Dry Eye Syndrome Treatments

The first and most important step in treating dry eye disease is to determine the type of dry eye disease and the severity of the dry eye disease. As stated before there are two major types of dry eye disease which are decreased liquid or aqueous production and evaporative dry eye disease. Once the eye doctor has performed the tests for dry eyes, they can customize a treatment plan for your particular dry eye disease.

Artificial Tears

There are nearly 60 different types and brands of artificial tears on the market. Pharmacies do not have all of them available at all the time. There are watery-like tears, gel-like tears, preservative-free tears and ointment. Artificial tears contain a variety of different lubricates to simulate the natural tear film and has certain components to correct the deficiencies in the tear film. Artificial tears are available in the typical large bottles containing preservatives and preservative free tears in small eye drop dispensers containing 10 to 12 drops. Preservative-free tears are only available in this small size as they could become contaminated if sitting around for a period of time. To begin, the mainstay of treatment is to use artificial tears on a daily basis. One of the main reasons for using artificial tears is to keep the salt levels in the tear film under control. The specific type of tear drop that is best for your dry eye condition will be determined and recommended after your dry eye workup.

Dry Eye Syndrome Treatments

HydroEye® Supplement

Dry Eye Syndrome Treatments

HydroEye is a patented nutritional supplement that has been shown in scientific studies to provide relief from dry eye syndrome. HydroEye is primarily composed of Omega-6 fatty acid gamma linolenic acid (GLA) from black currant seed oil. It also contains a small amount of fish oil, vitamins, magnesium, and /or nutrient cofactors which increases the efficacy of HydroEye.

How HydroEye® Works

HydroEye works to support a healthy tear film and decrease the inflammation related to chronic dry eyes. HydroEye helps the body produce a chemical called Prostaglandin 1 (PGE1) and Prostaglandin 3 (PGE3), which is an anti-inflammatory chemical that the body produces.

Clinical Study

A randomized double blind or masked study was completed at Baylor University and the University of East Virginia. Dr. Stephen Pflugfelder is one of the world’s leading authorities of dry eye syndrome at Baylor University. Participants were divided into two groups with one receiving a placebo and the other taking HydroEye. Several measurements of the eyes were taken before the study began and at the end of the study 6 months later. Dry eye symptoms, ocular surface inflammation, and corneal surface smoothness were measured.


The participants taking HydroEye were statistically significantly better that the placebo group. It can take up to 3 to 4 months for the effects of HydroEye to be fully seen. HydroEye taken on a consistent routine basis can provide significant improvement in people suffering from dry eyes. HydroEye is an important component of dry eye treatment.

Fish Oil Omega-3 Fatty Acids

EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are omega-3 fatty acids found in oily fish such as salmon, sardines, and tuna. EPA and DHA has been shown in many studies to have positive health benefits. Omega-3s have shown anti-inflammatory properties. EPA and DHA are found in high concentrations in brain tissue and are requires for maintenance of brain cells. DHA is highly concentrated in the retina of the eye especially in the rods and cones of the retina.

Fish Oil and Dry Eyes

Omega-3 fatty acids have shown in studies to improve the function of the Meibomian glands in the eyelid in producing lipid or oil. Several studies have shown to improve symptoms and dry testing in people that are taking omega-3 fatty acid supplements.

Eating a diet which includes oily fish and/or taking omega-3 fatty acid supplements can improve the symptoms of dry eye syndrome.

Dry Eye Syndrome Treatments


LipiFlow is the only FDA approved treatment for Meibomian gland disease causing dry eyes. The LipiFlow treatment unblocks the obstruction of the Meibomian glands that have been plugged by the sick and inflamed Meibomian glands. The Meibomian glands produce abnormal thick oil which blocks the glands causing them to shut down and atrophy or die. The oil can become so thick that it looks like white cheese that can be expressed from the glands instead a clear oil that looks like olive oil. The LipiFlow uses a combination of localized heat and intermittent pressure. A single-use component of an eye cup and lid warmer is placed in contact with the eyelids. The lid warmer contacts the inner eyelid surface and heats to a controlled temperature of 109 degrees. Once the oil have been heated and made easier to remove from the glands, the flexible bladder intermittently inflates in a precise manner on the outer surface of the eyelid to express the lipid or oil out of the glands. Both eyes can be treated at the same time. The treatment lasts for 12 minutes.

