CHRONIC DRY EYE
Date: 04/30/24
Dry eye is one the most common eye disorders. It is caused by the eye’s inability to produce tears or aqueous fluid to appropriately lubricate the eye. There are many reasons for decreased tear production including age and medications. See table 1 for a more complete list.
Dry eyes can lead to inflammation and damage to the eye surface. Signs and symptoms of dry eye include eye redness, itching, sensitivity to light, difficulty with nighttime driving, stinging and burning, and watery eyes.1
Table 1. Causes of Decreased Tear Production
Age |
Medical Conditions: Sjogren’s Syndrome Rheumatoid Arthritis Allergic Eye disease Scleroderma Sarcoidosis Thyroid disorders Vitamin A deficiency Parkinson’s disease |
Medications: Antihistamines Decongestants Antihypertensives Hormone replacement therapy Birth Control Acne |
Corneal nerve de-sensitivity: Laser eye surgery Contact lens use Nerve damage |
Complications1
Complications can occur due to the decrease in aqueous fluid production and subsequent inflammation:
- Eye infections, as tears protect the surface of the eye from eye infection
- Damage to the eye surface due to the constant inflammation leading to abrasion of the corneal surface (and rarely vision loss)
- A decreased quality of life and difficulty performing everyday tasks such as driving or reading
Prevention2
Members can be advised of non-pharmacological aids to help prevent dry eye or improve symptoms. They should avoid air blowing directly in their eyes from hair dryers, car vents, fans, or air conditioners, as examples. Adding a humidifier to increase the moisture in dry environments may help. Wearing sunglasses or protective glasses can help to block the eyes from wind and dry air.
If the member is doing tasks that require long periods of visual concentrations, they should take breaks or blink several times for a few seconds periodically to help distribute the tears evenly over the eyes. If the member smokes, smoking cessation is recommended along withing avoiding smokey areas. Lastly, members should use artificial tears throughout the day to help keep the eyes lubricated.
Table 2: Prevention Methods
Avoid air blowing in eyes |
Add moisture to air |
Wear sunglasses or protective eyewear |
Take breaks when doing long tasks |
Smoking cessation or avoid smoke |
Regular use of artificial tears |
Treatment1,2
- Mild dry eyes: Over the counter (OTC) medications can be utilized. Artificial tears are available as solution, ointment, and gel drops. Ointments can be used at nighttime as the patient’s vision will be blurry after administration.
- Moderate dry eyes: Cyclosporine (Restasis®) and liftegrast (Xiidra®) are available by prescription. The medications help the patient’s eye to produce more tears. Possible adverse effects include burning, stinging, redness, watery eyes, blurry vision, and discharge.3,4
- In some cases, the patient’s lower eye lid may be too loose. Punctal plugs may be helpful in keeping the tears in the eye.
- See Table 3 for dry eye product preferred status.
Table 3: Meridian’s Preferred Drug List Dry Eye Products
Medication | Preferred Status |
|---|---|
Restasis® | Non-Preferred |
Xiidra® | Non-preferred |
Artificial tear solution | Preferred |
Lacrisert | Preferred |
Polyvinyl alcohol 1.4% | Preferred |
White petrolatum-mineral oil | Preferred |
References
1. Dry Eyes. Accessed 4/15/24.
2. Dry Eye. Accessed /15/24.
3. Restasis. Accessed 4/17/24.
4. Xiidra. Accessed 4/17/24.