Have you ever had that annoying gritty feeling, like there is sand trapped in the eyes? That’s just a glimpse of what people with dry eye disease (DED) experience. Beyond the feeling of grittiness, they often battle with symptoms like redness, burning and itchiness. Over time, these issues can really throw a spanner in day-to-day activities. Sure, getting older can be a factor, but there is a laundry list of other suspects too: from hormonal changes and over-wearing contact lenses to certain medications and health conditions. Even just being in a dry, low-humidity environment can cause a flareup.
Why does it Happens
It’s not just about having enough tears. it is about the quality of those tears. When our eyes feel parched or gritty, our body’s instinct is to ramp up tear production. Yet, simply having more tears is not always the solution. Our eyes have specialized glands dedicated to producing high-quality tears that form protective layers and clear away debris. When these glands do not produce sufficient quality tears or cannot keep them from evaporating, that’s when DED takes hold.
The common RISK FACTORS for dry eyes include: 1. Aging: As we age, our eyes produce fewer tears, leading to a higher risk of dry eyes. 2. Gender: Women are more likely to develop dry eyes due to hormonal changes that occur during pregnancy, menopause, or the use of certain birth control methods. 3. Environmental factors: Exposure to dry or windy climates, air conditioning, or heating systems can contribute to the development of dry eyes. 4. Computer or screen use: Prolonged use of digital devices such as computers, smartphones, or tablets can cause dry eyes due to reduced blinking and increased evaporation of tears. 5. Contact lens wear: Wearing contact lenses can lead to dry eyes, especially if they are not properly cleaned or if they are worn for extended periods. 6. Certain medications: Medications such as antihistamines, decongestants, antidepressants, and hormone replacement therapies can cause or worsen dry eyes. 7. Medical conditions: Conditions such as autoimmune diseases (e.g., Sjögren's syndrome, rheumatoid arthritis), diabetes, thyroid disorders, and allergies can increase the risk of dry eyes. 8. Eye surgery: Certain eye surgeries, such as LASIK or cataract surgery, can temporarily cause dry eyes. 9. Eyelid problems: Conditions that affect the eyelids, such as blepharitis or meibomian gland dysfunction, can disrupt the production and distribution of tears, leading to dry eyes. 10. Nutritional deficiencies: Lack of essential nutrients, such as omega-3 fatty acids, vitamin A, or vitamin D, can contribute to dry eyes. It is important to note that these risk factors may vary in their significance for each individual, and a comprehensive evaluation by an Optometric or other Physician is necessary for an accurate diagnosis and appropriate management of dry eyes.
How to get Relief
If one is showing signs of dry eye, a simple first step is trying over-the-counter (OTC) artificial tears. Typically, a drop in each affected eye up to four times a day can bring improvement, which might be noticeable in a few days but can sometimes take up to a month for full effect. Options include multidose bottles with preservatives or single-use, preservative-free droppers, which are ideal for those with sensitivities. These OTC solutions are usually economical, costing about $6 per bottle.
However, if persistent dry eye symptoms are clouding the vision, it is time to consult an Optometric Physician. An OD will thoroughly evaluate eyes, checking for underlying diseases or medication side effects. With their expertise, they can then recommend Prescription or OTC treatment(s) to tackle DED symptoms.
OTC: These artificial tears are designed to provide temporary relief from dryness and discomfort associated with dry eyes. They work by lubricating the surface of the eye and supplementing the natural tears. Regarding the specific layers of tears, artificial tears are generally formulated to mimic the composition of the aqueous layer of tears, which is the watery component. They are primarily intended to provide lubrication and moisture to the ocular surface. However, some artificial tears may also contain ingredients that help stabilize the lipid layer of tears, which helps reduce evaporation and maintain tear film integrity. It is important to note that the choice of artificial tears may vary depending on individual preferences and the severity of dry eye symptoms.
Demulcents. These are usually a water-soluble polymer that helps to protect and lubricate the mucous membranes of the eye. Most commonly used in this category is carboxymethylcellulose and hydroxymethylcellulose, which increases the viscosity of tears and has mucoadhesive properties that allow for longer corneal coating.
For example, Refresh Tears (Allergan), TheraTears (Akorn) and Retaine (OcuSoft).
Emollients are a fat or oil used in both artificial tears and ointments. Most artificial tears use mineral oil, glycerin, castor oil or flaxseed oil. They are used to increase the lipid layer thickness, help stabilize the tear film and reduce evaporation. These mitigate meibomian gland disease (MGD) and lipid deficiency.
Artificial tears containing emollients include Systane Balance (Alcon), Systane Complete (Alcon), Systane Nighttime (Alcon), Refresh Optive Advanced (Allergan), Refresh Optive Mega-3 (Allergan), Refresh PM (Allergan), Soothe XP (Bausch + Lomb), Retaine MGD (OcuSoft) ,Optase Dry Eye Intense Drops and Biotrue.
FOR OTC artificial Tears, please visit dryeyerescue.com and use code, GOODEYES10 at time of purchase.
Prescription(RX) Treatment Options and Costs
DED treatments come in various forms, each addressing eye irritation differently. The most suitable treatment often depends on individual patient needs, the physician’s recommendation and insurance coverage. One challenge with many DED medications is the need for frequent dosing, which can sometimes intensify eye irritation.
Cyclosporine (branded as Restasis), which was introduced in 2003, has been a reliable choice. It’s generally well tolerated, though getting adequate relief may take up to six months. A single-use emulsion or multi-dose bottle of Restasis costs $700/month. A more recent version, Cequa, was launched in 2018, using nanomicellar technology to ensure better absorption and faster relief. It is priced closer to Restasis at about $500/month.
Xiidra (lifitegrast), approved in 2016, works differently than cyclosporine, and works to decrease the inflammation that may be causing DED. Priced at $700/month, Xiidra has shown effectiveness for mild to severe DED. However, about a quarter of its users reported side effects like eye irritation and an unusual taste in the mouth.
In 2019, Tyrvaya (varenicline) was approved as a nasal spray for DED, priced at $600/month. Interestingly, its active ingredient is also found in the cigarette cessation tablet, Chantix. When used nasally, it stimulates natural tear production, showing effectiveness in as early as a month. Some users reported sneezing and minor irritations in the throat and nose.
The newest addition, Miebo (perfluorohexyloctane), was approved in 2023. It’s the first to combat tear evaporation directly, a concern for about 90% of DED sufferers. Unlike others which boost tear production, Miebo stabilizes the eye’s lipid layer to minimize evaporation. Priced at $900/month, it’s the priciest in its category. During trials, Miebo showed a significant reduction in patient ranked eye dryness by Day 15 and 60. Despite its unique approach, its efficacy seems comparable to other DED treatments. One notable downside is its need for four times a day dosing.
Coming Soon
Vevye (cyclosporine) received FDA approval in May 2023 for DED treatment through the 505(b)(2) pathway. Vevye boasts an innovative water-free technology designed to enhance cyclosporine’s bioavailability. This medication is free of preservatives, oils and surfactants. There is considerably less irritation when compared to traditional cyclosporine agents. In just a month, up to 70% of patients showed significant improvement. within a four-week span. Vevye may cost about $600/month.
