Tips for Dry Eyes

Dry eyes are a common issue among people with forms of dysautonomia such as POTS. The autonomic nervous system regulates blinking, and blinking stimulates tear production. Therefore, if the autonomic nervous system gets messed up (dysautonomia), tear production can get messed up as well.

Another reason many people with dysautonomia have dry eyes is because Sjogren’s Syndrome is a common co-morbidity of dysautonomia. Sjogren’s is an autoimmune disease that attacks salivary and tear glands, causing dry mouth and dry eyes- sometimes to a very severe degree.

In general, autoimmune diseases are characterized by inflammation. Since POTS may be an autoimmune disease, there is most likely inflammation present. Inflammation can cause dry eyes. As you can see, there are several ways that POTS can cause dry eyes.

My dry eye is not severe although it was very bothersome for a time. I do not have Sjogren’s. My oily tear glands have a tendency to get clogged, so my tears evaporate quicker than they should. Keep those things in mind as I discuss the tips that have helped me with dry eyes.

Eye Drops

This is a basic first-line defense against dry eyes. You can use artificial tears as often as needed. Some drops are more watery, and others have oil or fatty acids to bolster the lipid component of tears to create less evaporation of the tears. The oily/fatty acid eye drops are blurry for a few minutes, but I find them to work better for me than the standard artificial tears. According to my eye doctor office, eye drops are like mascara: everyone has one that they “swear by”, but it is really a personal preference. That being said, the eye drops that I have liked are:

• Systane Balance– It has ingredients that bolster the lipid component of tears, which is important if you have evaporative dry eye. This was helpful when my eyes were mildly dry, but it didn’t cut it when my eyes got worse. I used to use this at night.
• Blink for contacts– I wear soft contact lenses almost every day, so I have to stick to contact-specific drops during the daytime. These have worked well for me.
• Soothe XP– These eye drops have mineral oil which bolsters the lipid component of tears. These are more hearty than Systane Balance and I currently like to use them at night or on glasses days.
• Systane Gel Nighttime– These are excellent for when your eyes get dry overnight. They are very thick and keep the eyes moistened for a long time.
• Refresh Optive– I haven’t been able to find Soothe XP lately and have been using these drops instead and like them. I use the preservative-free single use vials.
• GenTeal Gel Tears– In 2022, these are my new favorite non-contact drops. They last longer than any other that I have used.

I have also tried Blink tears and Blink gel tears for night time or when I occasionally wear glasses and they made my eyes feel more dry. They were a no-go for me, but everyone is different. Another tip regarding drops- do NOT use Visine drops or similar vasoconstricting drops meant to reduce redness, these can exacerbate dry eyes.

Warm Compresses

Warm compresses loosen up the oil in the tear glands to get them flowing better. This helps there be more of the oily component to tears. I will do a warm compress twice a day with a warm washcloth. I do it in the morning before I put my contacts in and at night after I remove makeup and wash my face. The doctor advised me to do it for 1-2 minutes and to get the washcloth warm again when it loses its heat. So, about every 20 seconds during the compress, I will replenish the warm water on the washcloth. I have tried doing compresses for a longer period of time and it was irritating to the skin on my eyelids. If I ever need to amp it up, I will use an eye mask instead so I’m not soaking my eyelids for so long.

Update: My eyes went through a rough patch again so I got the Bruder eye mask that I linked above. Guys, it is amazing. I use it for about 10 minutes every morning while I meditate and it is a night and day difference. My eyes feel basically normal again.

Omega-3’s

The eye doctor recommended taking fish oil because the omega-3 fatty acids can help boost the oily component of tears. Fish oil weebs me out. Instead, I add flax seeds to breakfast smoothies.

Treating allergies or sinus issues

I noticed a big difference in how my eyes felt when I finally kicked this most recent sinus infection. My eyes weren’t achy around the orbital bones anymore, my lids were no longer swollen, and my eyes were less dry.

Allergies can irritate your eyes and cause issues. It is a different mechanism than dry eye, but addressing it may improve your overall comfort. Be aware that certain antihistamines can exacerbate dry eye, so it is important to talk to your doctor about your options.

Contacts

Make sure your contacts are decent for dry eyes as some are better than others. I use Acuvue Oasys for Astigmatism brand. They are bi-weekly lenses, which works better for me than monthly pairs.

Eye makeup

Some eye makeup can make your issues worse. You don’t have to go sans makeup, just be aware of what irritates you, and avoid it.

Hypochlorous Acid Solutions

A few companies, such as Bruder, make hypochlorous acid solutions that you can spray onto your closed eyelid. It sounds scary, but your body actually makes hypochlorous acid to combat against bacteria. This allows your eye secretions to flow more freely. Hypochlorous acid also decreases inflammation. I haven’t used this consistently, so I can’t speak to its effectiveness.

Thoroughly removing eye makeup

Makeup can clog your tear glands and worsen dry eyes, so thoroughly removing your makeup at the end of the day is crucial. I use Paula’s Choice Gentle Touch Eye Makeup Remover. Leaving any makeup remover or micellar water on the skin can be irritating, so I wash my face immediately afterwards and gently wash my eye area with facewash too.

Lid scrubs

This helps by loosening up oil clogs and preventing future clogging. My preferred way to do this is by washing my lid area with Babyganics baby shampoo (just with my fingertips). Some people prefer to use a lid scrub like Ocusoft, or by using a washcloth with the baby shampoo. Those methods were drying and irritating to my eyelid skin. I only do this method when I feel like I need it.

Update 2023- I recently tried these lid scrubs and this lid wash, both by Optase, and they seem to have improved by dry eyes further and are not irritating for me. I am using the lid wash now because it is cheaper per use. They both work well at removing eye makeup too, so it replaces my usual eye makeup remover.

Blinking

This is a no-brainer, but blinking more often helps. So, for me that means less spacing out into oblivion.

Prescription eye drops

The eye doctor prescribed me Xiidra eye drops. They work by decreasing inflammation so that your eyes make more of their own tears. I have been using them for a little over a month now.

I used a shotgun approach to treat my dry eyes, so it is hard to say what helped the most. It is possible the Xiidra has been a factor. The downside is that it is hella expensive (Around $500 per month without insurance or coupons). After insurance and using the manufacturer coupon it was only $5 for a one-month supply. However, I may be in for a reality check in the new year when our deductible hasn’t been met. Update, it cost me my left kidney to purchase Xiidra in January.

2022 Xiidra update- I stopped using Xiidra for over a year, but my dry eyes were bothering me again this spring so I began using it again. Wow, it really makes a huge difference for me. This time it was the only thing I changed so I could truly tell the difference it makes. Before, when I would wake up, I could barely blink because my eyes were bone dry. That is totally normal now. I am also able to wear my contacts comfortably for longer and overall be bothered less by inconvenient dry eye symptoms.

With these strategies my eyes are much more comfortable. What tips do you have for dealing with dry eyes?

Disclaimer: I am not a medical professional. Statements on this site are not meant to be taken as medical advice. These statements reflect my personal experiences having mild-ish post-viral POTS and ME. Due to the wide spectrum of these diseases, comorbidities, and everyone being different, your experiences may be very different than mine.

Note: If you post a comment, this site does NOT have a feature to notify you of responses to your comment. I have not found a good solution for that yet. However, I usually respond to every comment in a timely manner, so be sure to check back.