I have dry eye. Now what?

I have dry eye. Now what?

This page is meant for you if:

You have recently been diagnosed with dry eye, and have lots of questions about what it means and what your next steps should be.

You have had dry eye for quite awhile, but it's recently gotten worse and you're looking for new answers or realizing you need to dig deeper this time around.

Dry eye is a surprisingly complex area of medicine, with surprisingly few real experts - considering how common the condition is. You may find you are not getting the information, guidance and treatment you need until and unless you start educating yourself and advocating for yourself. There are so many excellent eye doctors who are well qualified for general eye care, but who just do not have enough specialist training to give a really detailed diagnosis or personalize your treatment plan in the way that serves you best.

If you are motivated to get your dry eye under better control, it's well worth learning as much as you can so that you can feel like you have more control over the outcomes. That's what we're here to help you with. Below are some of the most common things people need help with, and there's lots more elsewhere on the site. Take time to read Dry Eye 101 at some point too!

IT STARTS WITH A DETAILED DIAGNOSIS.

Being told you have "dry eye" is not enough. Period. Ever. "Dry eye" is a catchall term for a lot of things. Do you have evaporative dry eye? aqueous deficient dry eye? both? if so, in what degree? lagophthalmos (incomplete eyelid closure)? blepharitis? meibomian gland dysfunction? any other corneal conditions coming into play? ocular allergy? rosacea? blepharospasm? blocked tear duct? erosions? These details matter.

Go back and find out more. Quite possibly more information was put in your chart, just not communicated to you. Or, maybe "dry eye" really was the beginning and the end of the diagnosis, in which case you either need to persuade them to dig deeper or you need to ask for a referral to a specialist - or find one yourself.

Don't succumb to one-size-fits-all treatment based on an over-generalized diagnosis. Do read up on dry eye (try Dry Eye 101).

PREPARING FOR DOCTOR VISITS

WHO TO SEE

Dry eye may be common, but it is not commonly well understood. Eye doctors just really aren't all equally well equipped to give a detailed diagnosis or to advise you on the full range of treatment strategies. Many people visit several eye doctors without seeming to find relief or answers and just get more frustrated.

The doctor that will be the most help to you is one who has lots of dry eye specific training AND who takes a personal interest in dry eye. To a certain extent you can do your homework on the doctor before you go, but you're also looking for some human qualities that you can only find out in practice.

Your "primary" dry eye care provider could end up being either an optometrist or an ophthalmologist. Don't make the mistake of assuming ophthalmologists are better merely because they're MDs. There are pitfalls with ophthalmologists too; general ophthalmologists may not have the specialty training or interest you need, and corneal specialist ophthalmologists are often more interested in cataract and laser surgeries than corneal disease as a professional focus. Read resumes carefully, and use social media to get leads on the good dry eye doctors in your area.

WHEN TO GO

Consider trying to get the first appointment of the day if you can, especially if your eyes are very dry eye at night. There may be more to see in the morning. Corneas heal fast, and the signs of what happens to them overnight (such as a subtle line from exposure where your lids weren't fully sealing, or even mini erosions) may have disappeared by your late afternoon appointment.

HOW TO PREPARE

Download OSDI, print and complete it and take it to all appointments about dry eye, unless your doctor's office has a different one they use. The point is that you need some way to convey the severity of your symptoms without it seeming completely subjective. Numbers aren't perfect, but they help, especially when you take the survey at regular intervals.

Write down all your symptoms and any patterns you've observed, such as time of day, environment, etc.

Write down everything you're doing for your eyes and how often, as well as any systemic medications you're taking.

Write down your main questions.

Set a specific goal for the appointment, and try to keep it simple. Remember it's a process and you won't get all the answers in one day.

JUST A FEW BASIC QUESTIONS TO ASK

If you're new to this business of getting into dry eye details, there are a few simple things you should find out:

How is my (aqueous) tear production?

How are my eyelids and oil (meibomian) glands looking? Are they secreting oil normally?

Do you see signs of anything else going on that could be part of what I'm experiencing? (e.g. allergy, rosacea, incomplete blink)

How exactly do you expect the treatment you're recommending will help with my problem? How will I know if it's helping?

What other treatment options are available?

TAKE SOMEONE WITH YOU?

If you get stressed at doctor appointments, take a friend or family member if possible, and give them a copy of your list of questions. Even for confident, experienced patients, it's normal to forget important questions in the stress and hurry that is characteristic of so many doctor visits.

