This may show my age, but when I think of tears, I immediately think of Barbara Walters interviewing the celebrity du jour and inevitably making that person cry. But lack of tears, or just dry eyes in general, is actually the number one reason for eye doctor visits (maybe doctors should keep videos of Barbara Walters interviews in their offices).
It’s common—about 50 percent of the population will experience dry eyes (also called xerophthalmia) —and often easily treated. But I think that physicians prescribe Restasis, a medicine that increases tear production, way too often (it’s a good drug, but it’s also pricey—maybe because of all the advertising they buy!). You should try a low-cost dietary supplement first; it’s safer, cheaper, and often just as effective. In addition, the active ingredient in Restasis is cyclosporine, which is an immunosuppressant.
They are very safe drugs, but people often get hooked on them, and I get nervous about taking anything that’s an immunosuppressant long term, even if it’s been deemed safe.
What is Dry Eye?
The surface of the eye is protected by tears, and tears themselves consist of three layers: an outer lipid layer (fatty or oily), a middle water layer, and an inner mucous layer—who knew? If your body manufactures insufficient tears or if they’re faulty (maybe they only have one layer instead of three or they produce less of the watery layer), the whole tear mechanism can become dysfunctional and the eye becomes dry and irritated. Symptoms include itchiness, a gritty feeling, stinging or burning, blurry vision, increased mucus, redness, sensitivity to light, trouble wearing contact lenses, and even bouts of excessive tearing. Chronic dry eye can lead to infections and in some cases loss of vision.
But it’s not just tears and their funky structure that are to blame here. To keep your eyes properly lubricated, you need meibum (rhymes with sebum, which is an oily, waxy secretion on your skin), an oily substance that keeps tears from evaporating too quickly. There are about 30 to 40 small meibum glands on the rim of each eyelid, and if those glands become clogged or irritated, it can cause dryness. (Meibomian gland dysfunction is another name for dry eye.)
Turns out, these little glands start going haywire as we age, sometimes due to hormonal fluctuations.
Environment (airplanes, excessive heat or air conditioning, low humidity, smoke, and pollution) is a big trigger, as well as computer use, contact lenses, and aging. I find this interesting because the risk of dry skin increases with aging, too, which suggests a common phenomenon occurring with the glands of the eye and skin. LASIK, a common vision-correction surgery, can also cause dry eye. With the exception of aging and eye surgery, the rest of these triggers generally cause temporary or less severe dry eye.
Home Remedies For Dry Eye
1. Omega-3 fatty acids and omega-6 fatty acids dosage varies by type
Warning: Be on the lookout for expensive dry eye supplements that are really just simple, low-cost omega-3 or omega-6 products!
Omega-3s: You can take flaxseed oil as a softgel, but you would need to down six or seven to get the 3,300 milligrams per day of alpha-linolenic acid, or ALA, that has shown anti-inflammatory benefits for the eyes in studies. It’s much easier to just take 1 or 2 tablespoons daily of flaxseed oil (my favorite is Omega Swirl from Barlean’s).
Alternatively, you could take 800 to 1,500 milligrams (one or two pills) of the active ingredients in marine or fish oil (EPA and DHA omega-3 fatty acids); Omega Swirl also has an incredible-tasting fish oil option. Many studies have found potential benefits at a variety of dosages, and even the American Optometric Association recommends omega-3s for dry eye now.
Omega-6s: We’re often told that omega-6 fatty acids are bad for us because they create inflammation, but this is a gross generalization. They’re not all bad. Some omega-6 compounds have anti-inflammatory effects, which is why they are potentially effective for the treatment of dry eye. Taking 57 to 224 milligrams of linoleic acid (LA) or 30 to 300 milligrams of gamma-linolenic acid (GLA) has been found to reduce symptoms of dry eye in studies. The human study that impressed me the most—and that also relates to my experience with patients who have dry eye from diverse causes, including contact lenses— used 300 milligrams of GLA from evening primrose oil (you can also use borage or black currant oil) or just two or three softgels per day (my favorite here is Barlean’s evening primrose oil because it is so concentrated and easy to take).
I recommend combining omega-3 and omega-6 supplements only if your dry eye condition does not improve in 3 months of taking either type on its own. The benefit in combining them is that they fight inflammation in different ways, so it’s possible for someone who’s not responding to omega-3 supplements to get a better response from omega-6s and vice versa. Both reduce inflammation and pain, but in some individuals one works better than the other or the combination works better than either one alone. By combining them, you’re essentially covering all your bases. Regardless, many sources of omega-3s (like flaxseed) also contain some omega-6s and vice versa, but larger doses are often needed to really see a benefit. If you want to combine them, try taking either 750 to 1,000 milligrams of fish oil or 1,000 milligrams of flaxseed oil plus up to 100 milligrams of GLA or 150 milligrams of LA.
