Standard Treatments

Eye Drops, Eyelid Scrubs, and Tear Duct Plugs

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:

Important!     Check with your eye doctor to determine which, if any, of the products or procedures described on this page might be appropriate for you. The information on this page is based on the experience and opinions of a very small number of individuals with dry eye and is not provided by a doctor or other medical professional. In addition, by the time you read this page, some of the information on this page might be out-of-date. Please see the Disclaimer below.

Eye drops, ointments, and medications to increase tear production

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

Methylcellulose irritates some people's eyes     Many of the products described in this table contain methylcellulose. Unfortunately, a considerable number of people with dry eye are sensitive or allergic to methylcellulose. Allergan's artificial tear "Refresh Lubricant Eye Drops" — not to be confused with "Refresh Plus" — does not contain methylcellulose and is mild enough for most people with very sensitive eyes. You can find Refresh Lubricant Eye Drops, which contain polyvinyl alcohol and povidone, at MedShopExpress.com or at Drugstore.com.

Eye Lubricant Description
Non-prescription artificial tears and other dry eye drops

Examples include Allergan Refresh Lubricant Eye Drops, Refresh Endura, Thera Tears Lubricant Eye Drops, GenTeal PF, or Bausch & Lomb Preservative-Free Moisture Eyes. High viscosity artificial tears, such as Refresh Plus, Celluvisc, Murocel, are also available. Available without a prescription.

New artificial tears are developed and existing ones are improved every year. Ask your eye doctor which artificial tears are available now. If you are sensitive to methylcellulose, be sure to ask for one or more eye drops that do not contain methylcellulose.

Tips    
  • To help keep unopened single-use artificial tear containers sterile when you leave home, put them in a clean sandwich bag.
  • To help keep an opened single-use artificial tear container sterile, use 99% rubbing alcohol to clean an empty pill bottle and carry the opened artificial tear container in that. Make sure that the rubbing alcohol is dry before you close the lid!
Ointments and gels Examples include TearGel, Duolube, Lacrilube, Genteal Gel. Available without a prescription.
Lacriserts Also called hydroxypropyl methylcellulose, this is a small pellet that you put in the eyelid that lubricates the eye surface and slows the evaporation of natural tears. If you are allergic or sensitive to methylcellulose, you won't be able to use Lacriserts. Requires a prescription.
Prescription eye drops — Restasis
(cyclosporine ophthalmic emulsion)
According to its manufacturer, Allergan, the eye drop Restasis can help increase tears for some people whose tear production is reduced due to inflammation on the eye surface characteristic of chronic dry eye. (Increased tear production is not seen in people who use topical steroid drops or tear duct plugs.) Requires a prescription.
  • Remember to gently turn the single-use container upside down a few times (do not shake) to obtain a uniformly white mixture before putting drops into your eye.
  • Do not use Restasis if you have an eye infection, if you have a history of corneal herpes, or while you are wearing contact lenses. According to Allergan, patients with decreased tear production typically should not wear contact lenses. If you do wear contact lenses, you must remove them before you put Restasis drops into your eyes. Wait at least 15 minutes before you put the contact lenses back into your eyes.
  • Do not use more than the prescribed dose.
For a good description of Restasis and how to use it, go to Drugs.com, search for Restasis, and then click the link for "Detailed Consumer Information: Restasis."
Evoxac Evoxac is a prescription drug used to treat the symptoms of dry mouth often experienced by patients with Sjogren's syndrome. Some doctors also prescribe Evoxac to treat dry eye. Evoxac is not appropriate for people with health problems such as asthma or other pulmonary disease, heart disease, and certain other medical conditions, so make sure that your doctor knows your complete health history before you try this drug.
Salagen Salagen is a prescription drug used to treat dryness of the mouth and throat caused by a decrease in the amount of saliva that may occur after radiation treatment for cancer of the head and neck or in patients with Sjogren's syndrome. Some doctors also prescribe Salagen to treat dry eye. Evoxac is not appropriate for people with health problems such as asthma or other pulmonary disease, heart disease, kidney problems, retinal disease, mental problems, and certain other medical conditions, so make sure that your doctor knows your complete health history before you try this drug.
FML or Lotemax (both are corticosteroids)

FML (a fluorometholone ophthalmic suspension made by Allergan) is a corticosteroid eye drop used to reduce inflammation of the cornea. It contains a preservative. Long-term use of FML might result in one or more problems, such as glaucoma. For more information about FML, see PDR Drug information for FML, which includes the statement that "Corticosteroids are not effective in mustard gas keratitis and Sjögren's kerato­conjunctivitis." One listed possible adverse reaction to FML is keratitis (inflammation of the cornea).