Dry Eye Syndrome Treatments

At 4 weeks after treatment, 80% of patients reported improvement of their dry eyes in the FDA study. There is little or no discomfort with the procedure. The indication for the LipiFlow treatment is there is Meibomian gland disease with a decreased lipid layer of the tear film and there are sufficient numbers of Meibomian glands still present that improvement can be expected

MiBo Thermoflo

Dry Eye Syndrome Treatments
Dry Eye Syndrome Treatments

The MiBo Thermoflo instrument is a therapeutic medical device that provides a safe and effective treatment for dry eyes secondary to Meibomian gland disease. This treatment is similar to LipiFlow.  The instrument uses a proprietary thermoelectric heat pump to maximize the liquefaction of abnormal oils or lipids in the blocked Meibomian glands. The MiBo Thermoflo provides continuous controlled heat device that is applied to the outer surface of the eyelids with the application of ultrasound gel.  This provides a comfortable massage of the Meibomian glands. A technician uses the sterling silver plate that heats up to 108 degrees to massage the eyelids. The heat is absorbed deep into the eyelid tissue resulting loosening of the lipids and expression from the glands. The treatment is performed for 12 minutes per eye. The eye doctor may express the Meibomian glands after the procedure to help clean them out. There is a total of 3 separate treatments 2-3 weeks part. You are placed on eye drop medications after the procedure to help with the healing of the Meibomian glands.

Meibomian Gland Probing

A tiny wire probe is inserted into the narrow Meibomian gland opening on the edge of the eyelid while using a microscope. In some cases, chronic inflammation has scarred the Meibomian glands and/or the openings of the glands closed causing a reduction in the lipid layer of the tear film. Opening the scar tissue in the gland and/or its opening can allow the glands to begin to secrete their oil.

Dry Eye Syndrome Treatments

Punctal Plugs

Dry Eye Syndrome Treatments

There are small openings on the medial side or toward the nose of the upper and lower eyelids called the puncta. The punctal openings lead to the lacrimal drainage duct that drains the tears from the eye into the nose. This is the reason why your nose runs when you get emotionally upset and cry. Many people believe that the tear ducts produce the tears in their eyes but instead the ducts drain the tears away from the eye. The different glands around the eye produce the tear film. Small plugs just like miniature cork can be placed in the punctal opening to block the tears from draining away from the eye resulting in more tears on the surface of the eye.

The best way to know if punctal plugs are going to be beneficial for your dry eye symptoms is to use temporary punctal plugs that dissolve in a few days. During those few days, you can evaluate the effectiveness of the punctal plugs resolving your dry eye symptoms. These types of plugs are made out of collagen. If your symptoms are improved, a permanent punctal plug composed of silicone can be inserted to permanently block the drainage of the tears from the eyes. In the beginning, usually the bottom or lower puncta are plugged. If you are doing well and symptoms have resolved or been significantly reduced, nothing else needs to be done. If your symptoms are not reduced to a comfortable level, then temporary punctal plugs can be inserted into the upper puncta to see they need to be plugged as well. If you get an additional reduction in symptoms, the upper puncta can be plugged as well. There are also temporary plugs that last as long 6 months. If you are having LASIK or other eye surgery and have dry eyes, these longer lasting temporary plugs may be beneficial.


Regener-Eyes is a sterile acellular amniotic fluid eye solution containing 777 proteins, cytokines, and growth factors. The science of regenerative medicine primarily focuses on the stimulation of the body’s natural ability to heal and regenerate itself. Regener-Eyes may offer new hope for the treatment of dry eye syndrome. Anti-inflammatory cytokines reduce inflammation associated with dry eye disease. Growth factors help with healing, and regeneration. Hyaluronic acid helps to protect and lubricate the eye. Regener-Eyes helps reduce the pain, irritation, inflammation and stimulate the body’s natural ability to heal, repair, and regenerate. Regener-Eyes is made with sterile D-MAPPS™ platform technology. It is packaged in sterile human birth fluid eye drop applicators with a 30-day supply. The donor’s medical and social history are screened for HIV, hepatitis, and other communicable diseases in accordance with current United States Public Health Services Recommendations and FDA Federal Regulations and Guidance documents. There have been no reported adverse reactions associated with Regener-Eyes Ophthalmic Solution. Possible adverse reactions are:

  • Transmission of diseases of unknown etiology
  • Transmission of unknown infectious disease
  • Allergic reaction to Regener-Eyes
  • Regener-Eyes is a new treatment for people with significant dry eyes
Dry Eye Syndrome Treatments

Autologous Serum

Autologous serum eye drops use serum from your own blood to help treat dry eye disease. Autologous serum has been shown to be useful in treating dry eyes as the serum contains growth factors, vitamins, and other nutrients found in blood. The person donates several vials of blood. The blood is allowed to coagulate, and it is placed in a centrifuge for about 10 minutes to remove the serum from the other components of blood. The blood serum is diluted into bottles of preserved artificial tears. The patient’s blood needs to be tested for communicable diseases such as HIV, and hepatitis to protect the safety of the technicians preparing the autologous serum.

