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Dry Eye Treatment

Different techniques to resolve naturally occurring dry eye or dry eye induced by Lasik or Bladeless Lasik.


Image of woman applying artifical tears to her eye.  
Dry eye treatment can resolve many problems associated with poor vision quality.  
   

Naturally occurring dry eye and dry eye related to Lasik can cause discomfort, vision fluctuations, slow healing, exacerbate astigmatism, damage epithelium, and cause poor vision quality.  Fortunately, there are many techniques to resolve dry eye problems. This article discusses naturally occurring dry eye, Lasik induced dry eye, and dry eye treatment solutions.

Lasik Dry Eye

The amount that dry eye symptoms affect an individual depends on many factors.  For the vast majority of conventional or custom wavefront Lasik, Bladeless Lasik, PRK, LASEK, or Epi-Lasik refractive surgery recipients, the degree of dry eye symptoms is not significant enough to cause difficulties.  Even those who do have some trouble most often find the dry eye symptoms resolve within the normal six-month healing period.

PRK Dry Eye

PRK and its cousins LASEK and Epi-Lasik may induce dry eye symptoms, however Lasik and Bladeless Lasik seem to be more commonly associated with problematic dry eye symptoms. Although what is discussed here relates to all refractive surgery procedures that induced dry eye problems, Lasik is referenced.

Exactly why Lasik induces dry eye is not totally understood. There is no doubt that Lasik induced dry eye is caused by a multitude of events. If the right combination of these events occurs, you have dry eye symptoms. It is generally thought that Lasik induced dry eye is caused by the nerves in the cornea being severed when the Lasik flap is created, when the excimer laser removes corneal tissue, and/or by the change in shape of the cornea.

The disruption of the cornea nerves causes a decrease in sensitivity of the cornea and interrupts the flow of information to the entire tearing system. The lack of sensitivity may cause a patient to blink less. The disruption of the normal flow of information may cause the system to not know that more tears are needed or that specific components of the tears are needed. It is also possible that the disruption of the corneal nerves will provide the sensation of dry eyes, when in-fact the eyes are appropriately wet, or the sensation of normal eyes, when in-fact the eyes are inappropriately dry.

Although the corneal nerve sensitivity returns in a relatively short period of time, while they heal there can be dry eye symptoms. Most Lasik induced dry eye is resolved within the normal six-month healing period.

Different Causes of Dry Eye

To properly maintain or resolve refractive surgery induced dry eye problems, it must first be determined exactly what is contributing to the dry eye. It is not as simple as not making enough tears. Dry eye symptoms are cause by one or more of three occurrences. Reduced tear production. Increased tear drainage. Distressed quality of tears. Each requires a very different response and responding to the wrong cause can exacerbate the true cause of dry eye symptoms..

Tear Layers

There are actually three layers of tears. The outermost is the lipid, center is the aqueous, and at the base of the tears is the mucin. Each of these are produced in separate glands near the eye and carried to the eye in tiny channels. These three combine to provide the eye, particularly the cornea, with nutrients and lubrication.

The mucin makes the tear viscous and allows it to spread evenly over the whole eye. If there isn't enough mucin, then the tear doesn't smooth out and cover the cornea. The mucin acts like a "glue" and helps hold the tears to the eye. The aqueous is the thickest layer in the tear and is the water that protects and lubricates. The lipid is the outermost layer and is essentially oil. The oil helps keep the aqueous from evaporating too quickly.

The other important component to healthy tears are the drains called punctum. These are tiny holes at the upper and lower edges of your eyelids that allow tears to flow out while new tears are developed and delivered to the eye. There one upper and one lower punctum for each eye.

Dry Eye Relief

Below are some ideas for treatment to manage dry eye problems, in no particular order. These techniques have helped patients with Lasik induced dry eye while they healed after surgery. These techniques can be used by anyone experiencing dry eye symptoms, not just those who have Lasik induced dry eye symptoms. All techniques should be verified with an eye doctor before utilization.

Eye Health Examination

Your doctor should be evaluating the health of your eyes. Dry eyes slow healing and can cause other problems. The doctor needs to be sure some other health problem is not contributing to your dry eyes.

Check Medications

Many medications have dry eye inducing properties. Antihistamines, allergy medicine, hormone replacement therapy, other over-the-counter and prescription medications can exacerbate dry eye symptoms. Tell your doctor any and all medications you are taking, even if you think they have nothing to do with your eyes. The darnedest things can contribute to dry eyes. Check with your doctor if an alternative that is less likely to affect dry eyes is available.

Dry Eye Testing

There are two primary tests to determine what is causing the dry eye symptoms. The Shirmer test is to determine tear quantity. This is the process of putting tiny strips of paper in your lower eyelid and determining how far out the tears soak the paper in a specific amount of time. The other is called a Tear Break-Up Test (TBUT). TBUT is the application of a staining solution that shows where on the cornea and when the tears break apart.

Drink Water

Drinking plenty of water and restorative fluids may seem obvious, but if you are dehydrated, your eyes will be dehydrated too.

Avoid Dry Areas

Air conditioning, heating, extreme cold and extreme hot weather will dehumidify the air. If possible, avoid these areas. Air movement will also dry tears. Avoid having a fan directly on your face.

Humidify

Wherever possible add a humidifier. A humidifier in your home or at your workplace can help dramatically. Add a humidifier to your bedroom for nighttime and, if possible, around your work area. If you don't have a humidifier, just bring a pot of water on the stove to a slow boil. You can even add potpourri or soup bullion to make the house smell nice.

Artificial Tears

Be sure any artificial tears you use are free of preservatives. Preservatives can actually cause dryness. We have a list of artificial tear eye drops that includes if they have preservatives and what type. You can always tell they are truly preservative free because they cost quite a bit more than the preserved drops and they come in single-use vials.

