DRY EYE SYNDROME
HEALTHCARE PROFESSIONALS - FACT SHEET
Lifestyle and environment factors
Mild or moderate dry eye symptoms
Treatment should initially focus on identifying and
• Artificial tears alone are usually sufficient to addressing lifestyle / environmental factors that may
cause or exacerbate dry eye syndrome. These include:
• Hypromellose is the most commonly used product, • Smoky or dusty environments
and can be administered frequently
• Air conditioning / heaters in the home or car
• Products containing carbomers or polyvinyl alcohol • Prolonged viewing of computer screens
• Contact lens wear
• Sodium chloride is short acting and suitable as • Over-rinsing with water or saline
‘comfort drops’ or for use with contact lenses
• Use of redness-relieving eye drops – Some eye drops contain preservatives and can cause
e.g. naphazoline, tetrahydrozoline, phenylephrine irritation. If someone is sensitive to preservatives
or herbals such as witch hazel
or uses soft contact lenses, consider switching to
The patient’s medication history should also be reviewed,
one that is preservative-free. Carmellose sodium,
as topical and systemic antihistamines have been
hydroxyethylcellulose, hypromellose and povidone are
associated with dry eye syndrome. Similarly, hormone
all available without preservatives.
replacement therapy (HRT), tricyclic antidepressants
(TCAs) and selective serotonin re-uptake inhibitors
Severe dry eye symptoms
(SSRIs) can aggravate ocular symptoms. Diuretic
• Preservative-free artificial tears are suitable, but therapy should additionally be taken into account.
consider adding an ocular lubricant ointment to use at night
A good level of daily water intake should be encouraged
• Eye ointments - such as paraffins - physically to aid hydration. As omega-3 fatty acids may reduce tear
lubricate and protect the eye surface from epithelial evaporation and inflammation, oral supplements or dietary
erosion and are particularly useful when the eye is intake via fish or flaxseed oil is often recommended.
closed during sleep
• As eye ointments containing paraffin may be Artificial tears and lubricants
uncomfortable and blur vision, they should only The term ‘artificial tears’ is commonly used to describe
be used at night and never with contact lenses
drops, solutions and liquid gels applied directly into
• Bicarbonate containing artificial tears have been the eye. Artificial tears don’t have all the component
shown to promote healing in severe dry eyes
of real tears - they mainly just act as a lubricant. The
term ‘ocular lubricants’ generally refers to more viscous
products such as ointments.
of Sjögren’s disease
Additional nonsurgical interventions
Topical corticosteroids can be used to reduce
These are used to prevent the eyes from drying out-
inflammation, a key component of dry eye syndrome.
during sleep, for example.
They cannot be used for more than 4 weeks, however,
due to a rise in intraocular pressure and risk of cataracts.
Hydroxypropyl methylcellulose inserts (lacriserts) are
small pellets that contain artificial tears and are inserted
Punctual occlusion surgery
under the eyelid once-daily, to help keep the surface of
This may be an option for patients whose symptoms
the eye moist. As a sustained-release formulation for
of dry eye cannot be adequately controlled with
artificial tears, the effect can last anywhere from 6 to 12
conservative measures. The goal of this surgery is to
hours. Lacriserts are usually used in patients with dry
occlude (block) the tear ducts that drain tears from the
eye whose symptoms cannot be controlled by frequent
eye. Temporary punctual occlusion involves surgically
instillation of artificial tears.
inserting collagen or silicone plugs into the tear ducts.
Permanent punctual occlusion involves using a laser or
electrocautery device to permanently seal shut the tear
Doxycycline and minocycline have been shown to be
ducts. This enables the tears to pool, thus delivering
effective for treating meibomian gland dysfunction.
moisture to the eyes
Salivary gland autotransplantation
This may act as a partial immunomodulator, although
This procedure is normally only recommended after all
its exact mechanism of action is unknown. It is used to
other treatment options have been tried. The glands
relieve dry eyes caused by suppressed tear production
that produce saliva are removed from the lower lip and
secondary to ocular inflammation, as well as meibomian
grafted into the side of the eyes. The saliva produced by
the glands acts as a tear substitute.
Autologous serum eye drops
For information on causes, symptoms • Are unpreserved and non-antigenic
and diagnosis, please see our fact sheet • Contain growth factors, fibronectin, immunoglobulins ‘About dry eye syndrome.’
and vitamins in a similar or higher concentration to natural tears
• Are used for severe dry eye with punctate epithelial defects and corneal damage, to promote re-epithelialisation
Tear secretagogues (muscarinic agonists)
These increase the volume of tears produced by the lacrimal gland and are used for the treatment