Evaporative dry eye occurs when the tear film, the thin layer of fluid covering the eye, is unstable, causing tears to evaporate quickly. While there is no cure for evaporative dry eye, there are many possible treatments that can help alleviate symptoms and improve overall eye health.
Over-the-counter (OTC) products offer convenient and accessible options for managing mild to moderate evaporative dry eye symptoms. These include artificial tears, sprays, and ointments, as well as various eyelid hygiene products and washes.
Artificial Tears
Artificial tears are lubricating eye drops that mimic the composition of natural tears, providing immediate relief from dryness, irritation, and the sensation of having something “stuck” in your eye. They work by adding to either the watery or fatty acid (lipid) part of your tear film, the thin layer of fluid covering the surface of the eye.
Some artificial tear formulations contain preservatives that prevent bacteria from growing in the bottle. Single-use, preservative-free drops are recommended for people with more serious dry eye who use artificial tears more than four times a day.
In 2023, the U.S. Food and Drug Administration issued consumer warnings of potential contamination for more than two dozen artificial tear products, though the vast majority are still considered safe. Ask your eye doctor for a recommendation for OTC artificial tears, and stick to mainstream, branded products.
Liposomal Eye Sprays
For individuals who struggle with using traditional eye drops, OTC artificial tear sprays, also called liposomal eye sprays, offer an alternative. They are applied by spraying a fine mist of lubricating solution directly onto the closed eyelid. The solution migrates to the edge of the eyelid, then is spread across the outer surface of the eye through blinking.
Liposomal eye sprays may be easier to use than eye drops for individuals with limited hand mobility or dexterity.
Eye Gels and Ointments
Unlike eye drops and sprays, eye ointments have a thicker gel-like formulation that provides prolonged lubrication. They’re recommended for overnight use, especially if your eyelids don’t close completely or you’re prone to nighttime dryness or discomfort while sleeping.
Eyelid Cleansers
Proper eyelid hygiene is essential for maintaining healthy tear film stability and preventing meibomian gland dysfunction, a common underlying cause of evaporative dry eye.
OTC eyelid hygiene products, such as eyelid wipes, foams, cleansers, and scrubs, help remove debris, bacteria, and excess oils from the eyelids and eyelashes.
This helps keep eyelid margins clean and free of blockages, allowing the meibomian glands to more easily release oils that are essential for robust tear films.
Proper eyelid hygiene is especially important if you wear eye makeup.
Supplements
Omega-3 fatty acid supplements such as fish oil have long been suggested as a possible remedy for dry eyes, but research does not support this.
For more severe cases of evaporative dry eye, prescription products may be necessary.
The corticosteroid eye drop loteprednol etabonate ophthalmic (Eysuvis) can temporarily (for up to two weeks) suppress inflammation in the meibomian gland, allowing for higher quality tears to develop.
Immunosuppressive drugs cyclosporine ophthalmic (Restasis and Cequa) and lifitegrast ophthalmic (Xiidra) fight long-term inflammation but without the side effects associated with steroids.
Varenicline (Tyrvaya), a nasal spray, stimulates a specific nerve to increase tear production.
The eye drop perfluorohexyloctane ophthalmic (Miebo) helps stabilize the tear film by forming an anti-evaporative layer.
Autologous serum tears and allogeneic serum tears, artificial tears created from your own blood serum, may be an option if you have severe dry eye.
Various in-office devices, each with their own pros and cons, apply heat, pressure, or both to the meibomian glands to improve function, including the LipiFlow Thermal Pulsation System, TearCare, Systane iLux, Mibo ThermoFlo, and Thermal 1-Touch.
Punctal plugs, also known as lacrimal or tear duct plugs, are tiny devices inserted into the puncta (tear duct openings) of the eyelids to block tear drainage, helping to conserve natural tears and maintain adequate moisture levels.
Scleral lenses are therapeutic contact lenses that can help protect and lubricate the eyes if you normally wear contact lenses (contact lens use can contribute to dry eye).
In addition to traditional treatments, several home remedies can complement dry eye management (and are often a first line of treatment). These include:
Applying warm compresses to closed eyelids to help unclog blocked meibomian glands
Using eyelid scrubs to remove debris and excess oils
Regularly performing blinking exercises to help stimulate tear production, distribute tears evenly across the ocular surface, and prevent tear evaporation
Using humidifiers to increase ambient moisture levels and alleviate dryness
Taking breaks during lengthy activities that require a lot of visual focus, such as reading and using electronic devices
Positioning your computer below your eye level so that you don’t have to open your eyes as wide to see the whole screen
Drinking plenty of water to stay hydrated
Wearing protective eyewear to shield your eyes from wind and dry air
Avoiding cigarette smoke
Identifying and reducing the use of systemic medications that contribute to dry eye, such as anticholinergics, antidepressants, or oral allergy and decongestant medications that are designed to dry up mucus membranes (but be sure to consult your doctor before stopping any prescribed medications)
Evaporative dry eye is most often caused by meibomian gland dysfunction, so it’s not always possible to prevent the condition from developing. But some preventive measures can play a role in reducing your risk of evaporative dry eye and in managing evaporative dry eye and reducing symptom severity, such as:
Getting yearly checkups with your healthcare provider
Staying hydrated
Maintaining adequate vitamin levels, particularly vitamin A
Taking regular breaks to rest your eyes and consciously blink
Protecting your eyes from environmental factors
Using humidifiers
Practicing proper eyelid hygiene
Managing other health conditions that may contribute to dry eye
