Dry eyes are a common complaint as we get older, more common in women due to hormonal changes. It turns out, there are steps you can take at home to improve some of the symptoms related to dry eyes. Let’s take a look at the common causes and symptoms of dry eyes and important steps for prevention and treatment.

Who is at risk for dry eyes?

Risk factors for dry eyes are menopause, diabetes, certain medications including antihistamines, and laser eye surgery (Lasik).  Menopausal women are at risk because the secretory glands in the eyes (meibomian glands and lacrimal glands) have estrogen and androgen receptor sites that stimulate secretions. As a result, dry eyes after menopause occur because of a decrease in estrogen receptor sites that stimulate the production of tears. Hormone replacement therapy in postmenopausal women, however, does not improve or prevent dry eye symptoms. Bummer. 

What symptoms will I notice from dry eyes? 

Dry eyes may cause redness, irritation, gritty or burning sensation, excessive tearing, light sensitivity, and blurred vision. The reflex watery eye is confusing to folks with dry eyes but is an attempt by the eye to overcompensate for excessive dry eyes or a response to micro-scratches on the surface of the eye.  So yes, excessive tearing may happen with dry eyes.

What medications cause dry eyes?

First, review your medication list for some known causes of dry eyes. Here are some of the repeat offenders:

• Antihistamines. Taken for allergy symptoms, this class of medications including loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) may dry your eyes out.
• Beta-blockers. Metoprolol, Carvedilol, Labetalol and Atenolol are taken for high blood pressure and can lead to dry eyes.  
• Diuretics: Dry eyes may occur with Furosemide (Lasix), Hydrochlorothiazide ( HCTZ) or Chlorthalidone prescribed for heart failure and high blood pressure. 
• Tricyclics: Medications like amitriptyline and nortriptyline are often prescribed for depression or chronic pain and are known causes of dry eyes. 

Prevent and treat dry eyes…where to start

• Artificial Tears. These are the first-line treatment for dry eyes. No brand has been shown to be better than another. Blink, Refresh, Soothe, Systane, Tears Again and Visine Tears are over-the-counter and come in liquid, gel, and ointment forms. Preservative-free forms are recommended because of potential inflammatory reactions to the preservatives. Remember that gels and ointments can blur vision because they are greasy so try them only at night. 
• Adequate hydration and sleep. I’ll just leave that right there. 
• Change your Environment. Minimizing exposure to air conditioning or heating and adding a humidifier may help. Minimize screen time but for long Zoom days put the screen below eye level (so the eyelid is partially closed) to help prevent the eyes from drying out. Glare protectors for your screen are also helpful.  
• Omega-3 fatty acids. Studies have shown that omega-3 fatty acid supplements may improve symptoms of dry eye. Omega 3 supplements, 1200 mg daily, have been shown to improve dry eyes. Make sure your diet is rich in omega-3 fatty acids which will also allow the body to produce oil improving the viscosity of the lipid layer on the eye surface.
• Acupuncture. Acupuncture may stimulate the production of tears by the lacrimal gland and small studies have shown some improvement in dry eye symptoms following acupuncture therapy. Worth a try.

Dry eye treatments that require a prescription and a visit to the doctor:

• Restasis. Restasis is a prescription steroid eye drop for the treatment of dry eye disease. It may take up to six weeks or longer to see noticeable improvement of dryness but Restasis can result in long term resolution of dry eye symptoms. The problem is the cost as there is no generic option….yet. 
• Xiidra. Xiidra is a newer non-steroid eye drop that is also very expensive and hard to obtain insurance coverage for. The exact way Xiidra works in dry eye disease is unknown but it may inhibit T-cell activation and reduce cytokine release and lower inflammation. 
• Time to see an Ophthalmologist. The eye doctor may start with the insertion of Punctal plugs. Punctal plugs, tiny devices placed in the tear duct, decrease drainage and evaporation of tears. This may sound scary but it’s easy, painless, and done in the office. There is more in the pipeline for the treatment of dry eyes so stay tuned.

Dr. O.