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`Dry Eye Treatment:
`Getting Relief From Dry Eyes
`
`Reviewed by Richard Adler, MD
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`On this page:
`Artificial tears Restasis Xiidra Steroid eye drops Lacrisert Punctal plugs Meibomian gland expression Warm compresses
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`Lipiflow Intense pulsed light (IPL) Nutritional supplements Home remedies Other considerations
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`See also: What is dry eye syndrome, and what causes it?
`
`Dry eye syndrome is a chronic and typically progressive condition. Depending on its cause and severity, it may not be completely curable. But in most
`cases, dry eyes can be managed successfully, usually resulting in noticeably greater eye comfort, fewer dry eye symptoms, and sometimes sharper
`vision as well.
`
`Because dry eye disease can have a number of causes, a variety of treatment approaches are used.
`
`. Your eye doctor may
`
`The following is a list of dry eye treatments that are commonly used by eye doctors to reduce the signs and symptoms of dry eyes
`recommend only one of these dry eye treatments or a combination of treatments, depending on the cause(s) and severity of your condition.
`
`Also, some eye doctors will have you complete a questionnaire about your symptoms prior to initiating dry eye treatment. Your answers to this survey
`are then used as a baseline, and the questionnaire may be administered again after several weeks of treatment to evaluate the effectiveness of the
`chosen treatment approach. If you haven't established an eye doctor,
`click here
` to find one near you.
`
`Successful treatment of dry eyes requires that you are willing to follow your doctor's recommendations and that you use the products he or she
`recommends consistently and as frequently as directed.
`
`1. Artificial Tears
`
`For mild cases of dry eyes caused by computer use, reading, schoolwork and other situational causes, the best dry eye treatment may simply be
`frequent use of artificial tears or other lubricating eye drops.
`
`There are many brands of artificial tears that are available without a prescription. The challenge with using artificial tears is not lack of product
`availability — it's the confusing number of brands and formulations available to choose from.
`
`
`
`Artificial tears and other over-the-counter (OTC) lubricating eye drops
`
` are available in a wide variety of ingredients and viscosity ("thickness").
`
`Artificial tears with low viscosity are "light" and watery. They often provide quick relief with little or no blurring of your vision when you apply them. But
`often their soothing effect is very short-lived, and sometimes you must use these drops very frequently to get adequate dry eye relief.
`
`On the other hand, artificial tears that have a high viscosity are more gel-like and can provide longer-lasting lubrication. But typically these drops cause
`significant blurring of your vision for several minutes immediately after you apply them. For this reason, these drops often are not a good choice for
`use during your work day or when you need immediate clear vision for tasks such as driving. Instead, high-viscosity artificial tears are recommended
`only for bedtime use.
`
`Also, the ingredients in certain brands of artificial tears may determine which type of dry eye condition they are better suited for. For example, one
`brand might work better for aqueous-deficiency dry eyes, while another brand may be more effective for an evaporative dry eye condition.
`
`If your eye doctor recommends that you use one or more brands or formulations of artificial tears, be sure to follow the directions he or she gives you
`concerning when and how often you use the drops. Also, do not substitute different brands from those your eye doctor recommends. Using a different
`brand or multiple brands of artificial tears will make it difficult to assess the success of the dry eye treatment your doctor recommended.
`
`2. Restasis
`
`Instead of OTC artificial tears (or in addition to them), your eye doctor might recommend daily use of a prescription eye drop called Restasis (Allergan)
`for your dry eye treatment.
`
`Restasis does more than simply lubricate the surface of your eye. It includes an agent that reduces inflammation associated with dry eye syndrome and
`helps your body produce more natural tears to keep your eyes moist, comfortable and healthy.
`
`It's important to know, however, that the therapeutic effect of Restasis is not immediate. You must use the drops daily for a minimum of 90 days to
`experience the full benefits of this dry eye treatment.
`
`A significant percentage of people who try Restasis will experience burning eyes early during the first few weeks of treatment.
`
`http://www.allaboutvision.com/conditions/dryeye.htm
`
`MYLAN - EXHIBIT 1097
`Mylan Pharmaceuticals Inc. et al. v. Allergan, Inc.
