Dry eye treatment

What is dry eye syndrome?

Dry eye syndrome is a very common condition that is estimated to affect at least 32% of the UK population. Unsurprisingly, the main symptom is a lack of lubrication on the surface of your eyes. This is usually because you either don’t produce enough tear film, or your tears evaporate too quickly. It can come and go, or remain constant and it can cause unpleasant, uncomfortable and sometimes debilitating symptoms. Thankfully, there’s a range of treatments available, from topical therapies like eye drops to dry eye surgery.

Dry eye surgery is usually a last resort treatment that is recommended for people who can’t get enough relief from their symptoms using alternatives.

What causes dry eye syndrome?

There are a variety of causes of dry eye syndrome. These include, but aren’t limited to:

• the natural ageing process
• eyelid glands that are responsible for producing tears (called meibomian glands) becoming clogged and blocked
• prolonged screen time/eye strain
• spending time in dry, dusty environments
• long term contact lens use
• sleeping in contact lenses
• long-term smoking, which could significantly increase your risk
• taking certain medications, including some antihistamines, blood pressure medications, oral contraceptives, sleeping pills and antidepressants.

What is dry eye syndrome also known as?

Dry eye syndrome is also sometimes known as dry eye disease or keratoconjunctivitis sicca.

What are the symptoms of dry eye syndrome?

Aside from the most obvious symptom – eyes that feel dry and dehydrated – there are several other signs of dry eye syndrome. These include eyes that are:

• itchy
• irritated
• sore
• gritty
• red
• sensitive to light.

You may have blurred vision, and your eyes may also be more watery than normal. This sounds implausible since the condition is caused by a lack of tear fluid, but excessive watering can occur because your brain tells your eyes to overcompensate for the dryness, causing flooding instead.

If you’re experiencing any of these symptoms, we recommend that you make an appointment with your optician, or a specialist eye doctor.

What are the treatment options for dry eye syndrome?

There are a lot of different ways to treat dry eye disease, and in most cases, you’ll start off with the mildest therapies first to see if they have a positive effect. Treatments for dry eye can be split into three areas – over the counter/lifestyle, prescription and surgery.

At-home tips for managing dry eye syndrome

There are plenty of things you can try to help reduce your dry eye symptoms at home, before you even seek a medical professional. These include:

• taking regular screen breaks
• using a humidifier to make sure the air isn’t too dry in the rooms where you spend the most time
• limiting exposure to wind, dust and chemicals
• avoiding smoke and air conditioning
• using warm compresses on your eyes
• eyelid massage, if you believe your meibomian glands may be blocked
• using artificial tears, which can be bought over the counter.

Prescription treatments for dry eyes

If you can’t get enough relief from your symptoms using the methods above, it’s time to speak to your eye doctor and discuss using prescription treatments. These may include:

• anti-inflammatory eye drops, such as cyclosporine
• a short course of steroid eyedrops (these should never be used long-term)
• tear-stimulating treatments, such as varenicline spray
• oil-layer treatments to help prevent tear evaporation
• Lipiflow, which is a non-invasive treatment that uses heat and massage to break down blockages in your tear ducts.

Surgery for dry eyes

If no other treatment is effective enough to help relieve your dry eyes, you may be a good candidate for surgery. There are several surgical solutions, including:

Punctal plugs

Punctal plugs are tiny, temporary or permanent inserts placed into your tear ducts to help stop tears draining away so quickly, keeping them on the surface of your eyes for longer.

The procedure is usually carried out using local anaesthetic to numb your eyes, before the plugs are placed via tiny incisions into the tear ducts. It’s usually painless and takes just a few minutes per eye.

There are no stitches and no downtime, meaning you can get back to your usual activities straight away. You may be prescribed eyedrops for a few days after your surgery and should use these exactly as directed.

IPL therapy

IPL stands for Intense Pulsed Light, which targets the blood vessels in your eyelids to reduce inflammation so that the meibomian glands can get back to producing tear film again. It also melts any clogged oils and improves the overall quality of your tears.

IPL treatment is non-invasive and takes place over several sessions (usually three or four). Each session takes about 15 minutes and is considered painless. Like punctal plugs, there’s no downtime. You’ll be advised to continue using lubricating drops after your treatment, but over time you should need to use them progressively less as your meibomian glands recover.

Thermal cautery

Also sometimes known as punctal cautery, this procedure uses heat to shrink and close your tear ducts to prevent tears from draining away. It can be done temporarily or permanently. It’s done using local anaesthetic so you shouldn’t experience any discomfort and takes just a few minutes per eye.

