close up of a wide open eye, frequent blinking, eye drop

Dry eyes can make people miserable. You might feel as though you have sand in your eyes all the time. Your eyes may itch or sting. The first line treatment is to replace the tears your own eyes aren’t making. But how can you find a good eye drop to moisturize your eyes?

Looking for a Good Eye Drop:

Q. Can you tell me if there are any eye drops without preservatives? I heard on your radio show that I should avoid benzalkonium chloride. I can’t find eye drops that do not contain that chemical. Can you help?

A. Look for a product that is preservative free. One such is TheraTears. Others include Systane Ultra, Refresh Optive Advanced and NanoTears TF.

Our guest expert, Dr. Peter McDonnell, director of the Wilmer Eye Institute, suggested a product with hyaluronic acid. One such is Hylo-Vision HD. You can listen to our interview with Dr. McDonnell about dry eyes at www.PeoplesPharmacy.com.

Other Approaches to Overcoming Dry Eyes:

Blink:

There are several other approaches that may be helpful for dry eyes. One of the simplest is to blink frequently. Blinking is like breathing. You do both without thinking thousands of times each day.

As long as everything is going well you won’t even notice when you blink. You also won’t be aware if you forget to blink. When you watch a video on your smart phone or get caught up in correspondence on your computer you may be so focused that you fail to blink frequently enough.

That may not seem like a big deal, but blinking is critical for spreading tears over the surface of the eye and keeping it moist, clean and well nourished. Infrequent or incomplete blinking may be contributing to an apparent epidemic of dry eye. A Wall Street Journal article (July 9, 2013) notes that as many as 25 million Americans suffer from this malady.

Optometrists and ophthalmologists are diagnosing this condition in increasing numbers of patients, who describe a persistent sensation of grit or sand in the eye. Sometimes dry eye feels like burning that becomes more intense as the day wears on. Severe dryness can damage the cornea, creating a vicious cycle of pain and dysfunction.

Why Blink?

Over the last several years, research has shown that tears are more than just salty water. In addition to the aqueous (watery) part of tears, the eyelids have glands that secrete a thin film of oil. Every blink brings the top and bottom lids together and they squeeze each other gently. This helps the glands release oil that floats atop the watery portion and keeps it from evaporating too quickly.

If you don’t blink often or hard enough, the oil will stay in the glands, thicken and eventually plug the opening. While eye drops can replenish the liquid, eye doctors have been challenged to help patients restore the natural oil.

LipiFlow to Restore the Oil Coating:

The LipiFlow machine warms and presses the eyelids to unclog the glands and get the oil flowing again. One study compared LipiFlow to warm compresses (the usual recommendation) and found the device was significantly better (Cornea, April 2012). For most people, one treatment can ease dry eye symptoms for up to a year (Clinical and Experimental Ophthalmology, online, Dec. 14, 2012). The downside of LipiFlow treatment is that it is expensive and it does not work for everyone.

Nutritional Supplements:

Some people have good results taking a supplement of omega-3 fatty acids. These seem to improve the quality of the oil produced by the eyelid’s meibomian glands. That helps keep the tears from evaporating off the surface of the eye.

DCF reported:

“After I went through menopause I had eyes so dry I’d have to take pain relievers every day. My work consists mostly of reading, writing, and using a computer monitor, so the dry eyes were a constant bother. Upon reporting this to my optometrist, I was advised to take 3 Thera-Tears Nutrition gel tablets, which consist of flaxseed oil and fish oil, daily at breakfast.

“Voilà! The Thera-Tears made all the difference in the world; I take them faithfully every day. No side effects, either.”

Lulu had a similar experience:

“My ophthalmologist told me to take a fish and a flax capsule in the morning and a fish and flax at nite…it works for me as I do not have to use an eye drop.”

MW also appreciates flaxseed oil:

“My doctor prescribed eye drops, but she also said that she takes 3000 mg of flaxseed oil every day. I started taking it about a month ago and it has made a tremendous difference.

“The supplements that I bought were only 1300 each so I take two, making it only 2600 per day. It’s worked like a charm.

“My ophthalmologist says that when she stops taking  the flaxseed oil, she notices the dryness comes back within a short period of time. I did the hot compress, lid scrubs, etc and it made little difference but flaxseed oil works better.”

Pay Attention to Medications:

Dozens of medications can contribute to dry eyes. Antihistamines such as cetirizine (Zyrtec), loratadine (Claritin) and diphenhydramine (Benadryl) can do it. So can drugs for overactive bladder like fesoterodine (Toviaz), oxybutynin (Ditropan) and tolterodine (Detrol). Antidepressants such as amitriptyline, citalopram, doxepin, fluoxetine and sertraline may also trigger dry eye discomfort for some people. You will find a more comprehensive list here.

Do You Need a Prescription Eye Drop?

If over-the-counter artificial tears do not reverse the symptoms of dry eyes, an eye doctor may prescribe a more powerful eye drop. One such product is cyclosporine (Restasis). Another is lifitegrast (Xiidra). Both act on the immune system to reduce inflammation in the eye. Before accepting a prescription for either one, ask your doctor how likely it is that it will help you. Not everyone benefits, and Xiidra, in particular, is extremely expensive. Both may cause blurred vision as a side effect.

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  1. Sandy
    Virginia
    Reply

    Was glad to see the preservative-free eye drops listed. Can these be used with soft contact lenses?

