LUBRICATING EYE DROPS (ARTIFICIAL TEARS)
There are many choices available over the counter. Research shows that eye drops that contain hyaluronic acid and polyethylene glycol help with dry eye. Typically you can use them when you wake up, before bed, and several times during the day.
It is best to use eye drops without preservatives. Long use of eye drops with preservatives can damage the eyes. But, preservative free drops are more expensive. There are newer preservatives (e.g., such as sodium perborate or stabilized oxychloro complex) that are gentler on the eye. However, there is less research on them to know if they are truly safe. You can discuss the options with your eye doctor.
TRY OTHER PRACTICAL STRATEGIES
- Add moisture.
- Drink plenty of water.
- Check the humidity level in your home. Air conditioners and heating systems can dry out the air, which can dry out your eyes. If the air in your home is dry, consider a humidifier to add moisture to the air. There are small humidifiers you can put on your desk, if you work at a computer.
- Avoid stressing your eyes
- Take eye breaks when using digital devices. We blink less when using computers and other close screens, which is also dries the eyes. One researcher recommends taking breaks every 30 minutes. Or, use the 20/20/20/20 rule: every 20 minutes, look 20 feet away for take 20 seconds, and blink 20 times.
- Avoid dust and other irritating particles in the air. Some people use air purifiers or HEPA filters to remove dust and other particles from indoor air. Glasses/sunglasses/protective glasses may help outdoors.
- Avoid direct airflow to your eyes. Direct car ventilation downwards. Don’t sit in a draft. Use glasses to block drafts or the wind.
- Quit smoking. Overall, studies suggest that smokers are more likely to develop dry eyes. It’s too early to know if vaping is less harmful to the eyes than smoking, but at least one study has shown negative effects of vaping.
- Try eating a Mediterranean Diet, rich with olive oil, fruit, vegetables, whole grains, and lean meats, seafood, and fish.
- Sooth your eyes
- Get enough sleep. Sleep helps the eyes heal.
- Warm compresses feel good. Apply warm compresses to your eyes multiple times a day for about 10 minutes. There are eye masks (available in drug stores) you can put in the microwave that will hold heat. Or, microwave a small hot/cold pack and wrap it in a washcloth. For both, be sure to follow the instructions for how long to microwave it. Always be careful to not burn your eyelids. The least expensive option is to use a warm damp washcloth, but it may be difficult to keep it warm for 10 minutes. Note that you can incorporate warm compresses into a meditation or paced breathing practice – two stress-busters at once!
- Massage your eyelids with clean hands. It’s easy to do this in the shower while washing your face.
SEE AN EYE DOCTOR
If your eyes continue to bother you or if you think they might be infected, see an eye doctor (ophthalmologist). The doctor will look for the cause of dry eyes, to better treat it. The doctor will review your other medicines to see if they may cause or worsen dry eye. The doctor may prescribe an anti-inflammatory drug (e.g. steroid eye drops) or immunomodulatory eye drops (e.g. cyclosporine). There are also new treatments they can try.
If your problems persist, consider seeing an eye doctor who specializes in dry eye disease. (You can check your doctor’s specializations on their website.)
OUR BOTTOM LINE: DOES IT HELP?
YES. There is evidence that lubricating eye drops help. The array of choices in drug stores can be bewildering. If you can afford it, use artificial tears without preservatives. If you still have questions, ask your eye doctor for recommendations.
MAYBE. The other practical things you can do on your own may help, and are unlikely to hurt you.
Lubricating eye drops help relieve the dryness. They do not cure dry eye disease, but they prevent the condition from getting worse.
POTENTIAL RISKS & SIDE EFFECTS
Long term use of some of the preservatives in lubricating eye drops can hurt the eye. Use artificial tears without preservatives if possible. Ask you eye doctor about drops using newer preservatives, to see if there is more data about their safety.
Never touch the eye drop container to your eye, because it might contaminate the bottle. Follow all instructions on the bottle/box.
The other practical things listed above can’t hurt you. Humidifying a dry environment and staying out of drafts may also help your skin retain it’s moisture, too.
IF I WANT TO COPE WITH DRY EYES, WHAT ARE MY NEXT STEPS?
- Begin using artificial tears. Think of it as a daily moisturizer for your eyes.
- Try the other practical strategies on your own.
- If your eyes are still bothering you after a few weeks, or if you see any sign of infection, trouble seeing, bumps or swelling of the eyelids, see an eye doctor.
