Figure out how much time you spend with screens. It may be that you just enjoy surfing the web for hours at a time, or it may be that your job requires you to stare at a screen for hours every day.Either way, when you stare at a screen for long periods of time, you blink less often. This, in turn, can cause dryness.
5. Look for other symptoms that suggest allergies. Of the 30 million Americans who have seasonal allergies, 70-80% experience problems with their eyes as a result. Other people may have allergic reactions to pet dander rather than seasonal allergens. However, dryness alone cannot point to allergies as a potential cause. Dry eyes must be paired with itchiness for a diagnosis of allergies. Other eye-related symptoms include:
   • Prominent blood vessels in the whites of the eyes and the eyelids
   • Conjunctival chemosis — appears as a blister of sack of fluid on the surface of the eye
   • Swollen eyelids
   • A clear, watery discharge
   • Confirm your diagnosis with a doctor.
6. See if your medications list dry eyes as a side effect. The medications used to treat conditions completely unrelated to your eyes can sometimes still affect your eyes. Give your doctor a complete list of all the medications you're currently taking. Go through them together and ask about whether any of them could be causing your eye dryness.
   • Acne medications, for example, can sometimes cause sudden dryness.
   • Hypertension medications (such as beta blockers) can also cause dryness.
   • Never stop taking a medication prescribed by your doctor, even if causes dry eye. Instead, ask your doctor what he or she recommends for dealing with this unwanted side effect. They may be able to adjust your treatment options or provide guidance for dealing with the dryness.
7. Consult a doctor. It may be that your dry eyes are a by-product of a chronic underlying condition — like diabetes or hypertension — that requires regular monitoring. For example, dry eyes may result from either the diagnosis or treatment of allergies, depression, acid reflux disease, or chronic pain syndromes. If your general practitioner has no explanation for it, you should see an eye specialist. During the appointment, the specialist will likely:
   • Ask a few questions about your general and eye health-related history
   • Examine your eyes, as well as the corneas and eyelids
   • Evaluate your tear production by using dyes to measure tear production
8. Seek immediate medical attention if necessary. If your dry eyes are paired with any of the following symptoms, you need to see a medical professional as soon as possible:
   • Blurred or double vision
   • Headaches or fever
   • Nausea or vomiting
   • Syncope (fainting) or lightheadedness
   • Dizziness or excessive drowsiness

Using Eye Drops and Medications

1. Try artificial tears. Artificial tear drops are available over-the-counter in any grocery store or pharmacy. Trial and error is usually the only way to find which brand works best for you, and you might even try the combined use of a few different brands. If you have chronic dry eyes, you should use artificial tears must even when your eyes feel fine.
   • Only use artificial tears four to five times per day maximum; the preservatives in the tears can cause more irritation if used more often than that. if you need tears more often, consider preservative-free artificial tears.
   • Artificial tears can only provide supplemental care and are not a substitute for natural tears.
   • They ease dryness by replacing the layer of tear film that keeps eyes moist and spreads tears evenly over the eye surface.
2. Use eye ointments. An eye ointment is a cream, rather than a liquid, that can treat eye dryness. It's also available over-the-counter at grocery stores and pharmacies. They're particularly useful during extended periods when artificial tears can't be applied — for example, when you’re sleeping.
   • Pull down the lower eyelid.
   • Squeeze a thin layer of ointment into the pouch created between the lid and the eye.
   • Close the eye for 30-60 seconds to let the ointment soak into the eye.
3. Look for specialized drops and ointments if needed. People who wear contact lenses should look for drops designed specifically for use with contact lenses. You can also find medicated eye drops that are geared toward specific symptoms, such as itchiness. Demulcent eye drops, for example, target inflammation and irritation. Other common treatments include hydroxypropyl methylcellulose and carboxy methylcellulose. Your doctor can also prescribe prescription drops and ointments after examination and diagnosis.
   • Prescription medications like Restasis (which stimulates more tear production) are generally administered twice daily.
   • Gels are usually administered about one to two times daily.
   • If you are unsure of dosages of your drops, contact your doctor or speak to a pharmacist to clarify the dosage.
4. Ask about antibiotic eye ointments. Depending on your doctor's examination and diagnosis, your eyes may need antibiotic treatment. If the dryness is due to diseased meibomian glands (glands that produce lipid layer of tear film) or blepharitis (swelling due to inflammation of lids), ask about antibiotic treatment. This dryness can usually be treated by ointments like tetracycline, ciprofloxacin, or chloramphenicol.
   • These ointments are applied at night and work to keep eyes moist while you sleep.
5. Do not wear contact lenses while administering medications. Remove contacts before applying the drops or ointment, as medications can get absorbed into the lens. You can reinsert your lenses 30 minutes after treatment.

