Advanced List of Dry Eye Treatment Options (Last Updated: November 2023)

The world of ocular surface disease (OSD) is complex, multi-factorial, chronic and progressive. Thankfully, the last decade has brought us a variety of new research and treatment options to provide relief for patients. With a thorough understanding of OSD, a properly trained and experienced dry eye specialist can customize an ideal therapeutic protocol. At Beverly Hills Optometry: Advanced Dry Eye Center, a majority of our patients respond well to this initial plan but some may need adjustments along the journey to success. Below we layout a comprehensive list of non-surgical treatment options that are currently available.

• In-office Treatments:
  1. MicroBlepharoExfoliation (MBE): BlephEx or ZEST
  2. Advanced Thermal (Heat) Expression/Pulsation: TearCare, Lipiflow, iLux 2, Miboflo
  3. Lumenis OptiLight Intense Pulse Light (IPL)
  4. Meibomian Gland Probing or Maskin Probing
  5. Prokera Cryo-Preserved Amniotic Membrane
  6. Punctal Plugs
  7. Scleral Lenses
  8. iLightPro Low Level Light Therapy (LLLT) 
  9. Lumenis OptiPLUS (NuEra Tight) Radio Frequency (RF) Thermal Treatment
  10. Dilation & Irrigation (D&I)
• At-Home Treatment Devices:
  1. NuLids Eyelid Hygiene
  2. iTear100 Neuro-stimulation
• At-Home Advanced Ocular Therapy Eye Drops:
  1. RegenerEyes (Pro vs Lite)
  2. Autologous Serum Tears (Vital Tears)
  3. Platelet Rich Plasma (PRP)
  4. Mucomyst (N-acetylcysteine)
• Pharmaceuticals:
  1. Prescription Eye Drops (Immunomodulators): Restasis, Cequa, Xiidra, Klarity-C
  2. Prescription Eye Drops (Steroidal Anti-Inflammatories): Eysuvis, Flarex, Lotemax, FML, Klarity-L, Pred Forte, Dexamethasone, Durezol
  3. Nasal Spray (neuro-stimulation): Tyrvaya
  4. Oxervate eye drop – Neurotrophic Keratitis 
  5. Oral Antibiotic/Steroids: Azithromycin, Minocycline, Doxycyline (Oracea or Targadox), Prednisone
  6. Topical Creams/Gels (external use): Ivermectin 1%, Oxymetazoline 1%, Azelaic Acid 10%, MetroGel, Zilxi (Minocycline  gel), Testosterone Cream. 
  7. FDA Approved (as of 2023): MIEBO eye drop (100% perfluorohexyloctane) which is also sold internationally as EvoTears or Hycosan Shield
  8. FDA Approved (as of 2023): VEVYE eye drop (0.1% cyclosporine ophthalmic solution)
  9. FDA Approved (as of 2023): Xdemvy eye drop (0.25% Lotilaner) Eye drop for Demodex blepharitis
• Eye Care Products:
  1. Eyelid Hygiene: Optase Wipe/Gel, Avenova, Zocushield Gel, Ocusoft or Zoria wipe/foam (Original, Plus, Platinum, Oust Demodex)
  2. Medical Grade Nutritional Dry Eye Supplements: PRN DE3, HydroEye, MaxiTear, Nordic Naturals ProOmega, EyePromise
  3. Warm compress (OcuSci/Optase), moisture chamber googles (TranquilEyes), TearRestore Open Eye mask
  4. Cold Compress mask (Optase)
  5. Preservative-Free Artificial Tears (PFATs): Optase MGD, Retaine MGD, Oasis Tears, Systane Hydration PF, iVizia
  6. Nighttime relief/therapy: HyloNight Ointment, EyeSeal 4.0, SleepTiteSleepRite (Obstructive Sleep Apnea/CPAP, noctural lagophthalmos)
  7. SkinCare/Cosmetics: Eyes Are the Story, Twenty/Twenty Beauty, Epionce, Oculaire, BeautyCounter, Eminence Organic Skin Care (Stone Crop Gel Wash), KINeSYS Fragance Free Sunscreen (Limit Retinol/Retin-A/Tretinion products orally or topically especially near the orbital rim). 
  8. Lumify OTC (Eye Whitening) - for occasional use
  9. Allergy eye drop - Alaway PF, Optase Allegro, Pataday, Patanol, Pazeo, Zaditor
• Lifestyle Consideration:
  1. Anti-inflammatory diet/elimination diet/Whole30 diet/AIP diet, food allergies/sensitives (avoid/limit caffeine, refine sugars, processed foods, dairy, gluten)
  2. Moderate exercise (ie yoga, walking, weight-lifting, swimming, tennis),
  3. Consistent sleep pattern and sleep position,
  4. Stress management (mindnessfulness meditation and breathing exercises),
  5. Managing systemic conditions,
  6. Certain systemic and topical medication side effects,
  7. Control digital device overuse, blink exercises/blink breaks, 20/20/20 rule,
  8. Proper contact lenses habits (consider premium daily, single-use),
  9. Application/removal of cosmetics and avoid toxic ingredients,
  10. Eliminate/limit smoking/alcohol consumption
• Blood Workup: 
  • Consider full lab workup to rule out systemic conditions: Thyroid Panel (TSH/T3/T4/TSI), Auto-immune (ANA/RF/HLA-B27), Lipid Panel, Vitamin Deficiencies (A & D), CBC, CMP, CRP, ESR, heavy metal testing (ie mercury), and hormone level testing.

At Beverly Hills Optometry, we are here to serve you and to help you see better, feel better and look better. For a virtual or in-person advanced dry eye consultation, schedule a visit with our office today.