`IPR2016-01127, -01128, -01129, -01130, -01131, & -01132
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`DRY EYE NEWS
`
`Study Reveals That Operating Rooms Are A Breeding Ground For Dry Eye
`
`September 2016 — Dry eye affects about 10 to 20 percent of the population, and most of those who have the disease
`are over age 50.
`
`But if you work in a "clean room" environment, such as an operating room, you're at even greater risk — as high as 56
`percent according to new research that evaluated dry eye prevalence in surgical residents with a mean age of only 27.8
`years.
`
`Clinicians have long known that activities that decrease blink rate can increase the prevalence of dry eye syndrome. For
`example, long hours spent at a computer is a well-established risk factor for dry eye.
`
`Sidebar continued >>
`
`But digital device use isn't the only activity that reduces blink rate, leading to dry eye. A study conducted at Western National
`Medical Center found that residents of surgical specialties are likewise exposed to risk factors, including decreased blink rate,
`which cause damage to the eye's surface.
`
`As the study explained, operating rooms are enclosed ventilation environments in which doctors and other team members
`perform activities that require intense concentration and fixation on details, such as using a microscope.
`
`
`
`The study report appeared in the July 2016 issue of BMC Ophthalmology
`
`
`
`. — A.H.
`
`3. Xiidra
`
`In July 2016, Shire announced it received FDA approval to market its new Xiidra (ZYE-druh) prescription eye drops for the treatment of dry eye in the
`United States.
`
`Xiidra, like Restasis, is aimed at reducing inflammation that is associated with the signs and symptoms of dry eyes.
`
`The safety and efficacy of Xiidra was studied in four placebo-controlled, 12-week clinical trials that included 1,181 people with dry eyes. Participants
`were evaluated for dry eye signs and symptoms just prior to starting use of the drops, then after two weeks, six weeks and 12 weeks of Xiidra use.
`
`In two of the four studies, participants noticed a significant reduction in dry eye symptoms after using Xiidra for two weeks. In all four studies,
`participants noticed a larger reduction in dryness symptoms after six weeks and 12 weeks of Xiidra use.
`
`Also, at 12 weeks, a statistically significant reduction in signs of dry eyes was found among Xiidra users compared with participants given a placebo in
`two of the four studies.
`
`
`
`, which occurred in The most common side effects of Xiidra reported in the studies were eye irritation, altered taste sensation and reduced visual acuity
`
`
`5 to 25 percent of participants.
`
`The recommended dosage for Xiidra, like Restasis, is two applications in each eye per day, approximately 12 hours apart.
`
`4. Steroid Eye Drops
`
`Over the past several years, doctors have discovered the importance of inflammation as a cause of dry eyes. Inflammation frequently causes the
`redness and burning associated with dry eye disease; but in many cases, it may be present without any visible signs or symptoms at all.
`
`Artificial tears usually do not adequately address these inflammatory changes, and your doctor may recommend steroid eye drops to better manage
`the underlying inflammation associated with dry eyes.
`
`Steroid eye drops are generally used short-term to quickly manage symptoms. They are often used in conjunction with artificial tears and Restasis, as a
`complement to these more long-term treatment strategies.
`
`While a small amount of the steroid may get absorbed systemically, in the right candidate, the effects of steroid eye drops are generally not noticed
`beyond the eye. Still, it's important to discuss your medical history with your eye doctor before starting steroid eye drops.
`
`Many different types of steroid drops are available and differ in their potency. Most doctors prefer to start with mild steroids that are quickly degraded
`inside the eye. In some cases, however, more potent drops are required to address more severe symptoms.
`
`
`
`Steroid eye drops can increase the risk of developing high eye pressure
`
`when the drops are used only on a short-term basis for dry eye treatment.
`
` if used for extended periods of time. But these risks are low or even cataracts
`
`SEE ALSO: How to Use Eye Drops Without Spilling Them All Over Your Face! >
`
`5. Lacrisert
`
`Lacrisert (Bausch + Lomb) is a sterile, slow-release lubricant that is placed under the lower eye where the
`the conjunctiva of the eyeball (this location is called the inferior cul-de-sac of the eye).
