June 3, 2011
Dear Mayo Clinic:
Could you please tell me how I might treat and overcome dry eye? My right eye is constantly tearing.
Dry eye disease is common and can develop for many reasons. Usually, the condition is chronic and cannot be cured. Instead, treatment for dry eyes focuses on relieving symptoms.
To maintain eye comfort and good vision, the front surface of your eye needs to be covered with an even layer of tears that contain the right mix of water and oils. If tears are not of sufficient quantity or quality to maintain that layer, dry eye disease (also called ocular surface disease) can develop.
Symptoms of dry eye disease may include a stinging, itchy or burning sensation in your eye, sensitivity to light, blurred vision, and mucus in or around your eye. As you've experienced, excess tearing can also be a symptom. Normally, tears are produced very slowly. But if that process fails to make enough tears, a different tear production system may be activated. And, unfortunately, this reflex mechanism usually produces too many tears.
Before you begin treatment for dry eyes, review your current medications and medical history with your doctor. Some drugs — such as high blood pressure medications, antihistamines, acne medications and decongestants — can cause dry eyes. If medication is causing the problem, a change in prescription may be all you need to relieve symptoms.
Certain medical conditions can decrease tear production. These include rheumatoid arthritis, Sjogren's syndrome, diabetes and lupus, among others. In some cases, systemic treatment for these conditions may ease dry eyes.
Smoking has also been associated with an increased risk of dry eye disease. Not only is the particulate matter that is released into the air irritating to the surface of the eye, other toxins in tobacco smoke actually alter the quality of tears produced by the eye.
If switching medication or treating an underlying medical condition isn't the issue or doesn't give you enough relief, a number of treatments are available. For dry eyes caused by a lack of tears, the first therapy is over-the-counter artificial tear eyedrops. For many people, eyedrops, used about four to six times a day, are enough eye lubricant to relieve dry eye symptoms.
If artificial tears don't provide enough relief, the next step may be punctual plugs. These tiny silicone stoppers are inserted into tear duct openings, blocking the eye's drainage channel so more tears stay on the surface of the eye. The plugs can be removed if having them in place makes the eyes water too much.
Prescription cyclosporine eyedrops (Restasis) can increase the amount of tear production. However, some people with underlying medical conditions may not be able to use cyclosporine because it suppresses the body's immune system.
If none of these therapies are sufficient, additional remedies — such as moisture-chamber glasses, special contact lenses or permanent tear duct closure — are possible options. Rarely, eye surgery may be necessary for severe cases of dry eye disease that don't respond to any of these treatments.
If the source of dry eye disease is eye oil glands that aren't working properly — rather than insufficient tears — treatment is different. When these glands don't produce the right amount or consistency of oil, tears can become thick and sticky. Using warm compresses over closed eyelids for three to five minutes once or twice a day, followed by a gentle lid massage, can help melt the oil in the glands and move it to the eye's surface.
Antibiotics may also be useful for reducing inflammation in the glands that can lead to oil production problems. In addition, some evidence indicates that dietary supplements containing omega-3 fatty acids (flaxseed oil, fish oil) can improve the quality of tear oil.
Work with your eye care provider to find the appropriate dry eye treatment. For most people, dry eye disease is a chronic condition that requires long-term treatment. These therapies won't cure dry eyes, but they should help reduce symptoms enough so that you can be comfortable and function normally in your daily activities.
—Muriel Schornack, O.D., Ophthalmology, Mayo Clinic, Rochester, Minn.