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If your eye doctor has told you that there is inflammation on the surface of your eye, or has suggested "moving on to prescription drops", this page is for you. We explain what drops like these do and how they differ from lubricating drops, who they are considered for, what to expect in the first weeks, and why follow-up is so important. This is not a guide to choosing non-prescription lubricating drops; for that, there is a basic explanation on the Mitzmutz site.
Important: do not start, stop or change prescription drops without your doctor's advice, even if they sting, even if they seem not to be helping, and even if you feel better. The information here is meant to help you understand the treatment and ask the right questions, not to replace the instructions you were given.
How do prescription drops differ from lubricating drops?
Lubricating drops (artificial tears) add fluid to the surface of the eye and bring relief for a short time. They do not treat inflammation. In dry eye a cycle sometimes develops: concentrated tears irritate the surface of the eye, the irritation triggers inflammation, and the inflammation further damages the stability of the tears. At this stage lubricating drops bring less and less relief.
Most prescription drops for dry eye are anti-inflammatory drops. Their aim is to calm the inflammation and break the cycle, not to replace the tears. So in most cases you also continue lubricating drops alongside them, and preservative-free drops are preferable when you put drops in often.
Who does the eye doctor consider prescription treatment for?
The professional guidelines (TFOS DEWS II and the American Academy of Ophthalmology guidelines) suggest considering anti-inflammatory treatment when the symptoms continue despite the basics, that is, suitable lubricating drops, compresses, eyelid cleaning and a review of medicines that may cause dryness. The decision is made after an examination, for example when signs of inflammation and damage to the surface of the eye are seen with a slit lamp (a microscope for examining the eye), when there is a sharp flare-up of the symptoms, or when there is a condition linked to inflammation, such as rosacea or Sjögren's syndrome.
Prescription treatment does not suit everyone, and it is also not a "stronger lubricating drop" that you can add on your own. If the dryness comes mainly from blocked meibomian glands, from eyelids that do not close or from pain that originates in the nerves, the treatment needs to target that too.
The main options
Steroid drops for a short period
Steroid drops calm inflammation relatively quickly, so they are used mainly during a flare-up, for a short period and under monitoring. The reason for the monitoring is that steroids may raise the eye pressure in some people and, with long-term use, also increase the risk of cataract and infection. So the eye pressure is checked during treatment, and sometimes the dose is reduced gradually rather than stopped all at once.
For the same reason, steroid drops left at home from a previous treatment are not used, and they are not passed on to a family member with similar symptoms. A red, painful eye can come from different conditions, and in some of them steroids may cause harm.
Drops that regulate the immune response
These are drops that regulate the immune response, such as ciclosporin, for long-term use. They do not work quickly: the improvement comes gradually, and it sometimes takes weeks to months before you feel it. The most common side effect is burning or stinging when you put the drops in, especially at the start of treatment, and for many people it eases with time. Sometimes the doctor adds steroid drops for a short period at the start, to give relief until the long-term treatment begins to take effect. With a treatment like this, it is important to use the drops regularly, even on days when your eyes feel better, because the effect builds up over time.
There are also other anti-inflammatory drops that are not steroids, and the doctor will choose between them according to the examination findings and what you have already tried.
Treatment by mouth when there is MGD or rosacea
This is not a drop, but it is part of the same anti-inflammatory approach. When there is marked MGD (meibomian gland dysfunction; the meibomian glands are the oil glands in the eyelid margins) or rosacea, the doctor may also consider a treatment by mouth from the tetracycline group, given here mainly for its anti-inflammatory effect. This treatment has side effects, such as increased sensitivity to the sun and stomach discomfort, and there are situations in which it is not suitable. So tell the doctor about all the medicines you take and about pregnancy or planning a pregnancy.
What to expect in the first weeks
- Stinging at the start: common, especially with drops that regulate the immune response. If you find it hard, tell the doctor rather than stopping.
- Brief blurring after putting the drops in: usually clears within minutes.
- Gradual improvement: with long-term treatment, slow improvement is normal, and not a sign that the treatment has failed.
