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Dry eye treatment
Last reviewed: 06.07.2025
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The main goal of dry eye treatment is to reduce discomfort and ensure optical preservation of the corneal surface, as well as to prevent damage to its structures. Several treatment methods can be used simultaneously.
Preservation of produced tears
- Reduce room temperature to reduce evaporation of tear film.
- Humidifiers can be used indoors, but this often does not bring results, since the device is not capable of increasing the relative humidity of the air. With the help of special protective glasses, you can "honestly increase the humidity.
- Partial lateral tarsorrhaphy reduces the area of the interpalpebral space, which may be beneficial.
Tear substitutes
Drops
- Hypromeldose (isopio plain, isopto alkaline, tears naturale).
- Polyvinyl alcohol (hypolears, Hquifilm tears, snotears).
- Sodium Hyaluronate
- Sodium chloride (normasoh sieripod blue).
- Having seen (oculotei).
NB! The main disadvantage of drops is the short duration of action and the development of sensitivity to the preservative (e.g. benzalkonium chloride, thimerosal). This can be avoided by using medications without preservative (e.g. minims).
Gels (viscotears, helium tear substitutes) consist of carbomers. They have a certain advantage over drops, as they require fewer instillations.
Ointments that contain petroleum jelly and minerals (lacrilube, lubritcars) can be used before bed.
[ Mycolytic factors
Acetylcysteine 5% - drops (ilube) can be used to treat patients with filamentous keratitis and infiltrates. Drops are used 4 times a day, but they can cause irritation after instillation. In addition, acetylcysteine has an unpleasant odor and a short shelf life (2 weeks).
Decreased tear flow
Occlusion of the lacrimal punctum allows for the preservation of natural tears and prolongation of the effect of artificial tears. This is important in the treatment of patients with severe dry eyes, especially in connection with the toxic effect of preservatives.
Temporary occlusion of the lacrimal punctum is also achieved by placing a collagen plug in the lacrimal canaliculi. The main purpose of temporary occlusion is to confirm that profuse lacrimation will not occur after permanent occlusion. Initially, all 4 lacrimal punctums are closed and the patient is examined after one week. If lacrimation occurs, the upper plugs are removed again and the patient is examined again after one week. If the patient has no complaints or symptoms, the plugs are removed and the lower canaliculi are closed. Temporary occlusion can be performed with an argon laser.
Temporary long-term occlusion (for several months) can be achieved using silicone plugs. Possible problems - nodding of plugs, formation of granulomas, which can cause inflammation.
Permanent occlusion is performed in patients with severe dry eyes and recurring Schirmer test values of 2 mm or less. This occlusion is not used in patients with lacrimation after temporary occlusion of only the lower lacrimal punctum. Permanent occlusion is best avoided in young patients, as their tear production volume is not constant. This occlusion is performed with significant expansion of the lacrimal punctum by cauterizing the mucous membrane of the proximal edge of the canaliculus for 1 second. After successful occlusion of the lacrimal punctum, it is necessary to monitor for signs of recanalization. It is important to prevent any inflammatory complications, such as chronic blepharitis and infection in the area of occlusion.
Other Dry Eye Treatment Options
Topically applied cyclosporine 0.05%, 0.1% - a safe, well-tolerated and effective drug that reduces inflammatory phenomena of lacrimal tissue at the cellular level.
Systemic administration of cholinergic drugs such as pilocarpine (salagan) is quite effective in treating dry eyes. Up to 40% of patients with dry eyes experience a positive effect.