This page briefly describes standard treatments typically prescribed by many eye doctors for dry eye. Most people find relief from dry eye pain, even severe dry eye pain, by using these standard treatments. If you have not yet tried the methods described below for treating dry eye, talk to your ophthalmologist or optometrist about what treatments are appropriate for you.

This page describes:

• Eye drops, ointments, and medications to increase tear production
• Eyelid scrubs for blepharitis or meibomianitis
• Doxycycline and other treatments for meibomianitis
• Punctal occlusion to prevent tears from draining

Typically, the standard initial treatments for dry eye include eye drops and ointments such as those listed in the following table.

Allergan's artificial tear "Refresh Lubricant Eye Drops" (available from MedShopExpress.com or Drugstore.com) contains polyvinyl alcohol and povidone and is mild enough for most people with very sensitive eyes. Refresh Lubricant Eye Drops is not the same as the more widely available Refresh Plus. Refresh Plus contains methylcellulose, an irritant to some people's eyes.

For more information about eye medications, including possible side effects, see:

• MEDLINEplus Drug Information
• Drugs and Medications Search Engine and Directory
• RxList.com
• MedSafe
• Drugs.com
• "A Complete Guide to Prescription and Non-Prescription Drugs," by H. Winter Giffith. This book is available at BarnesAndNoble.com and other bookstores.

The meibomian (oily) layer of tears exudes oil from the 23 oil glands that line the inner edge of the eyelid. Chronic blepharitis or meibomianitis causes inflammation of these oil secreting glands, and this inflammation can result in dry eye pain. You might experience this inflammation as waking up with your eyes "glued shut" by secretions. Common treatments include those listed in the following table. (See also What eyelid compresses can I use for blepharitis or meibomianitis? and see Allergic reactions to eyelid compresses.)

In addition to daily eyelid hygiene, some doctors prescribe the antibiotic doxycylcine for severe meibomianitis. Although a typical dose might start at 100 to 200 mg per day and is then decreased to 50 mg per day for several months (or longer), even the smaller dose can cause gastrointestinal reactions in some people, such as nausea, vomiting, or diarrhea.

Some recent research indicates that Periostat, a 20 mg dose of doxycycline, might be sufficient to treat meibomianitis with fewer side effects than the higher-dose formulations. See, for example, the June 2002 press release CollaGenex Pharmaceuticals Initiates Clinical Study of Periostat in Patients with Meibomianitis.

Taking doxycylcine for extended periods of time might not be a good solution. For those who cannot tolerate doxycycline, a possible alternative therapy, according to the article Managing Lid Disease in Lens Wearers in Review of Optometry, is topical metronidazole gel 0.75 percent (MetroGel) applied to the eyelids.

Another possible option for treating meibomianitis is castor oil drops. This option is described in the article Castor oil drops safely treat meibomian gland dysfunction, published in May 2003 in OphthalmologyTimes.com. Castor oil is a nonvolatile fatty oil obtained from the seeds of the castor bean. Prescription castor oil eye drops are not currently widely available. If your eye doctor thinks that this is an appropriate solution for you and writes a prescription for it, two possible sources from which to obtain this eye drop are the following compounding pharmacies, both of which can custom make a castor oil ophthalmic suspension:

• LeiterRX.com
• ApothecareOphthalmic

For more information about compounding pharmacies that make custom ophthalmic eye drops for dry eye and other purposes, see the Custom Eyedrops page.

See also What eyelid compresses can I use for blepharitis or meibomianitis?

When using artificial tears and other lubricating products is insufficient to provide relief from dry eye pain, an eye doctor might recommend punctal occlusion. This is a relatively simple procedure performed with local anesthesia in the doctor's office. A small silicone plug is inserted into the duct opening at the inner corner of each eye that normally allows excess tears to drain from the eye. The plug blocks the outflow of tears so that a person who has insufficient tears can retain what tears do exist.

Punctal occlusion, at least initially, often provides complete relief even to people who have been experiencing overwhelming pain. Temporary plugs can be inserted to test whether this approach is helpful. Once it is determined that plugs do help, permanent plugs can be inserted.

A newer plug is the SmartPlug,which shrinks in length and expands in width, adjusting itself to fit, and settles in place as a soft gel.

Who can perform this procedure?

• Optometrists
• Ophthalmologists

According to Where Plugs Fit in Dry Eye Management, an article by Dr. Douglas Blackmon published October 2004 in the Review of Ophthalmology, "Although simple, safe, and effective, punctal plugs are not risk-free. Documented complications include ocular discomfort and irritation, spontaneous ... loss ... and ... migration ... requiring surgical removal." The same article states that "another common 'complication' is loss of the plug."

In addition, the article Dry Eyes: A New Look at an Old Problem, published in February 2004 in Review of Optometry raises a question about the long-term effectiveness of punctal occlusion. If you are considering punctal occlusion, ask your eye doctor what the latest research says about its effectiveness as a long-term treatment.