Dry Eyes

eye drops 014One can spend a small fortune on eye drops.  Who knew there were so many options?

It turns out that there are (at least) two factors affecting eye lubrication.  First is tear production volume.  Eyes need to produce tears to moisten the eye.  If few tears are produced, then there isn’t enough moisture and the eyes will feel dry.  The second factor is evaporation rate.  If tears evaporate quickly, the eyes will be dryer than if tears evaporate slowly.

Regardless of the cause, when eyes are dry, they need to be moistened.

Artificial tears are available over the counter (OTC).  These liquid eye drops come in many brands, with different types available within each brand.  Plain artificial tears are what you want.  Drops for relief of red eyes usually contain an antihistamine, which is great for allergy sufferers but bad for dry eyes.  Note that bottles of eye drops contain preservatives.  In general, the recommendation is that if you use drops more than four times a day, switch to drops without preservatives.  Drops without preservatives come in tiny single-use applicators.  Whether it’s single-use tubes or full-size bottles, carrying them in your pants pocket all day 1) keeps them conveniently close at hand, and 2) keeps the drops warm, making them much more comfortable to put in.

Gels are also available OTC.  These are thicker than drops.  The advantage is that they don’t evaporate as quickly, so don’t need to be used as frequently as artificial tears.  One disadvantage is that they’re goopy, so cloud the vision for a short time after application.  For this reason, gels are usually used at bedtime.  Or, if you’re like me, you don’t mind enduring ten minutes of cloudy vision so that you don’t need to use drops quite so often.

Ointments are basically sterile Vaseline in a small eye-applicator tube.  These, too, are available OTC, and cost about $16 if you take one of the brands off the shelf.  My pharmacist has a $4 brand behind the counter.  Horrible as it might sound to put Vaseline in your eye, when your eyes are dry enough and you’re waking multiple times a night to use drops, you’ll try anything.  Ointments cloud your vision significantly more than gels, so if you try these, have everything ready so that  you can close your eyes and hop into bed immediately once the ointment is in.  You won’t even be able to see to find your way to bed, so if you can’t find your bed with your eyes closed, consider getting a mirror for your bedstand so that you can already be in bed when you put the ointment into your eyes.

Regardless of the amount of tears produced, sometimes those tears evaporate too quickly.  If the meibomian glands don’t work properly, the tears won’t contain enough oil to keep them from evaporating.  Sometimes these glands get clogged.  Applying a warm compress twice a day can help.  Although a hot washcloth can feel nice and relaxing, it won’t stay hot long enough.  One good option is a flexible microwavable heat pad.  This goes into the microwave for 25 seconds (approximately), and then will be the perfect temperature to place gently over the eyes for 10-15 minutes.  After this time is up, gently wash the eyes with warm soapy water.


A few other options for self-treating dry eyes:

  • Avoid antihistamines.  During the height of allergy season, this can be hard.  Allergy medicines are drying, though, so they will make dry eyes worse.
  • Avoid drafty air, fans, and air conditioners.  These tend to dry the air — and the eyes.
  • Seek out humid air.  Moist air can help the eyes retain their moisture.

If dry eyes persist, despite the best efforts of eye-drop manufacturers, make an appointment with your eye doctor.  This is not an appointment to have your vision checked to see if you need new glasses.  It will not be billed to your vision insurance, but to your medical insurance.  When you call, tell them that the reason for the appointment is “dry eyes.”  Take all your drops with you so that the doctor can see what you’ve tried.

When I saw my eye doctor, I led with, “My dermatologist says that my skin is dry. My dentist says that my mouth is dry. My eyes are so dry that I’m buying eye drops at Costco and emptying the bottles before they expire or get lost.  Can you tell me if this is Sjögren’s Syndrome, or something else that’s making my eyes so dry?”  Nope.  He couldn’t tell, but he could tell that I am both 1) not producing many tears, and 2) not producing much oil. Sometimes low tear production is due to inflammation, so I have $500 prescription eye drops that will take 6-8 weeks to take effect.  These are used every twelve hours, and are in addition to the preservative-free drops I need during the day and the ointment that I use at bedtime.

Wishing you pain-free days and nice, moist eyes.


4 thoughts on “Dry Eyes

  1. Hi Socks: I have Sjogren’s and your systemic symptoms really make it sound like you do as well. Regardless of whether it’s a Sjogren’s diagnosis, I would think you need something more than just topical eye drops that don’t do anything for the rest of you. I take Evoxac (Cevimeline), a prescription medication, for the Sjogren’s symptoms. It’s been a wonder drug for me (I can even comfortably wear my contacts!). I didn’t realize how dried out I’d become until I started taking it. I would strongly suggest you talk to your rheumy or even your PCP about it. Hopefully your medical/drug insurance will cover it. If not, the cash price here in Texas is about $300 for a 30 day supply (for three times a day). I sometimes only need two a day (morning and night) which stretches the prescription out. Good luck!

    • I usually just carry a bottle of water around to combat dry mouth. The problem with constant fluid intake is that it leads to frequent fluid output (which is a problem at baseball games), so it’s nice to know there are other options 😉
      My rheum appointment is next month. I was thinking of emailing to see if she wants to see me sooner. I’ve already told my PCp that I suspect I have Sjogren’s and discussed symptom management. At this point he’s letting rheum take the lead. We just had an insurance change, and so far I am liking the rx coverage better.

  2. Hi – why do you not get drops on repeat prescription? I have sjorgrens I need to lubricate hourly . At night it is 3 or 4 times. As my eyes are stil dry East Grinstead Hospital are taking blood from me every 6 weeks to make drops from my own plasma. This lasts longer than artificial tears and heals more. Only one license in UK to do this and its East Grinstead Royal Vicotria Mr Lake who runs it.

    • The customized drops sound wonderful. I’ll try to learn more about that process. Normally my eye dr would just recommend heat compresses and see how I responded before stepping up to restasis, but he said that given my medical history he’d go ahead and get me started on that. We’ll see what he decides at follow-up.

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