Artificial tears not a miracle cure

DEAR DOCTOR » My eyes are so dry, they often feel as if I have sand in them. I use drops, but they don’t always work. Is there anything else I can do? And will this hurt my vision over time?

DEAR READER » No doubt you’re frustrated. If it’s any comfort, your doctor probably is too. People suffering from dry eyes are frustrated because of the constant irritation; doctors are frustrated because they don’t have a miracle cure. The symptoms of dry eyes vary. Like you, many patients complain of a gritty or sandy sensation. Some also report red or watery eyes, a burning feeling, light sensitivity, blurred vision or a combination of these symptoms. Paradoxically, excessive tearing can also be a sign of dry eyes. Rarely, however, does prolonged dry eyes lead to scarring of the cornea or permanently altered vision.

That’s fortunate, because 14.5 percent of Americans report having regular dry eye problems, and the likelihood increases with age. The condition is more common in women, especially those undergoing menopause, as well as in people with certain chronic illnesses such as diabetes and Parkinson’s disease. People who have had laser eye surgery, wear contacts or use medicated eye drops also have a greater rate of dry eyes, as do people who have allergies.

As for treatment, it’s important to look at the possible cause. Some medications, such as antihistamines, antidepressants, niacin, estrogens and the arrhythmia drug amiodarone can cause dry eyes. So can the autoimmune disease Sjogren’s syndrome, which leads to inflammation of tear ducts, death of cells in the ducts and decreased formation of tears. Sjogren’s, which is accompanied by dry mouth, can be diagnosed with blood tests and other screenings that evaluate production of tears and saliva. Other conditions can affect the tear ducts as well, such as sarcoidosis, lymphoma and diabetes.

Eyelid health is also important. Normally, Meibomian glands in the eyelid produce an oily substance that prevents tear evaporation and helps trap tears upon the eyeball. Inflammation of the lid margin, termed blepharitis, causes these glands to malfunction, leading to dry eyes. Treatment of blepharitis includes lid scrubs (using baby shampoo and a warm wet cloth), lid massage, warm compresses and artificial tears.

Speaking of artificial tears, these drops add viscosity to the fluid surrounding the eye and thus maintain a natural tear covering the eye. Adding one drop to each eye three to four times per day will improve symptoms. Note that some people have sensitivity to the preservatives in artificial tears, so using preservative-free tears may be helpful.

For people with inflammatory conditions such as Sjogren’s syndrome or blepharitis, the immunosuppressive eye drop cyclosporine, applied twice a day, can significantly improve the symptoms of dry eyes.

A newer eye drop, lifitegrast, decreases inflammation in the eye, with twice-a-day application leading to significant improvement of symptoms. Note, however, that the medication can also cause eye irritation and taste abnormalities.

Not all treatments are drug-related. Omega-3 fatty acids with EPA, DHA and flaxseed oil can enhance tear production, decrease tear evaporation and improve overall symptoms. Similarly, diets deficient in omega-3 fatty acids have been linked to increased rates of dry eyes.