Medications for Dry Eye: In-Office & At-Home Treatments

Similar to evaluating other ocular surface diseases, diagnosing and treating a dry eye condition can be tricky. Most patients with dry eyes usually require a combination of therapies, including lifestyle modification and prescription medications, to achieve long-lasting relief.

Over-the-counter treatments such as artificial tears and eye wipes are the most common modality of relieving dry eye discomfort.

But if symptoms persist even after using home therapies, visit an eye specialist for in-office management. Doctors can recommend prescription eye drops, punctal plugs, eyelid cleaning or newer treatment options such as Reproxolap. 

How Is Dry Eye Diagnosed?

Your doctor will perform specific tests to determine the extent of your dry eye condition and also to look at a possible cause. Tests include:

• A comprehensive eye examination, which entails a detailed history of your overall and eye health, visual acuity, eye focusing, teaming and movement, plus refraction, among other tests. 
• A Schirmer test that measures the volume of your tears. The doctor will place blotting strips under your lower eyelids and remove them after five minutes to check sections soaked by tears.
• A tearlab test to determine the quality of your tears. A tear sample from each eye is placed in a device that gives the osmolarity of your tears, with a lower value indicating dry eye.
• Dry eye disease markers. Tests for matrix metalloproteinase and lactoferrin can help your doctor determine the cause of your dry eyes.

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Dry Eye Medications

“Having a wider breadth of options will help ophthalmologists to better customize treatments. This should lead to greater efficacy and faster symptom relief for patients.”

Medications for treating dry eye include over-the-counter medications and in-office prescription eye drops. Medicines approved by the U.S. Food and Drug Administration (FDA) for treating different types of dry eye include:

• Restatis
• Tyrvaya
• Eysuvis
• Xiidra

Restasis

Restasis is a cyclosporine eye drop explicitly designed for treating chronic dry eye secondary to inflammation. With consistent use, twice daily for about three to six months, 

Restasis will relieve eye discomfort by promoting the natural secretion of tears. Of note: You might experience a stinging or burning sensation when using this drug. 

Cequa, which also contains cyclosporine, shares the exact mechanism of action and indication with Restasis. 

Tyrvaya

Tyrvaya (varenicline solution) is the only nasal spray approved by the FDA to treat dry eye syndrome. The spray relieves symptoms by stimulating the production of tears, mucin, and oil for eye lubrication.

While it is more convenient to use Tyrvaya than the traditional eye drops, the risk of developing side effects such as sneezing, throat irritation, and coughing is notable.  

Eysuvis

Eysuvis (loteprednol etabonate) is a short-term corticosteroid suspension that treats dry eyes because of inflammation. The FDA recommends using the eye drop for only two weeks to avoid steroid-associated adverse effects. 

Symptomatic relief is quicker compared to immunomodulator-based eye drops like Restasis. You should not use Eysuvis if you have a viral disease of the cornea or conjunctiva. 

Xiidra

Xiidra is another anti-inflammatory ophthalmic solution used to treat dry eyes. The eye drop might take up to three months to alleviate symptoms. 

Other In-Office Treatments for Dry Eyes

Beyond over-the-counter drugs and prescription medications, eye doctors have other dry eye treatments they can rely on. Among them:

• Eye inserts. These rice grain-like inserts placed under your lower eyelids mimic artificial tears as they dissolve to release a substance that lubricates the eye. Lacrisert is one of the commonest inserts for treating dry eyes.
• Cholinergics. These are drugs such as cevimeline and pilocarpine that stimulate the production of tears. You can take them in pill form, as eye drops or in a gel formulation. 
• Scleral or bandage contact lenses. These special contact lenses that trap moisture and protect the eye surface can offer you significant relief if you have severe dry eyes. 
• Punctal plugs are small devices that doctors insert into tear ducts. Made from either collagen or silicon, they help tears stay longer in the eye by blocking the tear outflow pathway. They reduce the symptoms of dry eyes.
• Intense pulsed light therapy with eyelid massage. As a modality of treating inflammatory dry eye, light therapy and eyelid massage stimulate oil secretion from the glands while reducing redness around the eyes.  
• Autologous blood serum eye drops. If the other treatments do not resolve your dry eyes, autologous serum eye drops prepared from your blood are options. The doctor will draw your blood, process it to remove the red cells, and mix it with a salt solution to form serum eye drops.
• Eyelid scrub for unblocking oil glands. Your doctor uses a handheld device consisting of a medical-grade sponge spinning at high speeds to remove biofilm, toxins, or bacteria that might be blocking the eyelid glands. This promotes the flow of tears and relieves dry eyes caused by gland blockage.

Lifestyle Changes and Home Remedies for Dry Eye Syndrome

Available over-the-counter options include gels, eye drops and ointments.

Dry eyes with diminished tear production or poor-quality tears can come from multiple factors, including the use of certain medications, the presence of specific medical conditions, the existence of environmental irritants and aging. You can manage some of these dry eye triggers by home therapies like:

Applying over-the-counter (OTC) eye drops and ointments

OTCs are the primary home remedy for dry eye syndrome. These medications contain humectants, lubricants, and electrolytes that moisturize the eyes, relieving the symptoms. 

Available over-the-counter options include gels, eye drops and ointments. Ointments often deliver better results than drops because of their thickness and ability to coat the eyeball more fully. 

But ointments can hinder vision, making them most useful at bedtime.

Some multidose OTC preparations have preservatives that can induce eye inflammation and worsen your condition.

Other changes you can make to help your dry eye:

• Ensure the air in your home has plenty of humidity. Air humidification, especially when sleeping at night during winter. Low humidity typical of winter worsens dry eyes.
• Wearing sunglasses or any other protective eyewear when cycling, skiing or walking in strong wind. Glasses help dry eye symptoms from being exacerbated.
• Eating foods rich in omega-3 fatty acids like flaxseed, walnuts and fatty fish. Omega-3 has anti-inflammatory effects, thereby reducing dry eyes. 
• Make sure your dry eye is not because of a medication you are taking. Cessation of use might reverse the problem. Let your doctor know if you stop taking any of your medications or if you pull back on the doses you take. 

FAQs

What medicine is best for dry eyes?

Home remedies with over-the-counter ointments or gels can help manage mild or moderate dry eyes. However, severe dry eye syndrome requires anti-inflammatory drugs such as cyclosporine-based Restasis or Cequs.

What is the latest treatment for dry eyes?

Among the FDA-approved treatments for dry eyes, OptiLight, a form of intense pulsed light therapy, is the most recent device for managing dry eye syndrome. It promotes Meibomian gland function by enhancing oil production.

References

1. Improved Dry Eye Drugs for 2022 and Beyond. (November 2021). American Academy of Ophthalmology.

2. Comprehensive eye exams. American Optometric Association.

3. Dry Eyes. (December 2020) National Eye Institute.

4. How to relieve dry eyes, according to experts and eye doctors. (September 2020). NBC News Select.

5. Dry Eye Syndrome PPP – 2018. American Academy of Ophthalmology.