Treatment of dry eye

What are the causes of dry eye syndrome?

Most people with dry eye syndrome have no measurable abnormality of tear production, and no serious disease affecting tear composition.

Symptoms of dry eye may be caused by one or more factors such as:

  • Decreased tear production
  • Increased evaporation of tears
  • Abnormal ocular surface or disruption of the afferent sensory nerves
  • Decreased lipid production by Meibomian glands

Drugs which been reported to have adverse effects related to decreased tear production include:

  • Antihistamines
  • Tricyclic antidepressants
  • Selective serotonin reuptake inhibitors
  • Diuretics
  • Beta-blockers

Treatment Options

Patients who present with dry eye should initially be provided with education and advice regarding non-invasive, self-help interventions (see below). Many of these products are cheap to buy and are readily available, along with advice, from pharmacies. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet.

Clinicians should also consider medication which may be contributing to symptoms. Clinicians and patients should assess and evaluate the risk/benefit outcome and symptom severity before adjusting any treatment thought to be affecting dry eyes.

The severity of the condition and the person's preference should guide choice of pharmacotherapy for dry eyes.

Mild - moderate: Artificial tear substitutes

Severe: Non-preserved artificial tear substitutes


Simple, general advice to patients regarding the management of dry eyes should be offered to all patients to provide symptom relief. In mild cases of dry eye this may be sufficient and may avoid the need for pharmacological intervention.

  • Consider using humidifiers in the home
  • Drink plenty of fluids to keep hydrated
  • Try to avoid fumes, dust and smoke (eg, from cigarettes) which can irritate the eyes
  • Try not to rub the eyes
  • Wear wrap-around sunglasses outdoors to stop the wind drying the eyes too quickly
  • Limit the use of contact lenses, if these cause irritation
  • If using a computer for long periods, ensure that the monitor is at or below eye level, avoid staring at the screen, and take frequent breaks to close/blink eyes

Mild to moderate symptoms

Artificial tears required fewer than 6 times daily

Many products for mild-moderate symptoms can be purchased over the counter at a cost less than the prescription charge.

Products containing carbomers or polyvinyl alcohol require less frequent application due to their ability to cling to the eye surface but may be less well tolerated.

Eye ointments containing paraffin may be uncomfortable and blur vision; they are recommended for use at night and never with contact lenses. These products physically lubricate and protect the eye surface from epithelial erosion.

  • Hypromellose
  • Polyvinyl alcohol
  • Carbomer
  • Liquid paraffin

See section 11.2 Dry eye conditions

Severe symptoms

  • Artificial tears required more than 6 applications daily
  • The risk of irritation from preservatives (often benzalkonium chloride) increases with the frequency of dosing.
  • Patients presenting with severe symptoms should be treated with preservative-free preparations.

The products listed in this section are also suitable for patients with preservative allergy or intolerance, which should only be diagnosed by an ophthalmologist.

  • Polyvinyl alcohol single dose units
  • Carbomers single dose units
  • Carmellose sodium
  • Sodium hyaluronate
  • Sodium hyaluronate and trehalose

See section 11.2 Dry eye conditions


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