Your doctor may have explained this, but as a refresher: Dry eye happens when the amount or quality of your tears isn’t sufficient. This can occur if there’s something wrong with any of the components in your tear film, according to the National Eye Institute (NEI). There’s a lower mucous-based layer that binds with the water in your tears to help keep your eyes moist. There’s also a middle layer made up of water and water-soluble proteins secreted by the lacrimal glands under your eyebrows. It’s all topped off by an oily outer layer made by your Meibomian glands (located under your eyelids). This helps keep your tears from evaporating too quickly.
When this is all working the way it should, your eyes actually do a pretty good job of moisturizing themselves through this film, which spreads across your eyes when you blink. If it’s not working the way it should, you have dry eye and should treat it.
There are some great dry eye treatments out there that can help relieve your eye irritation and hydrate your eyes. In general, your doctor will want to start with the least invasive and easiest treatment and step things up if that’s not doing it for you, Mina Massaro-Giordano, M.D., co-director of the Penn Dry Eye & Ocular Surface Center and a professor of clinical ophthalmology at the University of Pennsylvania, tells SELF. Here are the best options available, plus when your doctor may recommend that you try them.
1. Artificial tears, gels, and ointment
Artificial tears are considered the first line of defense against dry eye, Vivian Shibayama, O.D., an optometrist with UCLA Health, tells SELF. Using them regularly should help lube up the surface of your eyes and provide you with some relief, she says. That’s most likely to happen if you use them before your eyes even get dry, not after they feel rubbed raw.
Since your eyes are already prone to irritation, Dr. Shibayama recommends choosing drops that are preservative-free to avoid further potential aggravation. You should also avoid eye drops that promise to eradicate any redness, because those can actually make your eyes more bloodshot over time.
If that doesn’t help, your doctor may recommend ramping things up to a gel or ointment, which are thicker and will likely stay on your eyes longer, Dr. Massaro-Giordano says.
2. Prescription dry eye medications
There are a few different options here depending on what’s going on with your eyeballs.
If your issue is inflammation of your cornea (the transparent protective dome on the surface of your eye), your doctor may prescribe eye drops that contain immune-suppressing medications to halt that inflammatory physiological response, the Mayo Clinic says. The Food and Drug Administration (FDA) has approved two drugs for treating dry eye, one of which is cyclosporine, which suppresses eye inflammation. The other FDA-approved dry eye treatment is lifitegrast, which also appears to suppress eye inflammation that can prompt dry eye symptoms.
Other prescription treatments can target different causes of dry eye. For example, if you’re dealing with eyelid inflammation that’s keeping those Meibomian glands from secreting oil into your tears, your doctor may recommend that you take antibiotics, according to the Mayo Clinic.
Or, if your eyes aren’t making enough tears overall, drugs called cholinergics can help increase tear production through pills, gels, or eyedrops, according to the Mayo Clinic.
3. Eye inserts that work like artificial tears
If your dry eye is moderate to severe, your doctor may recommend using little prescription eye inserts made of hydroxypropyl cellulose, a substance that’s often used as a lubricant in eye drops, the Mayo Clinic says. Each insert looks like a clear grain of rice. You pop them between your lower eyelids and eyeballs once a day, and they slowly dissolve to release that hydroxypropyl cellulose.
4. An FDA-approved device to stimulate your Meibomian glands’ oil production
If your dry eye is caused by blocked oil glands, your doctor may recommend that you try a treatment called LipiFlow, the Mayo Clinic says.
This is a battery-operated machine that uses a device resembling an eyecup. The device goes over your eye and performs a warm, gentle massage to your lower eyelid for about 12 minutes in your doctor’s office.
The hope is that it will help clear out blocked oil glands, but the jury is out on how well this works, the Mayo Clinic says. If it does work for you, it’ll likely take a couple of weeks to achieve maximum relief, Jennifer Fogt, O.D., fellow of the American Academy of Optometry and an associate professor in the College of Optometry at The Ohio State University, tells SELF. For some people, one treatment is enough (combined with any other dry eye treatments they use). Others need periodic treatment with the device, Dr. Fogt explains.
5. Bandage lenses
Also known as scleral lenses, these are special contact lenses that can help protect the surface of your eyes and trap moisture against them, per the Mayo Clinic. These are usually used when you have moderate to severe dry eye, Dr. Massaro-Giordano says. “If eyes are persistently dry and uncomfortable even after maximum therapy, scleral lenses may help,” Dr. Shibayama says. “[They create] a protective layer of fluid that keeps the cornea hydrated all day.”
6. Minor surgery
In some cases, your doctor may recommend that you have tiny plugs made of silicone or collagen inserted into the inner corners of your eyes to partially or completely obstruct your tear ducts, the NEI says. This helps keep tears from draining from your eye too quickly. “Putting a plug in is like placing a stopper in a tub,” Dr. Shibayama explains. “It reduces the outflow of tears and keeps more tears in the eyes.”
If you have a more severe case of dry eye, your doctor may even recommend surgically closing your tear ducts through a procedure called thermal punctal cautery, the NEI says—that involves burning your tear ducts so they scar shut. Obviously, your doctor will make the process as comfortable as possible if this is the best choice for you.
7. Eye drops made from your own blood
Yes, really. This sounds like something straight out of Netflix’s latest original horror movie, but it’s real. Eye drops made from your own blood (autologous blood serum drops) are an option for treating severe dry eye symptoms that don’t respond to other treatments, according to the Mayo Clinic.
To make these drops, your doctor will take a sample of your blood, process it to remove the red blood cells, mix it with a saline solution, and voilà: blood eye drops! It sounds totally out-there, but it’s thought that the blood has healing properties that can help soothe your eyeballs, Dr. Massaro-Giordano says.
8. For the best results, you might need to make some lifestyle changes, too.
Exhibit A: warm compresses. If your dry eye seems to be caused by a Meibomian gland issue, your doctor will also likely recommend that you use daily warm compresses to try to get those oils flowing, Dr. Fogt says. (Just wet a washcloth with warm water, wring it out, and hold it up against your eye for a few minutes to help stimulate the glands.)
No matter the cause of your dry eye, you should take seemingly small measures that can make a big difference, like always removing your contacts before bed, resting your eyes at least every 20 minutes when using digital devices, and wearing sunglasses when it’s windy outside.
If your current dry eye treatment and lifestyle changes just aren’t doing the trick, seek medical advice. “Keep talking with your eye doctor,” Dr. Fogt says. “If your symptoms are worsening, your treatment plan may need to change. Often, multiple elements of treatment are needed.”