Ask the Pharmacist

Q) My dry eyes are really hurting my quality of life. I feel like I have tried every artificial tear available. Beyond these, are there any other treatments I can try?

A) Those of us who do not suffer from dry eyes greatly underestimate its ability to really negatively impact one’s quality of life. It has been said, even among those with chronic conditions such as diabetes or heart disease, that their chief complaint in terms of their day to day health is the constant burning sensation in their eyes.

For some, one or more of the various artificial tears and ointments applied a couple of times a day may adequately alleviate their symptoms. However, there are an unfortunate number who find that these drops do little for them or that their effects last for such a short period of time that they need to instill them 10 or more times a day.

It is important to note that not all artificial tears are created equal despite a common misperception that the only difference between them is the name on the box. Some are thin or watery providing quick relief with little to no blurring of your vision but their benefits tend to be short-lived. Others are thicker or more gel like giving longer and often better results but they tend to blur the vision for several minutes which can be a pain when you’re trying to go about your daily activities. Most contain preservatives that are not an issue for the vast majority of users.

However, some of us (particularly those who need to use these products many times a day) will find that a preservative can actually worsen symptoms and as such would be better off choosing a preservative free products which are a little more expensive.

As well, artificial tears fall into 3 broad categories based upon how they work. There are tear changing ones (e.g. Thera Tears and others) that modify the chemical make-up of your tears and by doing so can lessen the negative changes that can occur to your eye as a result of having chronic dry eyes.

There are also products (e.g. Systane Ultra or Blink among others) that coat your eyes which promote the healing of the surface of the eye as well as improve the moisture content of its cells. Lastly, some products (e.g. Refresh Endura or Systane Balance) serve to stabilize the oil part of the tear film which can help to keep your own natural tears from evaporating as quickly as they currently do.

Seeing an optometrist can greatly aid you in picking the type of tear that that is most likely to work best for you. However, for some, none of the options will prove to be satisfactory.

There are now 2 prescription eye drop options that do far more than just lubricate the eye. Restasis and Xiidra both act to reduce the inflammation that occurs as a result of dry eyes. Restasis also helps your body produce more of its own tears however, its positive impact is far from immediate. It is suggested one must use the product for a minimum of 3 months to experience its full benefits (which is not to say you will not notice improvement before then) and some will experience an increase in the burning sensation during the first few weeks of treatment that will usually go away on its own despite continued treatment.

Xiidra has the advantage of generally being quicker to work, some noting improvement in as little as 2 weeks and also being significantly less likely to cause burning in the eye. It can also be used with contact lenses as long as they are removed for an appropriate length of time whereas Restasis should not be. On the downside, Xiidra can alter your taste sensation and is more likely to blur your vision. Both are applied twice a day and are covered by many private drug plans but neither is routinely paid for by the Ontario government.

There is a relatively new treatment available in Canada called Lipiflow which is done in a health care practitioner’s office and takes approximately 12 minutes per eye. Lipiflow fits over your eyelids and applies controlled heat to the meibomian glands (which secrete oil into the eye) softening the hardened oil while applying pressure to your eyelids to open these glands thereby helping them to start expressing the naturals oils again.

In one study, 76% reported improvements within 2 weeks although some may take a few months to notice improvement and undoubtedly some will not improve at all. The procedure does not generally hurt (1.4 out of 10 was scored on one pain scale) and side effects are generally not serious or common.

Cost can be an issue (it varies among practitioners) but generally goes in the $700-900 range per eye (it is not paid for by OHIP or many private insurance companies) with the duration of its benefits varying widely but typically lasting from 1- to 3 years or longer.

Another treatment done in office by some practitioners is called intense pulsed light therapy. In this treatment, a device applies light pulses to the area around your eyes, once again with the intended effect of getting your meibomian glands unclogged and working again. It usually requires 4 monthly treatments (lasting about 15 minutes) for optimum effects, is generally well tolerated (although it can make your eyelids more light-sensitive) but is not covered by OHIP. Most need to repeat this annually to maintain the benefits. The cost of this treatment was not disclosed without calling a clinic which undoubtedly means it won’t be cheap but may be still very worthwhile depending on how badly your eyes are bothering you. Prices can vary so it is smart to call around.

Other more commonly found treatments done in an office setting include meibomian gland expression or the insertion of punctual plugs. Your eye doctor might also teach you how to use Lacrisert (a solid device that is placed under the lower eye lid) which slowly releases a lubricating agent throughout the day. Other steps you can do on your own at home would be to take a source of omega-3 fatty acids (such as fish oils or flax seed) and to learn to properly apply hot compresses with a massage to the eyes which can be quite effective in opening up those pesky glands when done correctly.

For more information about this or any other health related issues, contact your pharmacist.