`
`
`
` of the inside of the eyelid meets conjunctiva
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`http://www.allaboutvision.com/conditions/dryeye.htm
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`Lacrisert is a solid insert composed of a preservative-free lubricating agent (hydroxypropyl cellulose) that slowly liquefies over time, providing an all-day
`moistening effect.
`
`For most people with dry eyes, a single Lacrisert is applied once a day. The device has been proven to relieve dryness, burning, watery eyes, foreign
`
`body sensation, itching, light sensitivity
` and blurred vision, according to the company.
`
`Lacrisert typically is recommended for patients with moderate to severe dry eye symptoms, especially if dry eye treatment with artificial tears alone
`proves unsuccessful.
`
`
`If improperly placed in the inferior cul-de-sac of the eye, it's possible Lacrisert could cause a
`. Also, Lacrisert may cause transient corneal abrasion
`blurred vision, eye discomfort or irritation, matting or stickiness of eyelashes,
` and sensitivity to light.
`red eyes
`
`6. Punctal Plugs
`
`Punctal plugs
`
` are sometimes used in dry eye treatment to help tears remain on the surface of the eye longer.
`
`A punctal plug is a small, sterile device that is inserted into one of the small openings (puncta) of tear drainage ducts that are located in the inner corner
`of the upper and lower eyelids.
`
`After these openings have been plugged, tears can no longer drain away from the eye through these ducts. In this way the tear film stays intact longer
`on the surface of the eye, relieving dry eye symptoms.
`
`So where do the tears go? Usually they will simply evaporate from the eye surface without symptoms. But if insertion of punctal plugs causes the eyes
`to "water," one or more of the plugs can be removed.
`
`7. Meibomian Gland Expression
`
`A very significant percentage of dry eye cases are caused by inadequate oil (meibum) being secreted from meibomian glands located along the margin
`of the eyelids.
`
`The openings of these glands are near the base of the eyelashes, and if these openings get clogged, the oil that is critical to keeping the tear film from
`
`evaporating too quickly cannot do its job. This is called meibomian gland dysfunction (MGD), which leads to a condition called evaporative dry eye.
`
`
`To treat MGD and evaporative dry eye, your eye doctor may perform an in-office procedure called meibomian gland expression. In this procedure,
`warm compresses may or may not first be applied to your eyelids; then a forceps-type device is used to squeeze the clogged contents (hardened
`meibum and possibly other substances) from the meibomian glands.
`
`To fully express the contents of the meibomian glands and get them functioning properly, significant pressure must be applied to the eyelids, which can
`be uncomfortable. But the results usually are worth putting up with the short-term discomfort of the procedure.
`
`8. Warm Compresses
`
`An alternative (and potentially more comfortable) way to help open clogged meibomian glands to treat dry eyes is to simply apply warm compresses to
`the closed eyelids to soften the hardened meibum.
`
`Unfortunately, for warm compresses to work well, some researchers say you have to use a compress that can maintain a temperature of 108 degrees
`Fahrenheit for more than 10 minutes, and the compresses have to be applied for this length of time at least twice a day.
`
`Most people are unable or unwilling to perform this type of dry eye treatment correctly, and shorter and less frequent use of variable-temperature
`warm compresses typically is ineffective.
`
`9. LipiFlow
`
`The LipiFlow Thermal Pulsation System (TearScience) is an automated, in-office dry eye treatment that combines the best features of warm compress
`therapy and meibomian gland expression.
`
`The patented device fits onto the eye and also over the eyelids and applies precisely controlled heat to the lids to soften hardened meibum. At the
`same time, the LipiFlow system applies pulsed pressure to the eyelids to open and express clogged meibomian glands, thereby restoring the correct
`balance of oils in the tear film to relieve dry eye syndrome.
`
`Lipiflow treatment takes approximately 12 minutes per eye. In a clinical study of the effectiveness of the procedure, most patients (76 percent) reported
`improvement of their dry eye symptoms within two weeks, and patients also showed improvement in the quality and quantity of meibomian gland
`secretions and the duration of time their tear film remained on the eye before evaporating. In some cases, however, it can take a few months for
`improvements to become apparent.
