Written by Austin Ulrich, PharmD, BCACP | Reviewed by Christina Aungst, PharmD

Key takeaways:

Over-the-counter (OTC) eye drops, like artificial tears, and prescription eye drops, like Restasis (cyclosporine) and Xiidra (lifitegrast), are effective treatments for dry eye.
Home remedies for dry eyes include avoiding wind and smoke, using a humidifier, and doing eyelid scrubs or warm compresses.
You should contact your healthcare provider if you have severe dry eye symptoms or if your dry eyes do not improve after a few weeks of self-treatment.
The Importance of Finding the Right Treatment for Dry Eye
Dry eyes are a common complaint for many people. People over the age of 65, especially women (due to hormone changes), may frequently have this problem.

Dry eye is no fun, either: You might have a gritty or burning sensation in your eyes, excessive tears, sensitivity to light, and even blurry vision. Some people use over-the-counter (OTC) products such as artificial tears (polyvinyl alcohol) to cope, while others turn to prescription medications, like Restasis (cyclosporine), to treat chronic dry eye.

Here’s how to weigh the options.

What causes dry eye?
Dry eye has several possible causes:

Less tear production (fewer tears made): Decreased tear production is usually related to a problem in the tear (lacrimal) gland. Sjögren’s syndrome is a medical condition that directly reduces tear production, but older age, diabetes, and contact lens use can also cause fewer tears. It’s common for the tear duct — which brings tears from the tear gland to the eye surface — to become blocked as you get older.

Increased tear loss (more tear evaporation): Increased tear loss means excessive water loss from the eye surface without any issues involving your tear duct. Increased tear evaporation is most commonly caused by a condition called posterior blepharitis (swollen eyelids). Decreased blinking, allergies involving the eyes, and chronic contact lens use can also increase tear loss.

Other things that can put you at risk for dry eyes include:

Age: You make less tears as you age. For women undergoing menopause, dry eye is even more common because hormone changes affect tear production.
Medical conditions: Some autoimmune conditions and COVID-19 infection can also cause dry eye.
Medications: Some medications can cause you to make less tears. Examples are allergy medications and blood pressure medications.
Eye conditions: Prior eye surgery and blepharitis can also cause dry eye.
Environment: People who live in windy or dry climates or who spend long periods of time looking at electronic screens are more likely to develop dry eye.
What treatments work for dry eye?
Fortunately, no matter the cause of your dry eye, there are several treatments. You can choose the OTC or prescription treatment for dry eye that you feel most comfortable with.

Over-the-counter dry eye drops
Using OTC eye drops, like artificial tears, are one of the first-choice treatments for dry eye. They come in many brands and forms (e.g. liquid, gel, ointment) without a prescription.

Preservative-free OTC eye drops tend to be more expensive, but they are often recommended if you are sensitive to preservatives or if you’ll be using them for a while. One drop four times a day is the place to start, and you may feel relief in a few days. Also, remember that gels and ointments can blur vision because they are greasy.

It’s possible that you could have itchy eyes along with dry eye symptoms. In these cases, artificial tears may be helpful. But you may find more relief from other OTC eye drops as well. Antihistamine eye drops, like olopatadine (Pataday) and ketotifen (Alaway, Zaditor), block histamine in the eyes to help relieve itchiness. Decongestant eye drops like naphazoline/glycerin (Clear Eyes) can help to treat dry, burning eyes.

Prescription eye drops for dry eyes
If your dry eye symptoms are more severe, you may need to use prescription eye drops. Two prescription eye drops are FDA approved to treat dry eyes: Restasis, which has been on the market for several years, and Xiidra (lifitegrast), a newer dry eye treatment. Both are usually dosed as one drop in each eye twice a day, about 12 hours apart.