  2. Colorado Conservative
    Reply

    Dry eyes have been an issue for me for at least 10 years. I had Lasik surgery which is attributed to the problem but most likely age, menopause, and climate are all factors. I do use prescription Restatis but still have to rely on OTC drops. For me preservative free BION Tears are one of the best (I order them online for the best price) and I recommend them highly. I also recommend using computer glasses if you are someone who is at the computer often. This has considerably decreased my need to use OTC drops when at the computer.

  3. Suzy
    Signal Mtn TN
    Reply

    I’ve used Thera Tears for year. It’s easy, safe, preservative free and it works great great😎

  4. Janet
    Ashford, WA
    Reply

    I have extremely dry eyes, apparently from sleeping with my eyes partly open, but I also notice while reading or driving or anytime I am not blinking enough. My eye doctor found an incredible solution in Oasis Tears. They also contain hyaluronic acid, (state of the art DNA? ingredient) as noted above, yet you can order them online here in the US. They are very expensive, and I get the small single dose type as they have no preservatives. They are approximately one dollar a dose, and I use about 6-8 a day so very expensive for me. I hope a generic, or other option will come out with this ingredient. But they have saved my eyes from terrible infections, and keep them healthy. I use Oasis tears Plus at night and regular Oasis Tears in the day. Best of luck!

  5. JJ
    Watertown SD
    Reply

    My eye doctor recommended using Cleansing Eyelid Pads daily to keep the oils flowing so the oil ducts don’t get clogged. She also recommended warm compresses for about 6 minutes each time to soften the oils. This helps both with itchy eyes and dry eyes.

  6. Lynn
    midwest
    Reply

    Dry eye can be helped by small things like blinking. Also when on the computer the 20/20/20 rule is advisable. Every 20 minutes look 20 feet away for 20 seconds. When you stare at the computer monitor you tend to blink less. So blinking and looking away is important. I would also advise those with dry eye to be aware where their TV is.

    If you watch a television that is high up, you eye is open father looking at it than if the TV is in a lower location. The same holds true for computers, That eye that is open further dries out more quickly. Each is best lower than the eye so you look down at them. Be aware of fans and heat in the car that they do not point directly to your eyes. If you use eye drops for lubrication more than 3 times a day, use drops without preservatives. Many brands have drops in vials and those are the ones that do not have preservatives as opposed to the bottled drops. There are also homeopathic drops that can help. Check your medications to see if they cause dry eye but also be aware that certain autoimmune diseases can cause it as well. One that is very common but not well known is Sjogren’s (show-grins). In Sjogren’s, dry eye occurs with dry mouth (which leads to dental decay) along with extreme fatigue and arthritic issues. Those with RA also can suffer from dry eye. If you are not sure what is going on, seek medical attention because dry eye can cause corneal abrasion in the eye.

  7. sherry
    Reply

    If you have rosacea, you may have it in your eyes also. It feels like sand. Washing eyes with a soft soap like Cetaphil can help for short term relief. Getting rid of rosacea altogether is difficult.

  8. Virginia
    Georgia
    Reply

    Dry eye plagued me for years & my eye doctor was of little help even though she tried. At one point my eyes itched so badly that I felt like clawing my eyes out! I finally decided that the extreme itch was something other than just dry eye. I suspected a fungal skin infection around my eyes, so I tried an anti-fungal cream around my eyelids. It worked like a charm, just be certain not to get it into your eyes and I bought one tube just for my eyes so as to avoid any possible contaimination

  9. Beth
    Reply

    I am unable to locate Hylo HD eyedrops. Does anyone know a source to purchase this product?

  10. LaRae
    AZ
    Reply

    After a procedure done on my eyes a while back, they would get very dry in the evening when I was tired. I put a couple of drops of organic virgin coconut oil in each eye and it worked wonders!

  11. Pam
    South Pasadna, Ca
    Reply

    Been taking Xiidra for about a year since I was allergic to Restasis. Has helped, but noticed lately my taste buds are loosing my ability to taste food and i’ve started having dry mouth during the night. Read the side effects and notice these could be a problem.

    Am trying zinc supplements to restore my taste buds. Will wait and see. I’ve also tried biotene, helps somewhat. I had to ask for a formulary exception with my insurance Scan. Took a while but it was granted after i appealed their initial decision. Price went from $500 to $95. Worth the effort.

  12. Jean
    Chapel Hill, NC
    Reply

    With my eye doctor’s approval I have used Similsan eyedrops for some years. They have one for dry eye, allergy eye, and one for complete. They are all very good, and have no artificial ingredients.

  13. Janie
    Washington State
    Reply

    Washing my face often and with lots of water also helps with my dry eyes during allergy season, by ridding my face of pollen and dust.

  14. Mary
    Reply

    A person must be very careful when using eye drops. Especially when a person had Cataracts removed from your eyes. Not all eye drops are made for that. That is why my eye surgeon gave me a prescription to get filled out just for dry eyes.

  15. Christine
    Chicago
    Reply

    I had dry eye and began taking Lutein and Zeaxanthin combination and it helped immediately no problem since,

  16. Jan
    UK
    Reply

    Hycosan, also marketed as Hyloforte are good effective drops, no preservatives, and useable for six months so although a bit expensive quite cost effective in the long run. I’m in uk so don’t know if available in US.

  17. Suzanne
    USA
    Reply

    If you get migraines do NOT use Restasis; many of us had a marked increase in the frequency and intensity of migraines from Restasis. My eye surgeon recommended Similason homeopathic drops. They do a better job, are much cheaper, and are OTC.

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