DEAR DOCTOR K: I have dry eyes. What are my treatment options?
DEAR READER: Tears are not just for crying. Your eyes are constantly making small amounts of tears to keep the surface of the eye and the underside of the eyelids moist. Tears also contain fat and mucus, substances that cleanse the eyes.
Tears are made by tiny glands in the eye called lacrimal glands. Dry eyes occur when your eyes don’t produce enough tears. As your tear production drops off, your eyes can burn or feel itchy, scratchy or irritated. It may suddenly become difficult to wear contact lenses.
Surprisingly, dry eyes can cause excessive tearing. These tears are “irritant tears,” made in reaction to your dry eyes. They contain more water and less fat and mucus than regular tears. As a result, they just run off the eyes without lubricating them as healthy tears do.
Dry eyes become more common when you get older, as tear production normally drops off. Women are more likely than men to get dry eyes. Certain commonly used medicines reduce the production of tears, including antihistamines, birth control pills and selective serotonin receptor antagonists (SSRIs), often used to treat depression.
Over-the-counter artificial tears mimic the makeup of natural tears, and their regular use effectively treats most cases of dry eye. Lubricating ointments can treat more serious cases, but they tend to blur vision, so apply them at bedtime.
In severe cases, your ophthalmologist may need to insert tiny plugs made of collagen or silicone into your tear drainage ducts. The plugs help both natural and artificial tears stay on your eye longer by preventing them from draining out of the opening in the inner corner of the eyelid.
Another approach is to increase tear production. Topical cyclosporine (Restasis) decreases inflammation in the tear-producing glands, which can lead to better tear production.