Treating Dry Eye

Get Your Patients Involved

Talk with your patients about their role in taking care of the health of their eyes. Discuss environmental and dietary modifications that can relieve their dry eye, including elimination of systemic medications. Discuss options to treat their dry eye, including natural tear substitutes, and how using preservative-free tears is best for their eye health. If compliance is an issue, tell them how punctum plugs can help.

How to Talk To Your Patients

  • Do you know that it’s important to take care of your eyes every day?
  • What are you doing to make sure your eyes are healthy?
  • Some artificial tears contain certain preservatives that can damage your eyes
  • Using tear substitutes that don’t have preservatives is best for keeping your eyes healthy
  • If it’s hard for you to use artificial tears every day, punctum plugs could help you

Natural Tear Substitutes, or Artificial Tears

Natural tear substitutes, or artificial tears, are a common treatment that supplements moisture that is missing and lubricates the eyes to temporarily relieve dry eye. However, not all artificial tears are the same. They can be in the form of liquid, gels, ointments, or sprays, and can have different active ingredients used to lubricate the eye. Some artificial tears contain certain preservatives, which can damage the corneal epithelium.

A Healthy Choice for Eyes

When tear substitutes that contain certain preservatives are frequently used, certain preservatives can harm the top layer of the cornea. This damage prevents the artificial tears from keeping the tear film in place, and can lead to ocular surface disease. For patients who use certain medication drops or wear contact lenses, it is even more important to use artificial tears that are preservative free.

Common chemical preservatives found in ophthalmic drops include benzalkonium chloride (BAK) and disodium EDTA. BAK is the most commonly used preservative and studies have demonstrated its cytotoxic effects. When frequently dosed, it can accumulate in ocular tissue and cause cell death.

Patients suffering from dry eye may have an especially high risk for BAK-induced adverse events. Because of the lack of natural tears, BAK is not as diluted in dry eye patients and would be expected to cause more damage than in a person with normal tear formation. Using more than 4 to 6 drops a day of artificial tears containing BAK increases the likelihood of BAK-induced adverse events.

Studies have shown that preservative-free eye drops are safe to use in patients, even when frequently used.

Punctum Plugs

Punctum plugs are small medical devices that are inserted into the tear duct of an eye to block tear drainage. This increases the eye’s tear film and surface moisture to relieve dry eyes. Punctum plugs are often no larger than a grain of rice, and are usually considered when artificial tears fail to relieve dry eye. Punctum plugs can be semipermanent (made of a long-lasting material such as silicone) or dissolvable (made of a material such as collagen, which the body eventually absorbs).