- Routine: when you use several kinds of drops, it is worth waiting at least 5 minutes between one kind and the next. If you wear contact lenses, ask when to take them out and when you can put them back in.
Why follow-up matters
The follow-up visit is part of the treatment. At it, the doctor checks whether the inflammation has calmed down and whether there are side effects, and, with steroid drops, also checks the eye pressure. Depending on the result, the doctor decides whether to continue, reduce the dose, switch treatment or add another treatment. The DEWS II review of dryness caused by treatments points out that eye drops themselves, and the preservatives in them, may also irritate the surface of the eye, so at every visit the whole list of drops is looked at, not just the new one.
Questions worth asking when you get a prescription
- How many times a day should I put the drops in, and for how long is the treatment planned?
- What should I do if I forget a drop, and what should I do if I find the stinging hard to bear?
- How do I combine the new drops with my lubricating drops and my other drops?
- When is the follow-up visit, and what will be checked at it?
- Which signs mean I should get in touch sooner?
It is worth writing down the answers, or asking for them in writing, so that it is easy to go back to them at home.
When drops are not enough
Prescription drops may help a great deal when inflammation is the main problem, but they do not fix blocked glands, inflamed eyelid margins or a significant shortage of tears. We have gathered the common reasons why dryness does not go away, and what is checked, on the dry eye not improving with drops page.
Depending on the findings of dry eye testing, treatments at the Dry Eye Clinic in Haifa can be combined, and they may help some patients:
- Meibomian gland expression and IPL treatment (broad-spectrum pulsed light, not a laser), when the problem is in the meibomian glands.
- Eyelid margin cleaning with BlephEx, when there is blepharitis or Demodex.
- Punctal plugs, when there is a shortage of tears.
- Autologous serum eye drops or a bandage contact lens, in severe dryness and in selected cases.
What happens at the visit itself, and what to bring, is explained on the dry eye consultation page. It is worth writing down in advance all the drops you use, including prescription ones, when you started them and how often you use them.
When to see a doctor straight away: a sudden drop in vision; severe eye pain; a red eye with strong sensitivity to light; heavy discharge; pain and redness in contact lens wearers (take the lenses out and get seen the same day); a headache with eye pain, blurred vision or haloes around lights while you are using steroid drops. In situations like these, do not wait for the follow-up visit.
Want a basic explanation first?For basic information on artificial tears (non-prescription drops): the guide on the Mitzmutz site
Frequently asked questions
My prescription drops sting. Should I stop them?
Do not stop them on your own. Stinging when you put the drops in is common, especially in the first weeks, and it sometimes eases with time. Tell your eye doctor, who will decide whether to continue, change or add something to make it easier.
If I have started prescription drops, can I stop my lubricating drops?
Usually not. The prescription drops target the inflammation, and lubricating drops continue to give relief in the meantime. Follow the instructions you were given, and when you use several kinds of drops, it is worth waiting at least 5 minutes between one kind and the next.
Can I use steroid drops left over from a previous treatment?
No. Steroid drops may raise the eye pressure and may mask or worsen an infection, so they are used only on the instructions of a doctor who has examined you now, and under monitoring.
How long do I need to wait to know whether the treatment is working?
It depends on the treatment. With drops that regulate the immune response, the improvement comes gradually, and it sometimes takes weeks to months before you feel it. So it is important not to give up too early, and to come to the follow-up visit.
What if the prescription drops do not help either?
Then it is worth checking again what is causing the dryness. Sometimes the main problem is in the meibomian glands, the eyelid margins or the quantity of tears, and then other treatments may help. See dry eye not improving with drops.
Home care not enough? We can look into it.
At the dry eye clinic in Haifa we find out what is causing the dryness and build a personal treatment plan.
Sources
- Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628.
- Gomes JAP, Azar DT, Baudouin C, et al. TFOS DEWS II iatrogenic report. Ocul Surf. 2017;15(3):511-538.
- Akpek EK, Amescua G, Farid M, et al. Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology. 2019;126(1):P286-P334.
- Geerling G, Tauber J, Baudouin C, et al. The International Workshop on Meibomian Gland Dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2011;52(4):2050-2064.
The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.