THE BIG PICTURE OF DRY EYE: MEDICAL TREATMENT VS. COMFORT MANAGEMENT

If your biggest dry eye issues are excessive discomfort or pain, one of the best things you can do for yourself is to keep a clear separation in your mind between the medical side of dry eye, which is aimed at improving the tear film, and the comfort management side of dry eye, which is all about seeing comfortably more of the time. There is plenty of overlap, and some treatments do make you feel better right away, but you should not assume dry eye treatments will translate into more comfort even if they do improve your tear film! If nothing else, the timelines may not overlap.

Most doctors' dry eye advice will be focusing exclusively on the medical side: improving your tear film, whether by treating inflammation, keeping glands clear, increasing tear volume or secretion, etc. Few doctors, even the best dry eye experts, are equally expert in the comfort management side, and you can't look to them for this. You have to become your own expert in the types of lifestyle and environmental modifications as well as, in some cases, pain management - as much as possible utilizing strategies and products that will not interfere with or conflict with any medical treatments you may have chosen to use.

When you learn to take charge of the comfort side of dry eye effectively, it makes it more possible to slow down and be methodical about the medical side - which means you're more likely to benefit from treatment.

NAVIGATING MEDICAL TREATMENT DECISIONS

People are coming from all different places on the medical questions involved in dry eye. What's your comfort level with prescription drugs of various sorts, from anti-inflammatories to immunosuppressants to oral antibiotics? Do you prefer to go all-natural, focusing on dietary changes and non-chemical tear substitutes where necessary? Wherever you are on this spectrum, you need a doctor who is willing to respect your views and seek out treatments for you, so far as is possible, that are compatible with your priorities. Thankfully, the sum total of well documented knowledge about dry eye treatments is growing all the time, and neither you nor your doctor has to be limited by your current personal knowledge.

Whatever direction you go with treatment choices, though, one thing you will benefit from is regular examinations to measure the progress of your clinical signs of dry eye.

IMPROVING COMFORT (DAYTIME)

Some people are uncomfortable everywhere, but driving, being outdoors in wind, and working in an office on a computer are some of the most challenging environments. Big box stores are hard too, with their blowers and fluorescent lighting.

Check humidity levels at home and office. Use a humidifier if needed. OSHA recommends that humidity at your office not be lower than 20%.

Check for vents that may need to be redirected. Moving indoor air is hard on dry eye, just like wind outdoors.

Keep upper vents of your a/c and heat in the car closed. Wear wraparound sunglasses while driving to keep blowing out air.

Wear wraparound sunglasses or moisture chamber glasses outdoors.

Wear moisture chambers while using a computer, if you have severe symptoms.

Adopt strategies for computer time, including lighting adjustments, justgetflux.com, visual reminders to blink more often, keeping well hydrated, and keeping your screen position low.

If you have a lot of pain, seek out pain management strategies that don't involve constant use of drops if possible.

Talk to human resources about accommodations in your workplace if necessary.

Get additional tips from online dry eye groups.

IMPROVING COMFORT (OVERNIGHT)

For many, though certainly not all, people with dry eye, nights are the most challenging, because you're not blinking while you're sleeping and tear production goes down during sleep. If you have a partner, you may find your needs and theirs conflicting when it comes to ceiling fans, heat and a/c.

Check humidity level in the bedroom and consider a humidifier if appropriate.

If your doctor has recommended warm compresses (for blepharitis/MGD), just before bed is a great time to do it, because compresses can blur your vision, but can also give you a boost that helps your eyes stay moister overnight.

Experiment with different lubricants for overnight use. While conventional wisdom says the thicker it is, the longer it lasts, not everyone does well on greasy ointments. Sometimes a gel or a drop with a particular formulation will actually work better in the big picture.

Consider physical barrier protection that will block moving air and trap moisture over your eyes. This can make a huge difference to overnight comfort for many people. It doesn't have to be fancy - for some people, a bit of plastic wrap will do the trick, or a simple sleep mask, while for others, moisture goggles give them the best relief.

For some people (especially those with extremely severe dryness, non-closing lids or corneal erosions), the best solutions will involve forcing the lids closed overnight, probably with medical tape.

NEED MORE? HAVE SEVERE SYMPTOMS?

Continue to "I have severe dry eye. Help!"