What is dry eye?
Dry eye is a common condition where the eyes do not make enough tears, or the
tears evaporate too quickly. This leads to symptoms like dryness, burning, stinging,
or a gritty feeling in the eyes. Sometimes, it can also cause blurry or fluctuating
vision. Dry eye can affect daily activities such as reading, driving, or using a
computer.
What causes dry eye?
Dry eye can have many causes, including:
• Aging (more common as people get older)
• Hormonal changes (such as menopause)
• Long periods of screen time or reading
• Contact lens use
• Certain medications (like antihistamines, antidepressants, or blood pressure
medicines)
• Medical conditions (such as autoimmune diseases)
• Environmental factors (wind, dry air, air conditioning)
• Eye surgery
What are the symptoms of dry eye?
Common symptoms include:
• Dryness, burning, or stinging
• Gritty or sandy feeling
• Redness
• Blurry or fluctuating vision
• Sensitivity to light
• Watery eyes (the eyes may make more tears to try to fix the dryness)
How is dry eye diagnosed?
Doctors diagnose dry eye by asking about symptoms and performing an eye exam.
They may use special tests to check tear quality and quantity, such as measuring
how long tears stay on the eye or using dyes to look for damage on the eye’s
surface.
How is dry eye treated?
Treatment depends on the cause and severity. Common treatments include:
• Artificial tears or lubricating eye drops (used as needed, sometimes several times
a day)
• Ointments or gels (often used at night)
• Warm compresses and eyelid hygiene (especially if there is eyelid gland
involvement)
• Avoiding things that make symptoms worse (like wind, smoke, or dry air)
• Using a humidifier at home
• Taking breaks during long periods of screen time
• Prescription eye drops (for more severe cases, such as anti-inflammatory drops)
• Procedures like tiny plugs to block tear drainage (for some people)
Are there lifestyle changes that can help?
Yes. Helpful changes include:
• Drinking enough water
• Using a humidifier
• Wearing wraparound glasses outdoors
• Taking regular breaks from screens
• Getting enough sleep
• Eating a healthy diet, possibly including foods rich in omega-3 fatty acids (like fish
or flaxseed), though the benefit of supplements is still being studied
Will dry eye go away?
Dry eye is often a long-term (chronic) condition. Symptoms can usually be
managed with ongoing treatment and lifestyle changes, but it may not go away
completely. Some people have periods when symptoms are better or worse.
When should someone see an eye doctor?
See an eye doctor if:
• Symptoms are not improving with over-the-counter treatments
• There is significant pain, redness, or vision changes
• There is a history of autoimmune disease or other medical conditions that could
affect the eyes
Can dry eye affect vision?
Yes. Dry eye can cause blurry or fluctuating vision, especially when reading or using
a computer. Severe dry eye can sometimes lead to damage on the surface of the
eye, which can affect vision if not treated.
Is it safe to use artificial tears every day?
Yes, most over-the-counter artificial tears are safe for daily use. Preservative-free
drops are recommended if drops are needed more than four times a day.
What else should be known about dry eye?
Dry eye is common and can be managed. It is important to follow the treatment
plan and talk to an eye care professional if symptoms change or worsen. Managing
dry eye often requires ongoing care and adjustments to treatment.
PUNCTAL PLUGS (LACRIFILL) FAQs
What are punctal plugs and how do they work?
Punctal plugs are tiny medical devices placed in the tear drainage ducts (puncta) of
the eyelids. Their purpose is to block the drainage of tears, helping to keep more
moisture on the surface of the eye. This can relieve symptoms of dry eye by
preserving both natural and artificial tears for longer periods.
What is Lacrifill?
Lacrifill is a newer type of punctal plug made from crosslinked hyaluronate gel.
Unlike traditional solid plugs, Lacrifill is a soft gel that fills the canaliculus (tear
duct) and gradually dissolves over time. It is designed to be comfortable, effective,
and reversible.
Who might benefit from punctal plugs?
Punctal plugs are usually recommended for people with moderate to severe dry eye
disease who have not found enough relief with artificial tears or other treatments.
They are especially helpful for those with aqueous-deficient dry eye, where the
eyes do not produce enough tears.
