Evaporative dry eyes happens when the tear film, the thin coating of fluid that covers the eye, is unstable, causing tears to evaporate quickly. While there is no cure for evaporative dry eye, there are many possible treatments that can help relieve indications and improve overall eye health.
Over-the-counter products
Over-the-counter products offer convenient and affordable treatment options for mild to moderate symptoms of evaporative dry eye. These include artificial tears, sprays, and ointments, as well as various eyelid cleansers and rinses.
1. Artificial Tears
Artificial tears are lubricating eye drops that mimic the composition of natural tears and provide instant relief from dryness, irritation, and the feeling of something being “stuck” in the eyes. They work by adding a thin layer of fluid to the watery or fatty acid (lipid) portion of the tear film that covers the surface of the eye.
Some artificial tear formulas contain preservatives to prevent bacteria from growing in the bottle. Preservative-free, single-use drops are recommended for people with more severe dry eye syndrome who use artificial tears more than four times a day.
In 2023, the U.S. Food and Drug Administration warned consumers about possible contamination in more than two dozen artificial tear products, though the vast majority are still considered safe. Ask your eye doctor to recommend over-the-counter artificial tears and stick with traditional brands.
2. Liposomal Eye Sprays
For people who have difficulty using traditional eye drops, over-the-counter artificial tear sprays, also called liposomal eye sprays, may be an alternative. They are functional by spraying a thin layer of lubricating solution directly onto the closed eyelid. The solution migrates to the edge of the eyelid and then spreads across the outer surface of the eye when you blink.
Liposomal eye sprays may be easier to use than eye drops for people with limited mobility or manual dexterity.
3. Eye gels and ointments
Unlike eye drops and sprays, eye ointments have a thicker, gel-like formula that provides long-lasting lubrication. They are recommended for use at night, especially if your eyelids do not close completely or if you are prone to dryness or nighttime discomfort while sleeping.
4. Eyelid cleaners
Proper eyelid hygiene is essential to maintain a stable, healthy tear film and prevent meibomian gland dysfunction, a common underlying cause of evaporative dry eye.
Over-the-counter eyelid hygiene products such as wipes, foams, cleansers and scrubs help remove debris, bacteria and excess oil from the eyelids and lashes.
This helps keep the eyelid margins clear and free of obstructions, allowing the meibomian glands to efficiently secrete the oils needed to form a strong tear film.
Proper eyelid hygiene is essential if you wear eye makeup.
5. Supplements
Omega-3 fatty acid additions, such as fish oil, have long been suggested as a possible remedy for dry eyes, but research does not support this.
Prescription drugs
More severe cases of evaporative dry eye may require prescription medications.
- Corticosteroid eye drops loteprednol etabonate (Eysuvis) can temporarily (up to two weeks) suppress inflammation in the meibomian gland, allowing it to produce better tears.
- The immunosuppressants cyclosporine ophthalmic (Restasis and Cequa) and lifitegrast ophthalmic (Xiidra) combat inflammation long-term without the side effects associated with steroids.
- Varenicline (Tyrvaya), a nasal spray, stimulates a specific nerve to increase tear production.[9]
- Perfluorohexyl octane eye drops (Miebo) help stabilize the tear film by forming an anti-evaporation layer.[10]
- Autologous serum tears and allogeneic serum tears, artificial tears created from your blood serum, may be an option if you have severe dry eyes.[11]
- Several office devices, each with its pros and cons, apply heat, pressure, or both to the meibomian glands to improve their function, including the LipiFlow Thermal Pulsation System, TearCare, Systane iLux, Mibo ThermoFlo, and Thermal 1-Touch. 12]
- Tear duct plugs, also known as punctae, are small devices inserted into the puncta (tear duct openings) of the eyelids to block the flow of tears, helping to preserve natural tears and maintain proper moisture levels.
- Scleral lenses are therapeutic contact lenses that can help protect and lubricate your eyes if you regularly wear contact lenses (contact lens wear can contribute to dry eyes).
Home Remedies
In addition to traditional actions, several home remedies can complement dry eye treatment (and are often the first line of treatment).
- Apply warm compresses to closed eyelids to help clear blocked meibomian glands.
- Use eyelid scrubs to remove dirt and excess oil.
- Perform regular blinking exercises to stimulate tear production, issue tears evenly across the surface of the eye, and prevent tear evaporation.
- Use humidifiers to increase ambient humidity levels and relieve dryness.
- Take breaks during prolonged activities that require a lot of visual concentration, such as reading and using electronic devices.
- Position your computer below eye level so you don’t have to open your eyes as comprehensively to see the entire screen.
- Drink plenty of water to prevent dehydration.
- Wear protection glasses to protect your eyes from wind and dry air. Avoid cigarette smoke
- Identify and reduce the use of systemic medications that contribute to dry eyes, such as anticholinergics, oral antidepressants or antiallergic, and decongestants designed to dry out mucous membranes (but be sure to check with your doctor before stopping any treatment medications)
Prevention
Evaporative dry eye syndrome is often caused by dysfunction of the meibomian glands, so it is not always possible to prevent the development of this condition. But, some preventative measures can play a role in reducing the risk of developing evaporative dry eye, as well as treating evaporative dry eye and reducing the severity of symptoms.
- Get annual checkups with your primary care physician
- Drink enough fluids
- Maintain adequate levels of vitamins, especially vitamin A
- Take regular pauses to allow your eyes to rest and blink attentively.
- Protect your eyes from environmental factors.
- Use humidifiers
- Maintain proper eyelid hygiene.
- Manage other medical conditions that may contribute to dry eyes.