Medicines and Products for Dry Eye

Dry eye treatment starts over the counter and, when needed, moves to prescription - knowing the difference keeps you safe and saves money.

Artificial tears (lubricating eye drops) - the foundation. For most people these are the main treatment. Practical guidance:

• For occasional use, almost any standard lubricating drop works.
• If you need drops more than 4 times a day, choose preservative-free - the preservative (usually BAK) in regular bottles itself irritates the eye surface with frequent use.
• Thicker gels and ointments last longer but blur vision - ideal at bedtime.
• Different drops suit different eyes; if one stings or disappoints, trying another formulation is normal, not failure.

Prescription treatments for moderate-to-severe or inflammatory dry eye:

• Anti-inflammatory drops (cyclosporine, lifitegrast) calm the gland-damaging inflammation cycle; they take 4-8 weeks to show full effect, so patience is built into the prescription.
• Short courses of soft steroid drops, strictly under an eye doctor's supervision, for flares.
• Antibiotic drops or ointments, or oral doxycycline, when lid-margin disease and gland dysfunction are prominent.
• Punctal plugs - tiny stoppers placed in the tear drains in a two-minute clinic procedure - keep your own tears on the eye longer.
• When dry eye is part of a larger condition (Sjogren's, thyroid eye disease), treating that condition is the real treatment.

The warning that belongs in bold: do not use steroid eye drops from the chemist without a prescription. Combination "redness relief" drops containing steroids are sold casually, feel miraculous for a week, and with unsupervised use can cause glaucoma, cataract and sight-threatening infections. Similarly, avoid drops whose main job is a decongestant "whitening" effect - they mask redness while the dryness marches on.

Start with preservative-free tears and lid care; let an ophthalmologist own anything stronger.