2. Vitamin A eye drops apply 4 drops a day of a 0.05 percent retinyl palmitate formula
This antioxidant and anti-inflammatory vitamin has specific benefits for the eye. Vitamin A deficiency is a common cause of dry eye in Third World countries, but not as much in the Western world. Still, make sure you’re getting it in your multivitamin (most have at least half if not the full 5,000 IU recommended daily intake). Or, if you like to eat fruits and vegetables (especially those deep green and orange veggies), chances are you’re getting plenty. There was a large Korean study that used vitamin A drops (the product studied is sold under the brand name VIVA) four times daily and found that they improved blurred vision and tear film about as well as the cyclosporine. Both the vitamin A drops and cyclosporine significantly improved the symptoms of dry eye within 2 to 3 months.
3. Sea buckthorn oil (Hippophae rhamnoides) 2,000 milligrams a day in divided doses
This product contains omega-3s (ALA) and omega-6s (LA) as well as several anti-oxidants that are important for proper eye function, such as vitamin E and carotenoids. The dosage used in studies is 2,000 milligrams a day (two capsules twice daily with meals). Over 3 months, subjects saw improved tear film and reduced redness and burning. (If you’re trolling for information on sea buckthorn oil online, you may read about something called an omega-7 fatty acid, but nobody really knows if these omega-7s do anything, so don’t buy it because the extra fatty acid impresses you.)
What Supplements Are Useless For Treating Dry Eye?
There aren’t many supplements out there being billed as dry eye treatments, besides the ones I’ve just mentioned, but there are a few that can cause dry eye, including niacin, echinacea, and kava. Some herbal products have also been associated with dry mouth, which could lead to dry eye (Rhodiola rosea and St. John’s wort). This is because the toxicity that affects salivary glands can also impact the glands or cells that produce tears.
What Lifestyle Changes Can Help With Dry Eye?
Reel in your dinner
Studies have shown that diets higher in omega-3 fatty acids from fish and plants may reduce the risk of dry eye (in other words, we’re talking about prevention here). Diets high in omega-6s (plant oils, nuts, and seeds) don’t seem to have the same benefit, but there have only been a few studies looking at this so far. Interestingly, consuming certain fish, such as tuna, several times a week was associated with one of the lowest risks of dry eye. You are not going to like this, but I have had several people recommend eating a few pieces of anchovy in oil daily for 2 weeks. I told patients about it and it worked! Of course, if you don’t like anchovies then it works too because you’ll be crying about having to eat them.
Exercise your eyes
Blinking produces meibum (the ever so tiny eye muscles squeeze the glands around the eyes). If you’re working at a computer for a long time, take several full blinks, where you forcefully squeeze your eyelids shut then open them, every 15 to 20 minutes. Moving your eyeballs from side to side and up and down (think of it as eye yoga) helps activate these glands, too. Finally, massaging your upper and lower eyelids with a cotton swab (small circles around each eyelid) also helps the glands produce more fluid.
Sunglasses protect your peepers from the sun, naturally, but also wind that can cause tears to evaporate quickly, leading to inflammation. Eyeglasses also discourage the evaporation of tears. (It’s always good to give your eyes a break from contacts, which can aggravate dry eyes, every few days.)
Use a humidifier
Dry air can make your eyes feel worse, so use a humidifier in rooms where you spend the most time.
Baby your peepers
Use a hot compress to loosen and release hardened oil in clogged meibomian glands. Twice a day, wash your face and then soak a cloth in warm water and use it as a compress over your closed eyelids for 30 seconds. Next, clean the lower lids with a dry, tightly wrapped cotton swab. This will help remove lid debris that could be disrupting the tear film. It also stimulates your own reflex tears.
Check your meds
There are a ton of prescription medications that can potentially cause dry eye, so talk to your doctor if you’re experiencing irritation. The list includes beta-blockers, antidepressants, anticonvulsants, anti- Parkinsonians, anti-histamines, decongestants, antipsychotics, pain medications, antithyroid drugs, cancer drugs, antiemetics, acid reflux medications, blood pressure meds, uri-nary incontinence drugs, antivirals, anti-malarials, respiratory medications—you get the idea.