Restasis is a brand-name formulation of the immunosuppressant drug cyclosporine. It’s available with a prescription for the treatment of chronic dry eye. With Restasis, it can take months to see noticeable improvements. This medication can be expensive, but after many years with no generic, there is a generic version of Restasis approved by the FDA.
Xiidra is a brand-name only prescription eye drop that was FDA approved in 2016. It’s not completely understood how Xiidra works to help with dry eyes, but it seems to affect proteins in the eyes to lower inflammation. Some people report that Xiidra starts working within 2 weeks of taking it, but full effects can take up to about 3 months.
Dry eye home remedies
Depending on the severity of your dry eye symptoms, you may not need eye drops. Sometimes, making changes to your routine or home environment can help clear up your symptoms.

But these dry eye home remedies can be used alongside OTC and prescription eye drops as well.

Changing your environment: Minimizing exposure to air conditioning or heating, and adding a humidifier to your bedroom may also help. You can take screen breaks, avoid smoke, and point fans away from your eyes to reduce dry eye symptoms. Eye care techniques, such as taking out contacts for sleeping, doing eyelid scrubs, and applying a warm compress, can also help.
Taking omega-3 fatty acids: A few studies have shown that omega-3 fatty acid supplements may improve symptoms of dry eye. In a small study with TheraTears Eye Nutrition Omega-3 Supplement, a single 1,200 mg capsule daily improved dry eye symptoms for people with Sjögren’s syndrome. This could be worth a try.
Getting acupuncture: It’s interesting to note that small studies have shown some improvement in dry eye symptoms following acupuncture therapy.
Other less common treatments for dry eye include punctal plugs and autologous serum tears. Punctal plugs are placed in the tear ducts by an ophthalmologist to keep tears on the eyes for a longer time. Autologous serum eye drops are tears made from your own blood by a special laboratory.

As you consider your options, you’ll want to weigh the costs and benefits. Most often, dry eye is a long-term condition that requires daily treatment. Only rarely is there a specific cause of dry eye that can be eliminated, like a medication side effect or symptom of uncontrolled diabetes.

This means that if you have chronic dry eye, you may be using a treatment indefinitely — and the cost could add up. A typical prescription of brand-name Restasis can cost an upward of several hundreds of dollars, though a manufacturer discount coupon may bring that cost to $0 for people with commercial insurance. You also may qualify to receive free medication from the manufacturer from myAbbVie Assist, the Restasis patient assistance program. Additionally, a bottle of artificial tears can cost as little as $5 with a GoodRx discount.

Is it OK to use dry eye drops everyday?
It depends. For OTC dry eye drops like artificial tears, the FDA indicates that use should be temporary. There is no specific length of time given by the FDA where OTC eye drops become unsafe.

You should check with your healthcare provider if you’ve been using OTC eye drops for several weeks with no improvement. Your HCP can help you avoid risks with long-term use, like eye damage or masking underlying eye problems.

For prescription eye drops for dry eyes, like Restasis and Xiidra, you should use the eye drops as recommended by your healthcare provider, which is usually every day. If you have eye irritation, burning or other side effects, let your healthcare provider know.

Can eye drops worsen eyes?
Dry eye drop treatments are not likely to damage the eyes or worsen eyesight, even when used for chronic dry eye, but it is possible.

For example, eye drops with preservatives can cause eye damage if used long term. With Xiidra, you may notice blurry vision right after using the drops, but this clears up quickly. Eye ointments and gels can also cause temporary blurry vision because they are thicker, but it’s not likely they will damage the eyes.

The bottom line
Dry eye is a common symptom that can be treated with eye drops and other remedies. OTC eye drops, like artificial tears, can help relieve pain and burning from dry eye. If your eyes are also itchy, antihistamine or decongestant OTC eye drops can also be helpful. Prescription eye drops for dry eye include Restasis and Xiidra, and it usually takes some time for these drops to relieve your symptoms.

Home remedies and changing your environment can also help with dry eye. Exposure to smoke, wind, and long screen times can worsen dry eye, so minimizing those exposures can be helpful. Other remedies for dry eye that may help include eyelid scrubs, warm compresses, and acupuncture.

If you have severe dry eye symptoms, or if your dry eye does not get better after a few weeks of self-treatment, you should talk to your healthcare provider. They can help you get the treatment that’s right for you.

References
American College of Rheumatology. (2021). Sjögren’s syndrome.

American Optometric Association. (n.d.). Dry eye.