Lotemax (made by Bausch & Lomb) is another corticosteroid that is sometimes prescribed for dry eye. Lotemax also contains a preservative and long-term use might result in one or more problems, such as glaucoma. For more information about Lotemax, see PDR Drug information for Lotemax. One listed possible adverse reaction for Lotemax is dry eye.


Watch for signs of delayed allergic reaction!     Your eyes can develop an allergic reaction to an eye drop immediately, or hours, days, or even weeks after you start using it. Therefore, if an eye drop seems to help at first, but then later your eyes experience as much or more pain as before, stop using that eye drop.

Do you use eye drops for eye allergies?     Most people who use over-the-counter or prescription eye drops for eye allergies are unaware that many eye drops used to treat eye allergies cause or increase dry eye.

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:

Eyelid scrubs for blepharitis or meibomianitis

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.)

Caution     Many doctors recommend using a diluted baby shampoo solution (for example, 1 part baby shampoo to 10 parts warm water) as an eyelid scrub to treat blepharitis. However, if you are allergic to baby shampoo or have sensitive dry eyes, using a diluted baby shampoo solution might make your eyes feel worse rather than better.

Eyelid Scrub Description
Novartis Eye-Scrub A commerically available hypoallergenic pad presoaked in a cleansing solution.
OcuSoft Lid Scrubs A commercially available pre-moistened cleansing pad. A similar product, but less expensive because it lasts for about three months, is the OcuSoft Lid Scrub Compliance Kit, which is a 4 oz. bottle with 100 lint-free pads.
Boiled Water Scrub

(alone or with ointment)
Follow these steps once in the morning and once in the evening:
  1. Boil one pint of distilled water (in a pan you use only for this purpose, not for food) and allow the water to cool.
  2. Wash your hands.
  3. Use a clean cloth dampened with hot or warm water as a compress on your eyes for three to five minutes.
    Caution     Typically, doctors advise using a hot compress. However, if you have sensitive eyes, a hot compress might cause irritation rather than relief. If that happens to you, use warm or lukewarm water instead.
  4. Dip a cotton bud (Q-tip) in the cooled boiled water, and then brush the edges of the upper and lower lids gently to clean off the secretions arising from the base of the eyelashes. Start at the part of the lid near the nose and work across to the other side.
  5. (Optional) If your doctor has prescribed an eye ointment, place a very small amount on the tip of your finger and rub it into the roots of your lashes.
Mineral Oil and Saline Scrub

(or saline-only scrub)
Mineral oil is a clear, colourless, oily liquid that is a by-product of the distillation of petroleum (if your eyelids are allergic to vaseline, they might also be allergic to mineral oil). Follow these steps once in the morning and once in the evening (if your eyes are allergic or sensitive to mineral oil, skip the mineral oil and use only the sterile saline solution):
  1. Wash your hands.
  2. Use a clean cloth dampened with hot or warm water as a compress on your eyes for three to five minutes.
    Caution     Typically, doctors advise using a hot compress. However, if you have sensitive eyes, a hot compress might cause irritation rather than relief. If that happens to you, use warm or lukewarm water instead.
  3. Dip a cotton bud (Q-tip) in either in the mineral oil (such as Squibb Mineral Oil) or, alternatively, in a sterile saline solution, and then brush the edges of the upper and lower lids gently to clean off the secretions arising from the base of the eyelashes. Start at the part of the lid near the nose and work across to the other side.
  4. If you used mineral oil to scrub your eyelids, you need to rinse off the mineral oil: dip a fresh Q-tip in the sterile saline solution and use it to gently dab the mineral oil off of the base of your eyelids. You might need to use more than one Q-tip to get all the oil off.
  5. Very gently, squeeze the upper and lower lids to "milk" oil from the lid into the eye. If you squeeze too hard, your eyes might be sore for some time afterwards.

Doxycycline and other treatments for meibomianitis

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:

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?

Punctal occlusion to prevent tears from draining

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.

Closing tear ducts

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.

DISCLAIMER: Do not use any tip described on these pages without first consulting your physician.
All content on this Web site is for informational purposes only; it is not to be used for diagnosis or treatment; and it should not be construed as personal medical advice. Information published on this Web site is not intended to replace, supplant, or augment a consultation with an eye care professional regarding the user's/viewer's medical care. Every effort has been made to present accurate and safe information, but the creator of the Web site is not a health care professional, does not warrant the correctness of the information, and is not liable for any direct or consequential injury or other damages that could result from the use of the information obtained from this site. Products are mentioned as examples only. No mention of a product constitutes an endorsement for that product; other products might be successfully used for dry eye and other conditions described here. It is not the intent of this Web site to promote any eye care products, procedures, or medications.