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There are 4 main strategies for dry eye management – which one is best for you?

Strategies for dry eye

Fundamentally dry eye disease is caused by a reduction in the quantity or quality of your eyes natural moisturising protection – your tears. These changes result in the natural balance being lost, your tears becoming too salty, and the triggering of an inflammatory response. Returning balance to ocular environment is critical if you want to take control of your dry eye. If you do not, then the disease will continue, becoming progressively worse, and ultimately it could result in permanent damage to the surface of the eye. 

 

Understanding the options available to you is important as it means you can have a more meaningful conversation with your Eye Care Professional and get the right routine in place for your dry eye. Like most things in life it is always more complex that you might first think, with most people requiring a multiple strategy approach.

 

The Dry Eye Zone explains more about these options and how they can help manage your symptoms – from the mildest to the most severe.

 

1.      Add more tears

The use of special dry eye drops or artificial tears is a front-line therapy to help rehydrate your dry eyes and put a stop to those annoying symptoms. These drops are formulated to mimic the work of your natural tears, but not all dry eye drops are created equally. Your eye care professional is there to help you, and will almost certainly advise you to use a preservative free formulation. You will ideally want an eye drop which is retained in the eye for as long as possible for the best results. You can find out more about what to look for in a dry eye drop here.

 

When you use artificial tears you are helping repair any dry spots that are appearing on the delicate surface of your eye, this helps protect the ocular surface. You are also lowering the salt concentration of your tears by diluting them, and this helps to restoring the natural balance.

 

 

2.      Slow tear loss

Your tears are produced by a series of glands found around the eye and along the edge of the eye lid, there are also special mucin secreting cells in the surface membrane of the eye (the conjunctiva). Your tears are complex and are made of three interacting layers, it is the job of the outer-most lipid-layer to slow evaporation and help avoid dry eye symptoms. If the lipid-layer is not functioning as it should then you will not be able to produce enough tears to keep your eyes hydrated.

 

You can take steps to slow this evaporative rate by wearing protective eye wear, such as wrap-around glasses. These can be particularly useful when faced with drying environments like that of a windy day or an airconditioned plane or car. You can also reduce evaporation by adding moisture to the air around you, this can be achieved using a humidifier or a home remedy such as damp towels on radiators.

 

Your Eye Care Professional can help too. In more severe cases they can use tiny little plugs to stop or slow the natural tear drainage process. Some experts also fit special contact lenses, known as scleral or bandage lenses, to shield the surface of the eye and help hold in tears.

 

 

3.      Make more tears

This easier said than done, but there are certain things you can do to help your natural tears flow. The most used technique is ‘heat therapy’ which encourages the production of the protective lipid layer to better flow into the eye. This is recommended when meibomian gland dysfunction is indicated.

 

You can also get more tears flowing by keeping up your blink rate and doing some simple eye exercises to literally ‘squeeze’ some extra tears out. The Dry Eye Zone has an easy eye exercise routine for you to follow. This includes the 20-20-20 rule (every 20 minutes focus your eyes on an object 20 meters away for 20 seconds) which is particularly useful if your working days centred around the digital devices this is easier said than done. However, working at a screen has the effect of reducing the natural blink rate, this means fewer tears are produced and spread over the surface of the eye.

 

And do not forget, life style matters too, and there is evidence to link sedentary life styles and a lack of physical exercise to the incidence of dry eye. A regular exercise programme has been shown to reduce symptoms in people who already suffer from dry eye disease.

 

Dry eye is a global problem which impacts the quality of life and work productivity. New treatments are in the pipeline but there are already drug interventions available for the most severe cases. This includes new emerging medications called cholinergics which are designed to stimulate the lacrimal glands to produce more natural tear production.

 

 

4.      Stop the inflammation

The notion that dry eye is an inflammatory condition is now firmly established among dry eye experts. The changes in tear composition described above all result in the surface of the eye becoming far saltier (concentrated) than is desirable. The result is the triggering of an inflammatory reaction and the release of histamine. This response is known as the ‘vicious-cycle’ and needs to be broken by re-establishing the correct tear concentration, this can be achieved with the addition of dry eye drops.

 

Diet can also play a role here. Omega-3 is known to help reduce inflammation. The addition of extra oily fish into your diet or other foods rich in these essential oils can help. You might also want to consider omega-3 supplements, your Eye Care Professional can advise.

 

Make sure you explore the many links in this blog to bring more depth to the subjects touched on here and to help give you a fuller knowledge of all things dry eye related.

 

 

 

You can learn more about all things dry eye related at the DRY EYE ZONE. Don’t forget to subscribe to the regular free information and research updates.


If you are experiencing dry eye symptoms then you should ask the advice of your eye care professional. Why not book your next eye examination with an independent optician today.

Sources:

Talens-Estarelles C, García-Marqués JV, Cerviño A, García-Lázaro S. Determining the Best Management Strategy for Preventing Short-Term Effects of Digital Display Use on Dry Eyes. Eye Contact Lens. 2022 Oct 1;48(10):416-423. doi: 10.1097/ICL.0000000000000921. Epub 2022 Jun 30. PMID: 36155947.

 

L. Jones et al. TFOS DEWS II Management and Therapy Report. The Ocular Surface xxx (2017) 580e634

 

Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK. The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci. 2011 Mar 30;52(4):1994-2005. doi: 10.1167/iovs.10-6997e. PMID: 21450917; PMCID: PMC3072161.

 

Rabensteiner DF, Aminfar H, Boldin I, Schwantzer G, Horwath-Winter J. The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population. Acta Ophthalmol. 2018 Sep;96(6):e707-e711. doi: 10.1111/aos.13732. Epub 2018 Apr 15. PMID: 29656524; PMCID: PMC6619403.

 

 

Katipoğlu Z, Abay RN. The relationship between dry eye disease and anticholinergic burden. Eye (Lond). 2023 Oct;37(14):2921-2925. doi: 10.1038/s41433-023-02442-x. Epub 2023 Feb 9. PMID: 36759707; PMCID: PMC10517132.

 

Yamaga, M., Imada, T., Tani, H., Nakamura, S., Yamaki, A., & Tsubota, K. (2021). Acetylcholine and Royal Jelly Fatty Acid Combinations as Potential Dry Eye Treatment Components in Mice. Nutrients, 13(8), 2536. https://doi.org/10.3390/nu13082536

 

Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017 Jul;15(3):276-283. doi: 10.1016/j.jtos.2017.05.008. Epub 2017 Jul 20. PMID: 28736335. https://pubmed.ncbi.nlm.nih.gov/28736335/

 

Hessen M, Akpek EK. Dry eye: an inflammatory ocular disease. J Ophthalmic Vis Res. 2014 Apr;9(2):240-50. PMID: 25279127; PMCID: PMC4181208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181208/

 

 

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