Medicines for Chronic Dry Eye

Chronic dry eye, often simply called “dry eye,” is a disease of the surface of the eye that can happen when your eye does not make enough tears or there is an issue with the tears that are made. Chronic dry eye may also be called dry eye syndrome (DES), dry eye disease (DED), or keratoconjunctivitis sicca.¹

Treatment is not always easy, as dry eye disease can have multiple causes and can be hard to manage. There are several types of medicines used to treat dry eye disease.

Ocular surface lubricants

Ocular surface lubricants are also known as artificial tears or lacrimomimetics. These eye drops are used to supplement 1 or more layers of the tear film. Most of these types of drugs are available without a prescription as over-the-counter (OTC) products.²

It may take several brands or types to determine which one works best. These are available as solutions, gels, or ointments.

Some OTC eye drops have preservatives added to them to prevent the growth of bacteria. Benzalkonium chloride (BAK) is the most commonly used preservative, though it has been shown to cause further inflammation and irritation to the surface of the eye. It is best to avoid eye drops with added preservatives.²

It may also be best to avoid OTC eye drops with additives to decrease redness of the eye. These drops work by constricting the blood vessels in the eye. However, they can lead to rebound redness after the eye drop wears off and overall worsening redness over time.²

Lacrisert®

Lacrisert® (hydroxypropyl cellulose ophthalmic insert) is a slow-release artificial tear that is placed inside the eyelid. This acts to lubricate or moisten the surface of the eye. This treatment is only available by prescription.³

Immune-modulating (anti-inflammatory) eye drops

Chronic dry eye can cause a vicious cycle of inflammation. If the surface of the eye is inflamed, damage can happen to the glands that make tears, the tissues on the surface of the eye, and even the eyelids. Immune-modulating eye drops work to stop this inflammation.⁴

Decreasing inflammation can lead to better functioning of the glands that make tears and help overall healing of the eye surface. Anti-inflammatory eye drops can be beneficial for dry eye associated with autoimmune diseases, such as Sjogren’s syndrome.⁴

Cyclosporine

Cyclosporine ophthalmic emulsion (Restasis®) is an immune-modulating eye drop. Restasis helps decrease inflammation of the ocular surface and tear glands, restoring the eyes’ natural ability to produce tears. This drug blocks a specific protein that is linked to inflammation.⁵

Cequa™ is another cyclosporine ophthalmic solution that helps to restore tear production and decrease inflammation.⁶

Lifitegrast

Lifitegrast ophthalmic (Xiidra®) is also an immune-modulating eye drop that targets a specific inflammation source that occurs in dry eye disease.⁷

Regenerative eye drops

Some of the latest research in the treatment of dry eye disease has been finding treatments that help regrow damaged tissue. This type of treatment aims to slow the progression of the disease, regenerate tissue, decrease scarring, and maintain the surface of the eye.⁸

Autologous serum tears and plasma rich in growth factors (PRGF)

Autologous serum tears (AST) are made from the blood of the person who will use them. The person has blood drawn, then the blood is treated and separated, and part of the blood called serum is mixed in a solution. This solution creates the eye drops that are used to treat dry eye disease.^9,10

Plasma rich in growth factors (PRGF) is also made from blood, similar to serum tears. However, it also contains molecules that aid in blood clotting and other growth factors. Overall, research shows that nutrients collected from blood are helpful in healing damaged eye tissue.^9,10

Short-term drugs

Some people with dry eye disease only experience periodic flares of the disease. Others may have had mild symptoms of chronic dry eye, and an increase in dry eye symptoms led them to see their doctor. Flares of dry eye are often treated with artificial tears and occasionally other short-term drugs. These may include:¹¹

• Cholinergic (tear-promoting) agents
• Antibiotic eye drops
• Low-dose oral steroids or steroid eye drops

Cholinergic agents

Drugs such as cevimeline and pilocarpine are cholinergic agents. These are usually used in moderate to severe dry eye. These drugs work on the nerves in the body and result in increased saliva and tear production.¹²

Topical antibiotics

Antibiotic eye drops may be needed if dry eye disease leads to infection of the surface of the eye. These drops may also be used to treat blepharitis, which is inflammation of the eyelid. Blepharitis may lead to symptoms of dry eye disease, especially if meibomian glands of the eyelids are affected, leading to reduced production of the oily layer of the tear film.¹³