You might experience some redness, swelling and blurred vision for a few days after, and you’ll be given some eyedrops to use to help prevent infection. Your vision should get back to normal within 48 hours, but you won’t be able to drive until you meet the minimum visual standard for driving.

Who is suitable for dry eye treatment?

You may be a good candidate for dry eye treatment if you are experiencing any of the symptoms of dry eye. The exact treatment you are recommended will depend on the severity of your symptoms and the cause of your dry eyes.

Since there are so many different dry eye therapies available, there’s almost certainly one to suit everyone.

Who is not suitable for dry eye treatment?

There are some people who may not be suitable for some specific types of dry eye treatment. Some of the reasons why you may not be able to have certain treatments could include:

• you have an active eye infection
• you suffer from a severe autoimmune condition, like Lupus
• you have structural abnormalities of your eyelids
• you have darker skin tones (as IPL treatment can cause burns of scarring).

How should I prepare for dry eye surgery?

As with any surgery, it’s important to follow any preparation guidance provided by your consultant and medical team. Since dry eye surgeries are quick, performed only using local anaesthetic and have little to no downtime, you can expect any preparatory advice to be minimal and related to the specific procedure you’re having. It may include information about:

• when to stop wearing contact lenses
• avoiding wearing make up on the day of your surgery
• stopping certain regular medications (if required)
• arranging for someone to drive you home after your appointment.

It’s always recommended to stop smoking as far in advance of any surgical procedure as possible, even for a minor surgery like those for dry eyes. This is because smoking has been proven to increase the risk of complications and delay recovery.

How long does dry eye surgery take?

Again, this depends on exactly what surgery you’re having, but in most cases dry eye treatments take less than 15 minutes per eye. When you include preparatory time and getting aftercare advice, you can expect to spend no more than 90 minutes at your appointment.

Will I still have dry eyes immediately after surgery?

In most cases, yes. Even if you opt for a treatment that is effective immediately, such as punctal plugs, your eyes may still feel dry and uncomfortable for some days after. You’ll be advised to keep on using your lubricating drops in all cases, with the aim of reducing their use over time as your treatment takes effect and your symptoms reduce.

Can I wear contact lenses after dry eye treatment?

Yes, most people can wear contact lenses following dry eye surgery, but you won’t be able to start using them right away. In fact, it could take several weeks before your consultant recommends that you can go back to wearing contacts, so make sure you’ve got glasses for this period.

There are some brands of contact lenses that are designed specifically for people with dry eyes, so it may be worth speaking to your optician to see if you can make the switch.

When can I return to normal activities after dry eye surgery?

Most people can get back to their usual daily activities within 24 hours of dry eye surgery, although in some cases it may take a few days before your vision is completely back to normal. Always follow the guidance of your Nuffield Health medical team.

What should I avoid after dry eye surgery?

It’ll be crucial that you protect your eyes as much as possible in the days following your surgery, and you may be given shields to wear to help you do this. Avoid:

• rubbing your eyes
• wearing eye makeup
• swimming
• strenuous exercise
• dusty environments
• having wind or air conditioning blowing directly onto your face
• extended screen time without breaks
• going outside without sunglasses
• any other procedures on or near your eyes for at least two weeks.

But again, always follow the guidance of your Nuffield Health medical team.

What are the possible risks and complications of dry eye treatment?

Like any medical treatment, there are some risks and complications associated with dry eye treatments. Again, they are often specific to the exact treatment you’ve had. For example, long-term use of eye drops containing preservatives can cause damage to the surface of your eye while punctal plugs could potentially migrate out of the tear duct or trap bacteria and lead to infection.

Your consultant ophthalmologist will explain all possible risks and complications of your chosen dry eye treatment, so that you know what to expect and are fully informed ahead of your procedure.

What is the success rate of dry eye surgery?

Each of the dry eye surgery options has a high success rate. One study found that 89% of patients who underwent IPL therapy for dry eye saw significant improvement in their symptoms. Meanwhile, another found that punctal plugs had an 86% success rate in treating moderate to severe dry eye syndrome. When it comes to punctal cautery, studies show a 90% to 95% success rate.

What happens if dry eye surgery is unsuccessful?

If dry eye disease is left untreated, or if surgery is unsuccessful, you’re likely to experience worsening symptoms including burning, irritation and blurred vision. Your consultant ophthalmologist may recommend an alternative surgery if your first option isn’t successful.

How much does dry eye treatment cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.