How are punctal plugs placed?
The procedure is quick and done in the office. After numbing drops are used, the
plug or gel is gently inserted into the tear duct. Most patients feel little or no
discomfort during the procedure.
How long do punctal plugs last?
There are different types of plugs:
• Temporary (dissolvable) plugs: Made from materials that dissolve over days to
months.
• Semi-permanent plugs: Made from silicone or other materials and can last for
months or years, but can be removed if needed.
• Gel fillers like Lacrifill: Typically last several months before dissolving naturally.
How effective are punctal plugs?
Studies show that punctal plugs, including Lacrifill, can improve dry eye symptoms,
reduce the need for artificial tears, and increase tear film stability for many
patients. In a recent clinical trial, Lacrifill was found to be as effective as traditional
hydrogel plugs in improving both symptoms and clinical signs of dry eye for at least
3 to 6 months.
Are there risks or side effects?
Most people tolerate punctal plugs well. Possible side effects include:
• Watery eyes (epiphora)
• Mild irritation or a foreign body sensation
• Plug loss or displacement (more common with solid plugs)
• Rarely, infection or inflammation of the tear duct (canaliculitis or dacryocystitis)
Serious complications are uncommon. Gel fillers like Lacrifill may have a lower risk
of some complications compared to solid plugs, but all types can cause side effects.
Can punctal plugs be removed?
Yes. Most plugs can be removed in the office if needed. Gel fillers like Lacrifill
dissolve on their own, but if removal is necessary, it can be done by an eye care
professional.
Will I still need to use artificial tears?
Many patients still use artificial tears, but often less frequently after plug
placement. Punctal plugs help keep tears on the eye longer, but may not eliminate
the need for other dry eye treatments.
Are punctal plugs safe for everyone?
Punctal plugs are not recommended for people with active eye infections, certain
eyelid or tear duct problems, or uncontrolled inflammation of the eye surface. An
eye doctor will determine if they are appropriate based on individual needs.
What should I expect after the procedure?
Most people notice improvement in dry eye symptoms within days to weeks. Some
may experience mild discomfort or watery eyes at first, which usually resolves. If
there is persistent discomfort, increased tearing, or signs of infection (redness,
pain, discharge), contact an eye care provider promptly. [2-3][7-8]
How do I know if punctal plugs are right for me?
Punctal plugs are one of several options for managing dry eye. They are usually
considered after other treatments have not provided enough relief. Discuss with an
eye care professional to see if this option fits your needs and medical history.
DED PRESCRIPTION MEDICATION FAQs
What are prescription medications for dry eye disease?
Prescription medications for dry eye disease are eye drops or solutions that help
treat the underlying causes of dry eye, such as inflammation or problems with tear
production or evaporation. These are used when over-the-counter artificial tears
and other basic treatments are not enough to control symptoms.
Which prescription medications are approved for dry eye disease?
The main prescription medications approved in the United States for dry eye
disease include:
• Cyclosporine eye drops (brand names include Restasis, Cequa): These are
immunomodulatory medications that reduce inflammation and help increase
natural tear production. They are usually used as one drop in each eye twice a day.
• Lifitegrast eye drops (brand name Xiidra): This medication blocks a specific part
of the immune system involved in dry eye inflammation. It is also used as one drop
in each eye twice a day.
• Perfluorohexyloctane eye drops (brand name MIEBO): This is a newer, water-free
prescription drop that helps prevent tear evaporation by forming a protective layer
over the eye. It is especially helpful for people with dry eye related to meibomian
gland dysfunction (a problem with the oil glands in the eyelids). The usual dose is
one drop in each eye four times a day.
• Topical corticosteroids (such as loteprednol, fluorometholone, or
dexamethasone): These are anti-inflammatory steroid drops sometimes used for
short periods to quickly reduce inflammation. They are not for long-term use due
to possible side effects.
How do these medications work?
• Cyclosporine and lifitegrast both reduce inflammation on the surface of the eye,
which is a key cause of dry eye symptoms. By calming inflammation, they help the
eyes make more of their own tears and improve comfort.
• Perfluorohexyloctane works differently by creating a barrier that slows down the
evaporation of tears, helping keep the eyes moist.
