Dry eye

Tests and procedures that may be used to determine the cause of your dry eyes include:

A comprehensive eye exam. An eye exam that includes a complete history of your overall health and your eye health can help your doctor diagnose the cause of your dry eyes.

A test to measure the volume of your tears. Your doctor may measure your tear production using the Schirmer test. In this test, blotting strips of paper are placed under your lower eyelids. After five minutes your doctor measures the amount of strip soaked by your tears.

Another option for measuring tear volume is the phenol red thread test. In this test, a thread filled with pH-sensitive dye (tears change the dye color) is placed over the lower eyelid, wetted with tears for 15 seconds and then measured for tear volume.

A test to determine the quality of your tears. Other tests use special dyes in eyedrops to determine the surface condition of your eyes. Your doctor looks for staining patterns on the corneas and measures how long it takes before your tears evaporate.

A tear osmolarity test. This type of test measures the composition of particles and water in your tears. With dry eye disease, there will be less water in your eyes.

Tear samples to look for markers of dry eye disease, including elevated matrix metalloproteinase-9 or decreased lactoferrin.

For most people with occasional or mild dry eye symptoms, it's enough to regularly use over-the-counter eyedrops (artificial tears). If your symptoms are persistent and more serious, you have other options. What you do depends on what's causing your dry eyes.

Some treatments focus on reversing or managing a condition or factor that's causing your dry eyes. Other treatments can improve your tear quality or stop your tears from quickly draining away from your eyes.

Treating the underlying cause of dry eyes

In some cases, treating an underlying health issue can help clear up the signs and symptoms of dry eyes. For instance, if a medication is causing your dry eyes, your doctor may recommend a different medication that doesn't cause that side effect.

If you have an eyelid condition, such as your lids turned outwards (ectropion), your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids (oculoplastic surgeon).

Medications

Prescription medications used to treat dry eyes include:

Drugs to reduce eyelid inflammation. Inflammation along the edge of your eyelids can keep oil glands from secreting oil into your tears. Your doctor may recommend antibiotics to reduce inflammation. Antibiotics for dry eyes are usually taken by mouth, though some are used as eyedrops or ointments.

Eyedrops to control cornea inflammation. Inflammation on the surface of your eyes (cornea) may be controlled with prescription eyedrops that contain the immune-suppressing medication cyclosporine (Restasis) or corticosteroids. Corticosteroids are not ideal for long-term use due to possible side effects.

Eye inserts that work like artificial tears. If you have moderate to severe dry eye symptoms and artificial tears don't help, another option may be a tiny eye insert that looks like a clear grain of rice. Once a day, you place the hydroxypropyl cellulose (Lacrisert) insert between your lower eyelid and your eyeball. The insert dissolves slowly, releasing a substance that's used in eyedrops to lubricate your eye.

Tear-stimulating drugs. Drugs called cholinergics (pilocarpine, cevimeline) help increase tear production. These drugs are available as pills, gel or eyedrops. Possible side effects include sweating.

Eyedrops made from your own blood. These are called autologous blood serum drops. They may be an option if you have severe dry eye symptoms that don't respond to any other treatment. To make these eyedrops, a sample of your blood is processed to remove the red blood cells and then mixed with a salt solution.