UNC Health Care
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How to Identify and Treat Dry Eye Disease

Many of us have experienced the discomfort of dry eyes at one time or another—that feeling of burning, pain or itchiness in the eyes that can make it difficult to read, work, use a computer, watch TV or drive. In most cases it’s a temporary problem that goes away on its own without a trip to the doctor’s office.

But for millions of people, dry eyes are more than just an occasional irritant. They experience a chronic health condition called dry eye disease or dry eye syndrome. People affected frequently have problems such as itching or burning eyes, blurry vision, sensitivity to light or a feeling that something gritty is in their eyes.

“Dry eye disease is something I see frequently in my practice,” says Julie Skaggs, MD, an ophthalmologist and corneal disease specialist at the UNC Kittner Eye Center in Chapel Hill. “It can happen to anyone at any age, but I see it most often in women over the age of 50.”

What Is Dry Eye Disease?

Dry eye disease is a common problem that can get worse over time. It occurs when a person’s tears do not adequately lubricate and nourish the eyes. When tears function properly, they keep the surface of the eyes smooth and clear and protect against infection. Many things can have a negative impact on your tears, such as living in a dry climate or wearing contact lenses, but in general the quality and quantity of tears you produce diminishes as you get older. For that reason, dry eye disease is much more prevalent in older adults than in younger adults. It’s also twice as common in women than in men.

Tears are made up of three layers: oil, aqueous (a waterlike liquid) and mucus. In many cases, Dr. Skaggs says, the symptoms of dry eye disease are caused by deficiencies in either the oil or water layers. For example, there may not be enough oil or water in a person’s tears, or the quality of the oil or water may be poor.

First-Line Treatments for Dry Eye Disease

Dr. Skaggs says her first line of treatment for dry eye disease includes three steps. First, she directs the patient to use preservative-free artificial tears three to six times a day. These are over-the-counter drops you can buy without a prescription. Some patients may also need to use gel tears, which are thicker than regular artificial tears, or a lubricant eye ointment, which is applied at bedtime to relieve dryness while you sleep.

Second, the patient applies a warm compress over the eyes each day to melt the oils in the oil glands, allowing them to be expressed onto the surface of the eye, which increases the time it takes for tears to evaporate.

“Some people try to use a washcloth with warm tap water for this, but that doesn’t stay warm long enough,” Dr. Skaggs says. “So I recommend that they fill a clean sock with dry rice, heat it in a microwave oven for 30 seconds or less, and use that instead.”

Third, Dr. Skaggs recommends that patients with dry eyes take 2 grams per day of an omega-3 fatty acid supplement. Some studies suggest that taking omega-3 supplements may help reduce dry eye symptoms.

Second-Line Treatments for Dry Eye Disease

Many patients experience improvement after using these three measures, Dr. Skaggs says. For those who don’t, prescription treatment options are often the next step.

Steroid eye drops may be used to quickly get symptoms under control in the short term, but these have the potential to cause unwanted side effects (such as high eye pressure) when used for longer periods. If a patient develops an eye infection while using steroid eye drops, they can make the infection worse. There are also prescription eye drops developed specifically for the treatment of dry eyes. These include Restasis and Xiidra.

Another option is autologous serum drops, which are customized drops made from the patient’s own blood diluted in sterile saline or hyaluronic acid. (“Autologous” means that the main ingredient comes from the patient’s body.) For some patients, autologous serum drops work much better than store-bought artificial tears.

Some patients may be treated with tiny plugs—called punctal plugs—that are inserted into the punctum, the openings of the ducts where tears drain from the eyes. Punctal plugs help tears remain on the surface of the eye longer, and that provides relief for dry eye symptoms.

Wearing contact lenses is generally not recommended for people with dry eye disease, because people who wear contacts tend to blink less often, which can make their dry eye symptoms worse. However, Dr. Skaggs says, sometimes a special type of contact lens, called a bandage contact lens, is used in the treatment of dry eyes because it helps keep the cornea properly hydrated by locking in moisture and reducing tear evaporation.

Newer Treatments for Dry Eye Disease

Two of the newer dry eye treatment options offered at UNC Kittner Eye Center are LipiFlow and intense pulsed light therapy.

LipiFlow is an electronic device approved by the U.S. Food and Drug Administration for the treatment of meibomian gland dysfunction, the leading cause of dry eye. LipiFlow works by precisely applying heat to the inner eyelids and targeting gentle pulsations to remove blockages from the affected glands. The goal is to restore natural oil flow to the tear film that covers the eye’s surface.

Intense pulsed light, or IPL, is a type of laser treatment that is also used to treat conditions such as rosacea, acne and burn scars. In IPL treatment for dry eyes, the doctor applies ultrasound jelly to the skin under the eyes and then uses a hand-held device that flashes bright light onto the skin. The light is filtered to allow only wavelengths that can be absorbed by dilated blood vessels, which helps reduce eyelid inflammation that contributes to dry eye symptoms.


If dry eyes are affecting your daily activities, talk to your doctor. Find an ophthalmologist near you.