Once a diagnosis of Dry Eye has been made, choosing the proper treatment is the next step, and can be a bit complicated. The first step is to make sure that the eyelids and Meibomian Glands are healthy and working well. I usually start with hot compresses, getting the patient more hydrated and when necessary medications that help suppress inflammation in the glands.
I will often recommend over the counter nutritional supplements at this point in my treatment plan. Omega 3 and Omega 6 fatty acids (from fish oil and flax seed oil supplements) often help improve the quality of the secretion from the Meibomian Glands.
Once these steps have been taken, improving the quantity and quality of the tear film are next. The first step is to supplement the natural tears with tear film supplements. Drops such as Systane Ultra and Soothe XP are two of the tear film supplements that I frequently use. Using these drops three to four times per day will improve the quantity and the quality of the tear film. This is usually all the treatment that most patients need.
Some patients need further treatment however, my next step is usually a medication that usually stimulates the Lacrimal Gland to produce more of the watery tear film component. This medication is Restasis, a form of Cyclosporin. The mechanism of action for this medication requires a few months of use before its true efficacy is known.
In the event that Restasis and over the counter tear film supplements don’t adequately treat Dry Eye, I will insert long term punctal plugs. These removable soft plugs slow down the rate that tears are removed from the surface of the eye.
Using this “staged” approach to managing my Dry Eye Patients allows me to adequately treat my patients without over-treating them.