There are many reasons for feeling dry eye. New research shows that while some patients have decent Schirmer's scores (the little papers they stick in your eye to measure tear production), they seem to have a neuropathic sensation of dry eye, even when there is no "classic" dry eye diagnosis. For others, there are definite issues with tear film production and/or composition. If you have not had a tear film test (Schirmer's) and a comprehensive "dry eye" evaluation, you probably should have one done. Most optometrists do this. You may have meibomitis, which means the meibomium glands (the glands where your eyelashes are attached) may be plugged, preventing the mucin (oil component) from blending with your tear film properly. Treatment for this is lid therapy (see below).

Dry eye also calls for better drops, and if you have not already tried them, I recommend "Dr. Holly's drops," Dwelle, Dakrina and NutraTear, available from dryeyezone.com. They have sample packs you can order to see which one is best. Dwelle is very viscous, good for nighttime use. Dakrina is thinner, but not thin, good first thing in the morning. NutraTear is good for all day maintenance. But be sure not to use them too frequently, or you may experience a rebound effect and your eyes will feel even worse. You might also try Soothe drops.

Fish oil or flaxseed oil supplements are also an important addition to dry eye treatment. Flaxseed is somewhat more palatable than fish oil, which can cause belching and fish breath throughout the day.

Some people also benefit from a course of doxycycline, which somehow seems to thin the secretions and improve tear film composition. Ask your OD about this.

Protecting your eyes is also important. If you are able to tolerate the overnight gels or goo, I suggest using them, but covering your eyes with saran wrap and then a sleep mask while you sleep. This keeps the moisture in. If you cannot tolerate that stuff, using Dwelle and then covering your eyes may help. Some people wear moisture chamber goggles, which are effective, but can be tough to get used to.

I also recommend that first thing in the morning and before going to bed at night, you flush your eyes with Unisol 4 unpreserved saline. This is what I use all day and during the night to keep my eyelids from sticking and my eyes from burning. If you wear makeup, be sure to cleanse thoroughly to make sure you get it all off and be careful not to get it in your eyes. If you should, flush them with the Unisol 4 immediately. I keep mine in the refrigerator, and it feels sooooooo good. I also have bottles of it all over the place in my home and at work. Overhead fans and forced air cooling and heating can also make a bad situation worse, so try to keep out of the air flow if possible.

Last, but not least, I recommend a book for the lay person, Reversing Dry Eye Syndrome, by Steven Maskin, MD. It has a wealth of information that can be of great help. It's available through Amazon.com.

Here's the lid therapy info:

LID THERAPY

Lid therapy is designed to eliminate surface debris and infection from the lids and improve the quality and flow of the oily secretion from the meibomian glands.

It is important that the entire procedure is performed twice daily for a period of three weeks.

1) HOT COMPRESS

Hold a hot washcloth (as hot as you can tolerate) over the eyes for 1 minute. Alternatively turn the water in your shower up as high as you can tolerate and have the hot water run over your eyes for 1 minute.

2) LID SCRUB

Gently rub the lid margin with the washcloth 2-3 times.

OR

Put 1 drop of Baby Shampoo into 5ml of water. Dip a Q-tip into the solution and scrub the lid margin gently for 20 seconds. Rinse the eye with an eyebath.

3) LID MASSAGE

The index finger is rolled up the lower lid to the lid margin. Pressure is applied inwards as the finger is rolled up to express the secretion from the gland. Lid massage should be done 20 to 30 times on each eye.

There are 23 glands in each eye, running upwards to the lid margin, behind the eyelashes. Ensure that you do 3 rolls to cover the entire lower lid and all of the glands. Research has shown that as few as 2 glands blocked can have a detrimental effect on tear film performance.

Think of your finger being like a steam roller. Pressure must be kept in against the eyeball to keep the gland blocked as your finger rolls up the lid and the fluid inside is pushed out.

There is also a wealth of information on dry eye available throughout the site, which can be accessed through the "find" tab at the top of the forums using keywords "dry eye." Information on Dr. Holly's drops is also available in many posts in the Dwelle diaries, keyword "dwelle."