What Works to Treat Dry Eye? The Best Eye Drops and Home Remedies

Dry eye is a common complaint for many people. People over the age of 65, especially women, frequently encounter this problem. Dry eye is no fun, either. You might have a gritty or burning sensation in your eyes, excessive tears, and even blurry vision.

Some people use over-the-counter (OTC) products, such as artificial tears, to cope. Others turn to prescription medications, such as Restasis (cyclosporine), to treat chronic dry eye.

Here's how to weigh your options for medications for dry eye.

What causes dry eye?

Dry eye has several possible causes. Top reasons include:

1. Fewer tears are made:Decreased tear production is usually related to a problem in the tear (lacrimal) gland. Sjögren's disease is a medical condition that directly reduces tear production, but older age, diabetes, and contact lens use can also cause fewer tears.

2. More tears are lost: Increased tear loss means excessive water loss from the eye surface without any issues involving your tear duct. Decreased blinking, allergies involving the eyes, and chronic contact lens use can all contribute to tear loss. Increased tear evaporation is most commonly caused by a condition called posterior blepharitis (swollen eyelids).

Other factors that can put you at risk for dry eye include:

• Age: You make less tears as you get older. It's common for the tear duct - which brings tears from the tear gland to the eye surface - to become blocked with time. For women undergoing menopause, dry eye is even more common because hormone changes affect tear production.

• Medical conditions: Autoimmune conditions, COVID-19, and more can all cause dry eye.

• Medications: Some medications can cause you to make less tears. Examples are allergy and blood pressure medications.

• Environment: People who live in windy or dry climates or who spend long periods of time looking at electronic screens are more likely to develop dry eye.

What treatments work for dry eye?

No matter the cause of your dry eye, there are several treatments to consider. You can choose the OTC or prescription treatment for dry eye that you feel most comfortable with.

Over-the-counter dry eye drops

OTC eye drops, such as artificial tears, are a first-choice treatment for dry eye. They come in many brands and forms (e.g., liquid, gel, ointment) without a prescription.

Preservative-free artificial tears tend to be more expensive. But they're often recommended if you're sensitive to preservatives or if you'll be using them for a while. One drop 4 times a day is the place to start, and you may feel relief in a few days. Also, remember that gels and ointments are thicker than liquid drops and can blur vision. Applying them before bedtime is ideal.

It's possible that you could have itchy eyes along with dry eye symptoms. In these cases, other OTC eye drops offer benefits. Antihistamine eye drops, such as olopatadine (Pataday) and ketotifen (Alaway, Zaditor), block histamine in the eyes to relieve itchiness. And redness-reliever eye drops, such as Clear Eyes Redness Relief (naphazoline / glycerin) and Lumify Redness Reliever (brimonidine), treat temporary eye redness.

Prescription eye drops for dry eyes

If your dry eye symptoms are more severe, you may need to use prescription eye drops. Available options include:

• Restasis, Cequa, and Vevye: These are different brand-name formulations of the immunosuppressant drug cyclosporine. They're all FDA approved to treat dry eye, but they contain different amounts of active ingredient per drop. Each product should be applied twice daily in order to reduce the inflammation related to dry eye. A generic version of Restasis is also available.

• Xiidra (lifitegrast): This is a brand-name eye drop that was approved in 2016. It's not completely understood how Xiidra works to help with dry eyes, but it seems to affect proteins in the eyes to lower inflammation. Xiidra is also applied twice per day.

• Miebo (perfluorohexyloctane): Approved in May 2023, Miebo is the first in a new class of medications called semifluorinated alkane medications. It works on your eye's surface to reduce natural tear evaporation. The typical dosage is 1 drop applied 4 times per day.

• Eysuvis (loteprednol): This is a corticosteroid eye drop that reduces inflammation related to dry eye. It should be applied 4 times per day for a maximum of 2 weeks. Eysuvis is only approved for short-term use.

• Tyrvaya (varenicline): Tyrvaya is actually not an eye drop, but a nasal spray for dry eye. It boosts tear production when sprayed into each nostril twice per day.

Dry eye home remedies

Depending on the severity of your dry eye symptoms, you may not need eye drops. Making changes to your routine or home environment may clear up your symptoms on their own. But, when needed, dry eye home remedies can also be used alongside OTC and prescription eye drops.

Dry eye home remedies include:

• Changing your environment: Minimizing exposure to air conditioning or heating and adding a humidifier to your home may help. You can also take screen breaks, avoid smoke, and point fans away from your face to reduce dry eye symptoms. Eye care techniques, such as taking out contacts for sleeping, doing eyelid scrubs, and applying a warm compress, can also help.

• Taking omega-3 fatty acids: A few studies have shown that omega-3 fatty acid supplements may improve symptoms of dry eye. In a small study of Sjögren's disease, a daily 1,200 mg TheraTears Eye Nutrition Omega-3 Supplement was found to improve dry eye symptoms.

• Getting acupuncture: It's interesting to note that small studies have shown some improvement in dry eye symptoms following acupuncture therapy.

Other less common treatments for dry eye include punctal plugs and autologous serum tears. Punctal plugs are placed in the tear ducts by an ophthalmologist to keep tears on the eyes for a longer time. Autologous serum eye drops are tears made from your own blood by a special laboratory.

Is it OK to use dry eye drops every day?

The FDA indicates that OTC eye drops should be used temporarily. They recommend that you should only use OTC dry eye drops on your own for a maximum of 3 days. If symptoms continue or worsen after that, they recommend checking in with a healthcare professional. A clinician can help you avoid risks with long-term use, such as eye damage or masking underlying eye problems.

By comparison, prescription eye drops for dry eye are often prescribed for daily use.

How do you choose the best drops for dry eye?

Choosing the best OTC eye drop for dry eye can be difficult. It's recommended to talk to your healthcare professional about the nature of your symptoms. For instance, is it a temporary symptom, or has it been an ongoing issue? And are there any other symptoms that you're experiencing along with dry eye, such as itchiness or redness?

If you won't be using the eye drops frequently (i.e., a few drops per week or less), eye drops with preservatives are an option. But if you'll be using them more frequently or for longer periods of time, preservative-free eye drops are a safer choice.

If you also have itchy eyes along with dry eye, antihistamine eye drops like olopatadine and ketotifen are good options.

If you have eye redness, redness-reducing eye drops such as Clear Eyes Redness Relief or Visine Red Eye Comfort (tetrahydrozoline) can help. But they're not necessarily recommended since they're less effective over time and can cause rebound redness when you stop them. Lumify Redness Reliever has a smaller risk of rebound redness.

Keep in mind: If your dry eye symptoms are severe or long lasting, your healthcare professional will likely recommend a prescription eye drop instead of an OTC one. They'll choose a specific product based on your insurance coverage status, symptoms, and personal preferences.

Cost considerations

As you consider your options, you'll likely want to weigh the cost of treatment too. More often than not, dry eye is a long-term condition that requires daily treatment. Only rarely is there a specific cause of dry eye that can be eliminated, like a medication side effect or symptom of uncontrolled diabetes.

This means that if you have chronic dry eye, you may be using a treatment indefinitely - and the costs could add up.

For instance, a typical prescription for brand-name Restasis can cost an upward of several hundreds of dollars, though a manufacturer discount coupon may bring that cost to $0 for people with commercial insurance. You also may qualify to receive free medication from the manufacturer from myAbbVie Assist, the Restasis patient assistance program.

GoodRx discounts are another opportunity. A GoodRx coupon can help you save over 85% off the average retail price of generic Restasis, for example. And a bottle of artificial tears can cost as little as $5.90.

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