Artifical lubricants/tears are the mainstay of therapy for dry eyes. In the more severe cases of dry eye, sustained release tear inserts can be used. Artificial collagen inserts and/or permanent punctal plugs can also be inserted to help preserve the tears that are produced. Steroids and/or cyclosporine may be used to treat patients with dry eyes caused by autoimmune diseases such as keratoconjunctivitis sica, rheumatoid arthritis, etc.

Diagnosis and Treatment of Tear Deficiencies
Source: Duane's Clinical Ophthalmology
Volume 4 Chapter 14 Diagnosis and Treatment of Tear Deficiencies - Copyright 1991

Tear Replacement with Artificial Tears/Lubricants

There are a wide variety of artificial tears available and it may be necessary for a patient to try several different formulations in order to find one that provides the greatest amount of comfort and relief.

Artificial tears can be divided into three groups:

  • With preservatives;

  • Preservative-free; or

  • Preservative free on contact

Preservatives help to retard bacterial growth. If the bottle of artificial tears comes in contact with the surface of eye while instilling the drops, bacteria from the eye can contaminate the remainder of the drops in the bottle. Preservatives prevent this contamination from taking place. Preservatives found in artificial tears can cause itching due to an allergic reaction, or can become toxic to the ocular surface, leading to irritation and inflammation. Some patients who require artificial tears more than four times a day may be required to use preservative-free artificial tear formulations.

The various artificial lubricants available for dry eye treatment also have a range of viscosity. In patients with more severe dry eye symptoms an artificial tear ointment or gel at bedtime helps to provide lubrication throughout the night. These ointments tend to blur vision and therefore have limited usefulness throughout the day.


Corticosteroids are used routinely after LASIK to reduce post operative inflammation and to relieve dry eye symptoms which are similar to those experienced by people with auto immune disease.

Tear Preservation with Temporary Collagen Inserts or
Permanent Punctal Plugs

Patients that do not find sufficient relief from artificial tears and have displayed evidence of decreased tear production, may be treated by the insetion of punctal inserts or plugs.

Both superior and inferior puncta are important in tear drainage. Rods or plugs can be inserted to block the puncta thus stopping the tears that are naturally produced from draining away.

Collagen Punctal InsertDissolvable punctal collagen inserts can be used as a cost-effective way to evaluate the benefits of permanent punctal occlusion. The collagen inserts are effective for 3-5 days and dissolve in approximately 7-10 days.

Permanent Punctal PlugPermanent Punctal plugs do not dissolve. They can be surgically removed if the need arises.



Tear Stimulants

The use of substances to increase lacrimal gland secretion is another option in the treatment of moderate to severe dry eye. They have been used both topically and systemically. Two such products are Bromhexine chloride and Eloisin. In order for tear stimulants to work, there must be adequate functional lacrimal tissue present.

Tear Replacement with Sustained Release Tear Inserts

Sustained release tear inserts reduce the necessity for frequent instillation of artificial tears. These inserts can be very useful in treating patients with moderate to severe dry eye syndrome, however, they tend to blur vision several hours after insertion. They are difficult for some patients to handle and are significantly more expensive than artificial tears. Tear inserts would be contraindicated in the first few weeks post LASIK because of the potential to cause wrinkles in the flap.


Hormone deficiencies (i.e. estrogen) have a strong link to dry eyes. Estrogen may be beneficial to menopausal and postmenopausal patients with dry eye syndrome. The decision to use systemic estrogen should be made after a patient has been diagnosed as having an estrogen deficiency with due consideration for all other potential side effects.


In cases where a patient displays dry eye symptoms prior to LASIK , some patients are now being treated with cyclosporine 0.05% pre and post-operatively. Preoperative treatment requires that the patient use the cyclosporine twice a day for a month. Then they go back on the cyclosporine within 24 hours of surgery.

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(BSc, MD, FRCS(C), Diplomate of the
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