Each artificial tear manufacturer uses a slightly different formula and one may be better for you than another.  Try different brands until you find one that is comfortable and provides relief.  Use these drops whenever you think you need them. If you do not notice an improvement, make an eye drop schedule and stick to it. Remember, your corneas may not be able to tell you they need more tears. Start with four times a day and adjust accordingly. Generally, you cannot use too many preservative-free artificial tears.

Make Your Own Artificial Tears

Several studies have shown that Autologous Platelet-rich Plasma eye drops resolve difficult dry eye symptoms where common artificial tears fail. The eye drops are manufactured by drawing the patient's own blood, extracting the plasma, and concentrating the platelets by centrifugation. Discuss this option with your eye doctor.

Flax Seed Oil

This is a nutritional supplement that you can purchase at most health food and vitamin stores. Taking flax seed oil each day has been reported to help with dry eye by increasing the quality and quantity of lipid tear layer. The flax seed oil liquid seems to get better results than the tablets, but it tastes awful. Mix it with fruit juice or even yogurt - something with a strong flavor. Dosage is around two tablespoons a day, or as recommend by the manufacturer.

Nutritional Supplements

Studies have found that certain combinations of vitamins, minerals, and omega-3 fatty acids tend to decrease inflammation and improve tear gland secretions.  TheraTears Nutrition, HydroEye, and Hydrate Essential are examples of these nutritional supplements.  Fish consumption, such as salmon, sardines, and mackerel, can be helpful in adding omega-3 to diet.

Lubricating Gels

Along with the preservative-free eye drops, you can get gels to use at night. A few brands are MoistureEyes, GenTel, and Refresh PM. These are especially helpful for those who do not close their eyes completely at night.

Punctal Plugs

An eye doctor can provide these tiny plugs that stop or slow the flow of tears away from your eyes. See Lasik and punctal plugs

Protective Lenses

In general, protect your eyes from windy weather or extreme cold/hot. If you are one of those who sleeps with eyes partly open, using a lubricating gel and small swimming goggles may be appropriate.

Blepharitis Treatment

Scrubbing under the eye lids with warm water and baby shampoo, plus warm compresses that are the normal treatments for blepharitis often are helpful. The warmth makes the oil in the tears flow better and the scrubs keep the openings open. Learn more at our Lasik and Blepharitis article.

Antibiotics

You need to talk to your doctor about this, but some antibiotics may be helpful. A new application of this treatment is in the drug Restasis.

Steroids

Some doctors try to treat dry eyes with topical steroids. While this may be helpful, long-term use of steroids can result in other problems. Consult your doctor.

Restasis

This is the brand name of a prescribed ophthalmic eye drop with a small amount of cyclosporine included.  Cyclosporine is an anti-inflammatory.  Restasis can help dry eye be reducing inflammation around the tiny channels that carry the mucin, aqueous, and lipids to the eyes.  If swollen shut, these channels cannot deliver the lubricants necessary for a health tear film.  Although some relief may arrive as quickly as within a week of use, Restasis achieves its full effect after at least three months of continuous use.  Restasis is the only medication approved by the FDA for the treatment of chronic dry eye (keratoconjunctivitis sicca).

Second Opinion

If you think your doctor is not knowledgeable enough to help you with your problem, get a second opinion. At the very least, you will know if you are receiving the care and treatment you should be receiving.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.


Recent Dry Eye Medical Journal Articles...

Related Articles

Corneal Sensation and Dry Eye Symptoms after Conventional versus Inverted Side-Cut Femtosecond LASIK: A Prospective Randomized Study.

Ophthalmology. 2014 Aug 29;

Authors: Kung JS, Sáles CS, Manche EE

Abstract
PURPOSE: To compare corneal sensation and self-reported dry eye symptoms after femtosecond-assisted LASIK with conventional versus inverted side cuts.
DESIGN: Prospective, randomized, eye-to-eye study.
PARTICIPANTS: A total of 120 eyes in 60 participants with myopia.
METHODS: Fellow eyes were randomized to receive femtosecond-assisted LASIK with a conventional 70-degree side cut made with the 60 kHz IntraLase FS (Abbott Medical Optics, Santa Ana, CA) or an inverted 130-degree side cut made with the 150 kHz IntraLase iFS (Abbott Medical Optics). Cochet-Bonnet aesthesiometry (Luneau Ophthalmologia, Chartes, France) measured corneal sensation (60 mm = normal sensation; <60 mm = depressed sensation) preoperatively and at postoperative months 1, 3, 6, and 12. Participants also completed serial dry eye surveys using the same subscales (frequency, severity, bothersome) as the validated, Rasch-tested, linear-scaled Quality of Vision questionnaire.
MAIN OUTCOME MEASURES: Objective corneal sensation and self-reported light sensitivity, dryness, foreign body sensation, and pain/discomfort.
RESULTS: Preoperative corneal sensation as measured by mean Cochet-Bonnet aethesiometry was equal between the inverted and conventional side cut groups but was better in eyes with an inverted side cut compared with a conventional side cut at all postoperative months (inverted vs. conventional: 1 month, 14.5 vs. 13.2 mm; 3 months, 24.9 vs. 18.4 mm; 6 months, 51.2 vs. 42.6 mm; 12 months, 59.8 vs. 58.3 mm; all P ≤ 0.02). None of the subjective dry eye parameters demonstrated statistically significant differences between the groups at any time point.
CONCLUSIONS: The LASIK flaps with an inverted side cut are associated with superior recovery of corneal sensation compared with flaps with a conventional side cut during the first postoperative year; however, this may not translate to significant improvements in subjective dry eye symptoms.

PMID: 25178805 [PubMed - as supplied by publisher]

 


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