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.