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? That question is especially important now that the FDA has warned that many lubricant eye drops pose a problem. You can read our analysis of this problem at this link.
Brand Name Eye Drops vs. House Brands?
A reader of our nationally syndicated newspaper column asks:
Q. I’ve suffered from extremely dry eyes for more than three decades. However, my ophthalmologists have always recommended that I stick with single-dose packaged drops, containing no preservatives, and not generic brands.
I’ve always wondered if this is really necessary, since these drops are certainly pricey. With the recent recall, though, I’m thinking maybe these precautions are appropriate. I suppose even the name brand, single-dose drops could be subject to contamination. Honestly, I cannot live without these drops, and I hope you can reassure me.
A. The FDA’s warning about eye drop problems involves house brands from CVS Health, Leader, Rugby, Target, Rite Aid, Velocity and Walmart’s Equate Hydration PF Lubricant Eye Drop. These were all multi-use bottles containing 10 to 15 ml.
As far as we can tell, brand name products such as Systane, Refresh, TheraTears or Blink products are not included on the FDA’s problem list. Single-use artificial tears are also less likely to pose a problem.
Looking for a Good Eye Drop:
Another reader asks:
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. It is show 1154: How to Take Good Care of Your Eyesight.
Other Approaches to Overcoming Dry Eyes:
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.
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.
Ask Your Doctor About Sjögren’s Syndrome:
Sjögren’s syndrome is an autoimmune condition that can cause dry eyes as well as dry mouth. Because it isn’t limited to the eyes, doctors may treat this condition with systemic medications as well as prescription eyedrops. Drugs for rheumatoid arthritis such as hydroxychloroquine or methotrexate can also help control Sjögren’s syndrome.
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.
“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.
To learn more about a variety of dry eye treatments, you can listen to another expert guest from our radio show. We highly recommend this free podcast. You can listen to the streaming audio by clicking on the arrow inside the green circle below the photograph of our expert ophthalmologist. She provides lots of practical advice at this link. Please share your own experience with DED (dry eye disease) in the comment section below.