The bottles need to be stored in the freezer except for the current bottle being used which should be stored in the refrigerator. The concentration of the serum tears varies from 20 percent to 100 percent. The most common concentration used is 20 percent since this is believed to closely match in a normal tear film.

The current indications for using autologous serum tear drops is Sjogren’s syndrome and moderate to severe dry eyes. Some of the difficulties with using autologous serum tears is the requirement to refrigerate the drops and the possibility of contamination of the drops. The drops can be difficult to obtain.


Indication and Usage

Xiidra is indicated for the treatment for the symptoms and signs of dry eye syndrome.

Side Effects

The three most common side-effects of Xiidra are irritation after instillation of the medication, dysgeusia (unusual taste), and blurred vision for a period of time after instilling the eye drop. Other side-effects are redness, headache, increased tearing, eye discharge, eye discomfort, eye pruritus or itching, and sinusitis. There are clinical studies on use in pregnant women to report any potential risks for its use in pregnant women.

Dry Eye Syndrome Treatments

Mechanism of Action

Xiidra or lifitegrast ophthalmic solution 5% binds to the integrin lymphocyte function-associated antigen-1 which is a cell surface protein and blocks the interaction ICAM-1 which is fond to be elevated in the eye related to dry eye syndrome. This is thought to decrease inflammation in the eye secondary to dry eye syndrome.

How Supplied, Storage, and Handling

Xiidra is supplied in a foil container containing 5 polyethylene 0.2mL single use eye drop dispensers. It should be stored at a temperature between 68 to 77 degrees.


The medication is instilled into the eye two times a day. It may take as long as 3 to 4 months to obtain the maximum effect of Xiidra in the eyes.

Testosterone Cream or Solution

It has been discovered that there are hormone receptors on the surface of the eye. There are studies that show that women with Sjogren’s syndrome who are androgen deficient have increased Meibomian gland disease, tear film instability, and evaporative dry eye syndrome. It appears that Meibomian glands are regulated by testosterone. Testosterone is present in men and women and the3 levels decrease as we age. Women have lower levels to begin with which may be one reason why women are two to three times more likely to develop dry eyes. Androgens have been found to be involved in regulating the immune system, health of the lacrimal glands, and secretions from the lacrimal glands.

Studies have shown that nearly 70 percent of post-menopausal women on estrogen therapy have dry eyes and 29 percent of women taking estrogen and progesterone. The dry eye disease severity may be related to the strength of the estrogen dose. Exposure to increased estrogen can also come from other sources such as food sources, birth control pills, environmental, and cosmetics.

Post-menopausal women comprise the largest group of dry eye patients. Several studies have shown that in post-menopausal women, application of testosterone cream to the eyelids or solution in the eye has improved the tear film and relieved symptoms of dry eyes in many of those women. The treatment in men  has not shown the same results as in women.

Scleral Contact Lenses

Dry Eye Syndrome Treatments

A scleral contact lens is a large contact lens that rests on the sclera (white portion of the eye) and not on the cornea as most lenses. The scleral lenses are more stable than gas-permeable conventional that fit on the cornea. They are less likely to dislodge from the eye and tend to be more comfortable that conventional gas-perm contacts. The scleral contact lens vaults over the cornea creating a tear-filled space under the contact lens. There are three types of scleral contact lenses which are based on the size of the lens.

Corneo-scleral lenses or semi-scleral lenses which rest on the junction of the cornea and sclera.

Mini-scleral lenses vault over the whole cornea and rest on the just on the beginning portion of the sclera.

Full-scleral lenses are the largest of the scleral lenses and provide the largest vault and/or space over the cornea. These work best for dry eye patients.

These types of lenses can be used to treat people with dry eye syndrome who are not doing well with more traditional dry eye treatments. The liquid space under the contact lens provides a liquid pool that covers over the cornea. The lenses are made of a permeable polymer that is highly permeable to oxygen for the health of the cornea. These lenses are custom designed to fit the eye precisely to provide the most comfort and best results. Typically, these lenses are more expensive than conventional gas-perm contacts.

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The Cataract & Refractive
Institute of Florida

James E. Croley III, M.D.

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