Considering Your Other Options

1. Talk to your doctor about oral treatments. Many people have trouble applying eye drops and ointments directly to the eye, as it can be uncomfortable or unnerving. Sporadic or improper application of such topical products won't adequately treat the problem. If you don't want to apply treatments directly to the eye, ask your doctor or eye care professional about an oral treatment. For example, if the dryness is due to infection, an antibiotic pill will help relieve dryness.
2. Ask your eye care professional about special contact lenses. Though they will likely cost a bit more, you can use contact lenses that will work better for your needs. Some contacts are more "breathable" and cause the eyes to dry out less than other lenses. Other lenses trap moisture in the eye, keeping it moisturized. Talk to your ophthalmologist about his or her recommendations for your options.
3. Consider lacrimal gland plugs. These should be considered only if your doctor pinpoints inflamed lacrimal glands as the underlying cause of dryness. The lacrimal glands produce the watery tear film that moisturizes the eye. A lacrimal plug can be used to stop tears from exiting through tear ducts, allowing more moisture to remain in and lubricate the eye.
   • This is a more aggressive treatment that should only be considered in severe cases of eye dryness.
4. Unblock blocked oil glands. If the oil glands in the area are blocked, your eyes will get dried out. If your doctor finds this to be a cause of your dryness, ask him or her about LipiFlo thermal pulsation, a treatment that helps clear blocked oil glands. This outpatient procedure is noninvasive, and takes only 15 minutes. The doctor will place a device on your eye that sends massaging pulses into it, stimulating tear production. Most people see positive effects within a few days.

Making Lifestyle Changes

1. Relax your eyes from eyestrain. Because our eyes are working whenever we're awake, we may not think of them as something that can get tired, like our legs or arms do. However, our eyes can get strained just like any other part of the body. The most common cause of daily eyestrain is looking at screens. This includes jobs or hobbies that have you stare at computer screens for long periods of time, excessive television viewing, constantly staring at your cell phone, or any other electronic screen use. The eyes are strained especially when you view these screens for extended periods of time and at close distances.
   • If you use these devices for long periods of time, adhere to the 20-20-20 rule.
   • Every 20 minutes, stop looking at the screen and focus your eyes on something 20 feet (6.1 m) away for 20 seconds.
   • This helps with dryness and other eye conditions.
2. Blink frequently. The act of blinking spreads oils and natural lubricants across the eye, moisturizing it. It also clears away debris that can irritate the eye. Normal blinking rates are around 14 blinks per minute but can decrease to 4.5 blinks per minute, especially when you focus on a specific task or stare at an electronic screen. If your eyes feel dry, remind yourself to blink as often as possible to moisturize them.
3. Protect your eyes from the elements. The simple act of wearing sunglasses can make a big difference. They protect your eyes against harmful UV rays, but also against exposure to wind and sun that causes eyes to dry. Furthermore, they can block outdoor debris like dusk and pollen that can irritate the eye.
   • You should also wear goggles when swimming to protect your eyes from chemicals and irritants in the water.
   • Avoid exposing the eyes to direct air directly like car heater, hair dryers, and air conditioners.
4. Purify and humidify the air in your home. Often, environmental conditions can be the cause of dry eyes. Dust and pollen in the air can work their way into your eyes and cause irritations. Using an air purifier can keep the air consistently clean. An air humidifier can help diminish dry eye from dry air by keeping sinus membranes from drying out. The lack of moisture in the air can cause eyes to become dry and irritated.
   • A humidifier does not necessarily filter or clean the air, but it does create moisture for the air to keep your eyes hydrated.
   • Keep the humidity level in your home between 30-50% humidity.
5. Keep your body hydrated. Moisturizing with eye drops may temporarily fix dryness, but the underlying problem may be overall dehydration. The Institute of Medicine recommends 13 cups (3 liters) of total beverages a day for men, and 9 cups (2.2 liters) for women. This can help dry eyes by increasing blood circulation as well as eliminating toxins from lymph fluid. It also provides your body with the moisture it needs to increase tear production.
6. Eat foods rich in Vitamins A, C and E and in Omega-3 fatty acids. These vitamins and fatty acids provide eyes with the nutrients they need to stay healthy and well-hydrated. Foods you should look for include:
   • Cold-water fish (sardines, herring, salmon and tuna)
   • Flaxseeds and flaxseed oil
   • Walnuts
   • Sweet potatoes
   • Carrots
   • Grapefruit
   • Strawberries
   • Brussels sprouts
   • Seeds and nuts
   • Wheat germ
7. Get enough sleep. Getting a complete rest at night allows your body to restore itself and helps your eyes re-hydrate. When your eyes are closed during sleep, your eyelids replenish your eyeballs with the needed moisture. Most adults need between 7 and 9 hours of sleep every night, with teenagers and children needing slightly more, and senior citizens needing slightly less.
   • Have someone check to see if you keep your eyes partially opened for periods of time when you sleep. This, too, can contribute to dryness.
8. Quit or cut back on smoking. Smoking is associated with a wide variety of eye problems, from macular degeneration to cataracts. The smoke can also irritate the eyes and dry them out — even among people who are exposed to second-hand smoke. These effects are compounded in people who wear contact lenses.
9. Reduce salt in your diet. Dry eyes can come from too much salt in the diet. You can test this for yourself, especially when getting up at night to use the bathroom. If your eyes feel dry at that point, drink a few ounces of water (small coffee size) and see if your eyes don't feel nearly immediate relief. If they do, then reduce the salt in your diet and stay hydrated.

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