Deinema LA, Vingrys AJ, Wong CY, Jackson DC, Chinnery HR, Downie LE. A Randomized, Double-Masked, Placebo-Controlled Clinical Trial of Two Forms of Omega-3 Supplements for Treating Dry Eye Disease. Ophthalmology. 2017;124(1):43-52. doi:10.1016/j.ophtha.2016.09.023
Downie LE, Ng SM, Lindsley KB, Akpek EK. Omega-3 and omega-6 polyunsaturated fatty acids for dry eye disease. Cochrane Database Syst Rev. 2019;12(12):CD011016. Published 2019 Dec 18. doi:10.1002/14651858.CD011016.pub2
Farrand KF, Fridman M, Stillman IÖ, Schaumberg DA. Prevalence of Diagnosed Dry Eye Disease in the United States Among Adults Aged 18 Years and Older. Am J Ophthalmol. 2017;182:90-98. doi:10.1016/j.ajo.2017.06.033
Inomata T, Iwagami M, Nakamura M, Shiang T, Yoshimura Y, Fujimoto K, Okumura Y, Eguchi A, Iwata N, Miura M, Hori S, Hiratsuka Y, Uchino M, Tsubota K, Dana R, Murakami A. Characteristics and Risk Factors Associated With Diagnosed and Undiagnosed Symptomatic Dry Eye Using a Smartphone Application. JAMA Ophthalmol. 2019 Nov 27;138(1):58–68. doi: 10.1001/jamaophthalmol.2019.4815. Epub ahead of print. PMID: 31774457; PMCID: PMC6902113.
Karakus, S., Agrawal, D., Hindman, H. B., Henrich, C., Ramulu, P. Y., & Akpek, E. K. (2018). Effects of prolonged reading on dry eye. Ophthalmology, 125(10), 1500–1505. https://doi.org/10.1016/j.ophtha.2018.03.39
Liu, C., Liang, K., Jiang, Z., Tao, L. (2019). Sex hormone therapy’s effect on dry eye syndrome in postmenopausal women: A meta-analysis of randomized controlled trials. Medicine, 97:40.
Lurati, A. (2019). Menopause and Dry Eye Syndrome. Nursing for Women’s Health, 25, 1, 71-78. doi: 10.1016/j.nwh.2018.11.001
Matossian, C., McDonald, M., Donaldson, K.E., Nichols, K.K., Maclver, S., & Gupta, P.K. (2019). Dry eye disease: Consideration for women’s health. Journal of Women’s Health, 28, 4, 502-514. DOI: 10.1089/jwh.2018.7041
Molina-Leyva I, Molina-Leyva A, Riquelme-Gallego B, Cano-Ibáñez N, García-Molina L, Bueno-Cavanillas A. Effectiveness of Mediterranean Diet Implementation in Dry Eye Parameters: A Study of PREDIMED-PLUS Trial. Nutrients. 2020;12(5):1289. Published 2020 May 1. doi:10.3390/nu12051289
Oydanich M, Maguire MG, Pistilli M, Hamrah P, Greiner JV, Lin MC, Asbell PA; Dry Eye Assessment and Management Study Research Group. Effects of Omega-3 Supplementation on Exploratory Outcomes in the Dry Eye Assessment and Management Study. Ophthalmology. 2020 Jan;127(1):136-138. doi: 10.1016/j.ophtha.2019.07.009. Epub 2019 Jul 25. PMID: 31445751; PMCID: PMC6926153.
Peck, T., Olsakovsky, L., & Aggarwal, S. (2017). Dry eye syndrome in menopause and perimenopausal age group. Journal of Mid-Life Health, 8, 51–54. https://doi.org/10.4103/jmh.JMH_41_17
Xu L, Zhang W, Zhu XY, Suo T, Fan XQ, Fu Y. Smoking and the risk of dry eye: a Meta-analysis. Int J Ophthalmol. 2016;9(10):1480-1486. Published 2016 Oct 18. doi:10.18240/ijo.2016.10.19
Ziemanski, J.F., Wolters, L.R., Jones-Jordan, L., Nichols, J.J., & Nichols, K.K. (2015). Relation between dietary essential fatty acid intake and dry eye disease and meibomian gland dysfunction in postmenopausal women. Am J Ophthalmol 2018;189:29–40. https://doi.org/10.1016/j.ajo.2018.01.004
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Authors: Dr. Leslie Snyder & Dr. Katherine Newton. Last reviewed February 15, 2021