• Corticosteroids quickly reduce inflammation but are only used for short periods
because of the risk of side effects.
How long does it take for prescription drops to work?
• Cyclosporine and lifitegrast may take several weeks to a few months to show
their full effect. Some people notice improvement in symptoms as early as 2 weeks
with lifitegrast, but it may take up to 3 months for maximum benefit with either
medication.
• Perfluorohexyloctane may provide relief of symptoms within 2 weeks, with
continued improvement over time.
• Corticosteroids can provide rapid relief, often within days, but are not meant for
long-term use.
What are the possible side effects?
• Cyclosporine: The most common side effects are burning or stinging when the
drops are put in, eye redness, and watery eyes. These usually get better with
continued use.
• Lifitegrast: The most common side effects are a temporary burning or irritation,
an unusual taste in the mouth, and blurry vision right after use.
• Perfluorohexyloctane: Most people tolerate it well, but some may experience
mild eye irritation or blurred vision after use.
• Corticosteroids: These can increase the risk of eye infections, raise eye pressure
(which can lead to glaucoma), and cause cataracts if used for a long time. They are
only used for short periods under close supervision.
Will I still need to use artificial tears?
Yes, most people continue to use artificial tears along with prescription
medications. Artificial tears help provide immediate relief, while prescription drops
work on the underlying causes of dry eye.
Are there other prescription options?
Other treatments, such as autologous serum eye drops (made from a person's own
blood), are sometimes used for severe cases. Oral medications and other therapies
may be considered in special situations, but these are less common.
What should I do if I miss a dose?
If a dose is missed, use the medication as soon as remembered. If it is almost time
for the next dose, skip the missed dose and return to the regular schedule. Do not
use extra drops to make up for a missed dose.
When should I contact my eye doctor?
Contact an eye doctor if there is severe pain, vision changes, signs of infection
(such as pus or swelling), or if side effects are not improving. Regular follow-up is
important to monitor for side effects and to check if the treatment is working.
How do I know which medication is right for me?
The choice of medication depends on the type and severity of dry eye, other health
conditions, and how well previous treatments have worked. An eye care
professional will help decide which option is best.

Dry eye disease (DED), also known as dry eye syndrome (DES), keratoconjunctivitis sicca (KCS), is a
multifactorial disease of the ocular surface due to a loss of homeostasis of the tear film. It often
results in ocular symptoms and visual disturbance due to underlying tear film instability, ocular
surface inflammation and damage, and neurosensory abnormalities.
While diagnosis of DED does not require for any specific symptom to be present, the following are
the most common complaints associated with dry eye disease:
• Foreign body, burning, itching, gritty or sandy sensation
• Hyperemia
• Mucoid discharge
• Ocular irritation
• Excessive tearing (secondary to reflex secretion)
• Photophobia
• Blurry vision that may improve with blinking
Studies that may be used for diagnosis include the following:
• Vital staining of corneal and conjunctival epithelium with fluorescein, lissamine green, or
rose bengal
• Measurement of tear film osmolarity
• Detection of ocular surface matrix metalloproteinase 9 (MMP-9)
• Measurement of tear breakup time (TBUT)
Early detection and treatment of dry eye disease, or keratoconjunctivitis sicca (KCS), may help
prevent corneal ulcers and scarring. Lubricating supplements are the medications most commonly
used to treat dry eye disease. Agents that have been used to treat dry eye disease include the
following:
• Artificial tear substitutes
• Gels, emulsions, and ointments
• Topical anti-inflammatory agents: Topical cyclosporine and topical corticosteroids
(fluorometholone, loteprednol)
Although supplemental lubrication is the mainstay of treatment for mild and moderate aqueous
deficient dry eye disease, any concomitant lid disease also must be treated.
Several in-office procedures are available for the treatment of dry eye disease, including the
following:
• Meibomian gland liquefaction and expression (MiBo, TearCare System)
• Punctal plugs, to achieve either partial or complete punctal occlusion with or without
cautery,
• Amniotic membrane transplantation or amniotic membrane contact lens therapy (eg,
Prokera, AmbioDisk)
Environment-related issues that may exacerbate dry eye disease should be discussed; alternatives
may be needed.