`
`Typically, the beneficial effects of the LipiFlow procedure last one to three years or longer.
`
`Potential side effects from LipiFlow dry eye treatment include corneal abrasion, eye pain,
`transient blurred vision, itching, and red eyes.
`
`swollen eyelids
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`http://www.allaboutvision.com/conditions/dryeye.htm
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`
`
`, , eyelid irritation or inflammation, chalazion
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`LipiFlow dry eye treatment typically is not covered by health insurance. Fees for the procedure can vary from one practitioner to another and tend to
`range from $700 to $900 per eye.
`
`10. Intense Pulsed Light
`
`For well over a decade, the FDA has approved the use of intense pulsed light (IPL) to treat rosacea on the skin. Rosacea on the skin and eyelid often
`occur together.
` presents with dilated small blood vessels coursing along the eyelash margin in patients suffering from blepharitis and Ocular rosacea
`
`may contribute to dry eye symptoms.
`
`In IPL treatment, a hand-held device flashes bright light onto the skin. The light is filtered to allow only wavelengths that can be absorbed by the dilated
`blood vessels. The effect of this treatment may be the resolution of the dilated vessels and associated inflammation.
`
`Many patients experience relief from their dry eye symptoms and become less dependent on artificial tears and other eye drops to control dry eye
`symptoms after IPL therapy. For this reason, IPL treatment may be well-suited for dry eye patients who don't want to be troubled by the inconvenience
`of frequent eye drop use.
`
`Patients usually require four to six intense pulsed light treatments, with about one month between each treatment. Typically, the treatments are well-
`tolerated and are not associated with any down-time. However, prior to the treatment it's important to discuss with your doctor how much time you
`spend in the sun.
`
`IPL treatment generally is not covered by health insurance or vision insurance and it may not be appropriate for patients with certain skin
`
`
`
`
`pigmentations.
`
`11. Nutritional Supplements
`
`Doctors sometimes recommend
` as part of a holistic dry eye treatment plan. Studies have found that supplements containing nutritional supplements
`
` can decrease dry eye symptoms.omega-3 fatty acids
`
`
`Good sources of omega-3s include cold-water fish such as salmon, sardines, herring and cod. For a vegetarian source of omega-3s, some eye doctors
`
`recommend flaxseed oil to relieve dry eye.
`
`
`Drinking more water can help, too. Mild dehydration often makes dry eye problems worse. This is especially true during hot, dry and windy weather.
`Simply drinking more water sometimes reduces the symptoms of dry eye syndrome.
`
`12. Home Remedies for Dry Eyes
`
`If you have mild dry eye symptoms, there are several things you can try to get relief before going to the eye doctor:
`
`Blink more frequently.
` When using a computer, smartphone or other digital device, we tend to blink our eyes less frequently than normal, which can
`cause or worsen dry eye symptoms. Make a conscious effort to be aware of this, and blink more often when using these devices. Also, perform full
`blinks, gently squeezing your eyelids together to wash your eyes fully with a fresh layer of tears.
`
`Take frequent breaks during computer use.
` A good rule of thumb here is to look away from your screen at least every 20 minutes and look at
`eye care practitioners
`something that is at least 20 feet from your eyes for at least 20 seconds. Some
` call this the "20-20-20 rule," and abiding by it can
`computer eye strain
`help relieve both dry eyes and
`.
`
`Remove eye makeup thoroughly.
` Eyeliner and other eye makeup can clog the openings of the meibomian glands at the base of the eyelashes,
`leading to meibomian gland dysfunction and evaporative dry eye. At the end of the day, be diligent about remove all traces of makeup from your lids
`and lashes.
`
`Clean your eyelids.
` and meibomian
` When washing your face before bedtime, gently wash your eyelids to remove bacteria that can cause
`blepharitis
`gland problems that lead to dry eye symptoms. Apply a warm, moist washcloth to your closed lids for a minute or two. Then gently scrub your lids and
`lashes with a mild cleanser, such as diluted baby shampoo or premoistened eyelid wipes sold in drugstores.
