Managing daytime symptoms of dry eye

Today's focus

Today's post is aimed at people who are plagued a lot of the day by really substantial daytime symptoms: burning, grittiness, light sensitivity, and other forms of discomfort.

This post is not about medical treatments at all, though. The assumption is that you're working on addressing medical aspects as best you can. Instead, this is focused on practical measures you can take to manage symptoms in parallel with medical treatments.

What's your pattern?

Some people start out their days in pretty good shape, but their comfort and vision slowly degrade through the day. 

For others, symptoms are entirely driven by specific environments and activities; for example, their hard times are at the office, driving, or during computer use, or outdoors in cold weather.

Some people really don't have bad symptoms during the day and can get by with just drops — their real challenge is nights. (I'll be writing about that tomorrow.)

Repeat after me: moisture chambers.

I've been beating this drum for more years than I can remember. The reason I'm such an inveterate fan is that moisture chambers help most people with severe symptoms and really can't cause any harm. There's a lot to like about that combination.

• What are moisture chambers? Glasses or sunglasses that have some kind of added or built-in shield (foam, silicone, etc.) closing the gap between the frame and their face.
• What's the benefit? (1) Proofing against wind, vents, fans, and moving air in general, which all break up the tear film more quickly; (2) allowing humidity to build up immediately around the eyes; (3) keeping out infiltrates, allergens, etc. The net effect tends to be greater overall comfort with less need for constant lubrication. That's why moisture chambers are a staple for dry eye veterans.
• Outdoor use: 7Eye AirShields and WileyX Climate Control are the main contenders. Both brands have many different framestyles available and both sport a removable vented foam eyecup. 7Eye shields tend to be deeper than WileyX. For reference, these brands are $100-200 - you can definitely find much cheaper alternatives with built-in foam, in the $20-50 range. There are additional high end brands like Rudy Project.
• Indoors: This is where it gets tricky, because all of the foam-lined moisture chambers like the sports optical types look like goggles if you put clear lenses in them. Ziena Eyewear is really the only brand on the market designed specifically for dry eye and with a view to being reasonably discreet. But you can also get custom moisture chambers made for some conventional glasses — they're just very expensive.
• Need Rx? High-end moisture chambers are all Rx-friendly (7Eye, WileyX, Rudy Project, Ziena), though there are limits to how high the prescriptions can go. Some frames take a special high-Rx adaptor.
• Over Rx? This is a great way to test the concept before laying out a huge wad of cash on prescription moisture chambers. We have some options at dryeyeshop.com but you can also find them readily on Amazon.
• Cost? How long is a piece of string? You can find cheap ones ($20, Walmart, Amazon etc). Non-prescription quality ones run $100 to $200. With prescription lenses, you're looking at more like $300-500, more probably for progressives combined with special coatings. 

Humidification?

People living in very dry climates almost certainly need humidifiers at home and work. Some people also use car humidifiers, especially those who drive for a profession, and office workers sometimes use personal humidifiers at their desk.

Are you over-dropping?

• Constant dropping: Doctors' opinions will vary, so ask yours. But some people who put in drops more often than every hour or two may find themselves less rather than more comfortable.
• Sensitivities: Pay attention to how you are feeling in relation to the time after drops go in. People can develop sensitivities to common polymers in artificial tears and sometimes it never occurs to them that the drops that feel good going in might actually be contributing to discomfort with constant use. Switch things up, get something with a totally different active ingredient if your drops are feeling less comfortable.
• Autologous serum: When all commercial artificial tears just seem to make you worse, look into autologous serum, even if only as a way to take a 'drug holiday' for a while from conventional drops.
• WHY are you dropping? Many dry eye patients use eyedrops not so much for lubrication as for sensation management. That is, it's not because they're dry, it's because they're uncomfortable or in pain. This is a very important distinction. Those who have severe aqueous deficient dry eye really do have to be very careful to keep lubricated, for the health of their cornea, but those whose primary issues are discomfort rather than dryness per se also have the option to use alternative approaches to comfort... like cold compresses and moisture chambers. 

Are you focusing too much on nights?

I come across people sometimes who are putting all of their effort into maxing out moisture overnight, but whose main problems are actually occurring during the day (at least based on what comes out in conversation). Improving moisture during the night is great and will set you up to start the day in better shape, but in terms of setting reasonable expectations, that approach won't necessarily stretch very far into the day. It's important to make sure you're addressing symptoms at the time they're happening.

Cold compresses, chilled drops

Cold compresses are great for corneal pain, and also for inflammation and redness. Incidentally, just because you are doing warm compresses to treat MGD does not mean you can't also use cold compresses for pain management. I remember first hearing about chilled drops back in the early days when Dr Latkany in New York was practically the only one really popularizing the idea of a dry eye specialist. Cold drops were one of his common tips that many people picked up on.

How about a mid-day re-boot?

For those whose symptoms progress steadily downhill throughout the day, a half-hour break to baby them somewhere along the way can be very helpful.

15-30 minutes of shut-eye with a cold wet compress — anything from a wet cloth over a gelpack to the luxurious Tranquileyes XL Advanced kits — can do the trick.

PROSE, Sclerals

People who cannot get comfortable or functional at all during the day, even with maxed-out medical treatment and moisture chamber glasses, are probably going to want to investigate PROSE/sclerals.