National Eye Care Day - Pharmacists show you the symptoms and drug treatment of dry eyes

June 6, 2024 will be the 29th National Eye Care Day. This year’s theme is “Pay attention to universal eye health”. In my country, the incidence of dry eye is high, about 21%-30%[1], and it affects people of all ages. Therefore, it is particularly important to briefly introduce the relevant knowledge of dry eye to everyone.

1. Definition of dry eye syndrome:

According to the latest definition proposed in the 2020 version of the Chinese Dry Eye Expert Consensus, dry eye is a chronic ocular surface disease caused by multiple factors. It is caused by tear film instability or imbalance of the ocular surface microenvironment caused by abnormalities in tear quality, quantity, and dynamics, and may be accompanied by ocular surface inflammatory reactions, tissue damage, and neurological abnormalities, leading to a variety of ocular discomfort symptoms and/or visual dysfunction [2].

2. What are the symptoms of dry eyes?

Dry and painful eyes, a foreign body sensation, burning or nausea, and frequent rubbing of the eyes

Eyes are often red and bloodshot, and rubbing the eyes can easily cause eyelashes to fall off

Increased eye discharge (eye mucus), which is dry and powdery in the morning

Eyes get tired easily, can't look for long periods of time, and even don't dare to look people in the eye

Inability to fully open the eyes, upper eyelids feel heavy and tend to droop

Fear of light, wind and smoke. Eyes feel uncomfortable and tearful when facing wind, light or in smoky environment.

Occasional, brief blurring of vision that usually improves with blinking

I feel pain in my brow bone and nose bridge, and I like to rub it with my hands.

3. How to treat dry eyes?

There is currently no effective treatment for dry eye syndrome in clinical practice, and local eye medication is usually used as the main treatment:

1. Lubricate the ocular surface and promote repair

1.1 Artificial tears: The main function of artificial tears is to lubricate the ocular surface and is suitable for various dry eye symptoms. For mild dry eyes, it is recommended to choose artificial tears with lower viscosity, such as 0.1% sodium hyaluronate, polyethylene glycol, 0.5% carboxymethyl cellulose, etc., and use it 4 times a day. For moderate to severe dry eyes, it is recommended to choose artificial tears with higher viscosity, such as 0.3% sodium hyaluronate and 1% carboxymethyl cellulose. (Preservative-free artificial tears are preferred)

1.2 Eye drops that promote ocular surface repair: Bovine basic fibroblast growth factor promotes repair and regeneration of mesoderm and ectoderm cells. Adults are recommended to use 1-2 drops each time, 2-4 times a day (need to be refrigerated at 2-8 degrees). Human epidermal growth factor can promote corneal healing. The adult dose is 2-3 drops each time, 2-4 times a day (note that if the solution is turbid or flocculated, it should not be used).

1.3 Eye drops that promote tear secretion help promote the secretion of water and lipids. Diquafosol sodium eye drops, 1 drop each time, 6 times a day.

1.4 Ophthalmic serum preparations can promote the repair of the ocular epithelium. Calf blood deproteinized extract ophthalmic gel can be used 3-4 times a day by adults.

2. Anti-inflammatory treatment

2.1 Glucocorticoids: Fluorometholone eye drops, the adult dose is 1-2 drops each time, 2-4 times a day.

2.2 Immunosuppressants: For moderate to severe dry eye accompanied by ocular inflammatory reactions, cyclosporine eye drops (0.05%-1.00%) are recommended. The frequency of use for adults is 2 times a day. If the therapeutic effect is not good, it can be increased to 3-4 times a day.

2.3 Non-steroidal anti-inflammatory drugs: When used for non-infectious inflammation of the eye, it is recommended to use indomethacin eye drops (0.5%), the adult dose is 1 drop each time, generally used 2-4 times a day. In addition, the common dose of diclofenac sodium eye drops for adults is 1 drop each time, 4-6 times a day.

3. Antimicrobial therapy

3.1 Topical antibacterial drugs: Erythromycin eye ointment (0.5%) is recommended for the treatment of eye infections caused by sensitive bacteria. Adult patients should apply an appropriate amount of this product to the eyelid margin once in the morning and evening every day.

3.2 Systemic antibiotics: Oral tetracycline minocycline, 100 mg per day for adults, or doxycycline, 200 mg twice a day, may be considered. [3]

4. How to prevent and improve in life?

Wear sunglasses or goggles to protect your eyes from wind and sun.

Use mobile phones, computers and other electronic devices reasonably to avoid eyes fatigue and give your eyes rest regularly.

When staying in an air-conditioned or heated room for a long time, use a humidifier to increase the humidity of the surrounding environment.

Quit smoking and stay away from smoking environments.

Keep your eyes clean and hygienic and reduce the use of eye makeup.

Eat foods rich in vitamins.

References:

[1] Wang Ci. Clinical effect of cyclosporine eye drops (II) combined with sodium hyaluronate eye drops in the treatment of dry eye[J]. Clinical Rational Drug Use, 2024, 17(14): 130-132+136.

[2] Chinese dry eye expert consensus: definition and classification (2020)

[3] Chinese dry eye expert consensus: treatment (2020)