`
`Wear quality sunglasses.
` that block 100 percent of the sun's
` When outdoors during the day, always wear
`UV rays
`sunglasses
`wrap-style frame to protect your eyes from wind, dust and other irritants that can cause or worsen dry eye symptoms.
`
`. It's best if they feature a
`
`TOP DRY EYE HOT SPOTS
`
`The National Women's Health Resource Center has named the top 100 dry eye hot spots in the United States based on
`information compiled from the National Oceanic and Atmospheric Administration's Climatic Data Center and the
`Environmental Protection Agency.
`
`Factors used in the selection process included temperatures, humidity, wind, altitude, pollutants and ocular allergens.
`
`The top 20 U.S. cities named as dry eye hot spots are:
`
`1. Las Vegas, Nev.
`2. Lubbock, Texas*
`2. El Paso, Texas*
`4. Midland/Odessa, Texas
`5. Dallas/Fort Worth, Texas
`
`11. Oklahoma City, Okla.
`12. Albuquerque, N.M.
`13. Tucson, Ariz.
`14. Norfolk, Va.
`15. Newark, N.J.
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`Page 5 of 5
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`6. Atlanta, Ga.
`7. Salt Lake City, Utah
`8. Phoenix, Ariz.
`9. Amarillo, Texas
`10. Honolulu, Hawaii
`*Cities were tied for these spots.
`
`16. Boston, Mass.
`17. Denver, Colo.
`18. Pittsburgh, Pa.
`19. Bakersfield, Calif.*
`19. Wichita, Kan.*
`
`Other Dry Eye Treatment Considerations
`
`In addition to the dry eye treatments listed above, your eye doctor may recommend one or more of the following supplemental measures if any of the
`conditions below apply to you:
`
`Medication adjustment.
` Many medicines — including antihistamines, antidepressants, birth control pills, certain blood pressure medications and
`more — can cause or worsen dry eye symptoms. Even over-the-counter (nonprescription) medications for allergies and other conditions can cause dry
`eyes.
`
`Be sure to discuss all medications you are taking with your eye doctor if you are experiencing dry eye problems. In some cases, adjusting the type and
`number of medications you are taking may help reduce dry eye symptoms without causing adverse health effects.
`
`However, never discontinue a prescription medication without first discussing the matter with your physician. If your eye doctor feels an adjustment to
`one of your medications may help relieve dry eye symptoms, he or she can discuss it with your physician (or have you discuss it with your doctor) to see
`if such a change is possible.
`
`Treating eyelid conditions.
` If you have blepharitis, meibomian gland dysfunction or other eyelid conditions, these often are associated with dry eye
`disease and should be addressed as part of your overall dry eye treatment regimen. For example, if you have blepharitis, your eye doctor may
`recommend use of an antibiotic and/or steroid ointment or eye drop in addition to daily eyelid cleansing with a non-irritating shampoo.
`
`Discontinuing or reducing contact lens wear.
` If you wear contact lenses, it can be difficult to tell if an underlying dry eye condition is causing contact
`lens discomfort or if your contact lenses are causing dry eye symptoms. If you wear contacts, it's often best to discontinue wearing them (or perhaps
`switch to
` for part-time wear only) while your dry eye treatment is in progress.
`daily disposable contact lenses
`
`Back to top ⤴
`
`About the Reviewer:
` Richard Adler, MD, is a member of All About Vision's editorial advisory board. He is a board-certified ophthalmologist and corneal specialist at
`Belcara Health — a premier multi-specialty practice in Baltimore that offers ophthalmology (including laser vision correction), plastic surgery and dermatology.
`More about Dr. Adler
`
`[Page updated February 2017]
`
`More Dry Eye Articles
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` |
`Answers From a Dry Eye Expert Dry Eyes After Menopause
` |
`Meibomian Gland Dysfunction Sjogren's Syndrome
` |
`Dry Eye Treatment: Overview Dry Eye Treatment: Punctal Plugs
` |
`Dry Eye Prevention: Nutrition Contact Lenses for Dry Eyes
` |
`LASIK and Dry Eyes
`
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