be taken to treat dry eye syndrome. approaches include: avoidance of exacerbating factors (things that make it worse), tear stimulation and supplementation, increasing tear retention, eyelid cleansing, and treatment of eye inflammation. conditions such as blepharitis can often co-exist and paying particular attention to cleaning the eyelids morning and night with mild soaps and warm compresses can improve both conditions. avoiding exacerbating factors and environmental control dry eyes can be exacerbated by smoky environments, dust and air conditioning and by our natural tendency to reduce our blink rate when concentrating. purposefully blinking, especially during computer use and resting tired eyes are basic steps that can be taken to minimise discomfort. rubbing one's eyes can irritate them further, so should be avoided. dry, drafty environments and those with smoke and dust should be avoided. this includes avoiding hair dryers, heaters, air conditioners or fans, especially when these devices are directed toward the eyes. wearing glasses or directing gaze downward, for example, by lowering computer screens can be helpful to protect the eyes when aggravating environmental factors cannot be avoided. using a humidifier, especially in the winter, can help by adding moisture to the dry indoor air. tear stimulation and supplementation for mild and moderate cases, supplemental lubrication is the most important part of treatment. application of artificial tears is sometimes suggested every few hours and may provide temporary relief. there are many different types of artificial tear on the market, however, there is no strong evidence to suggest that certain artificial tear formulations are superior to others in treating dry eye. autologous serum eye drops eye drops that include autologous serum (serum taken from the same person's blood and used in an eye drop formulation) are sometimes suggested to help supplement natural tears. the composition of serum has similarities to natural tears may mimic natural tears. evidence supporting this approach shows that autologous serum may be superior to artificial tears at relieving symptoms in the short-term, however, there is no strong evidence that autologous serum eye drops are better than artificial tears or saline solution for long-term symptom relief. additional options lubricating tear ointments can be used during the day, but they generally are used at bedtime due to poor vision after application. they contain white petrolatum, mineral oil, and similar lubricants. they serve as a lubricant and an emollient. application requires pulling down the lower eyelid and applying a small amount (0.25 in) inside. depending on the severity of the condition, it may be applied from every hour to just at bedtime. it should never be used with contact lenses. specially designed glasses that form a moisture chamber around the eye may be used to create additional humidity. medication inflammation occurring in response to tears film hypertonicity can be suppressed by mild topical corticosteroids or with topical immunosuppressants such as ciclosporin (restasis). elevated levels of tear ngf can be decreased with 0.1% prednisolone. topical corticosteroids topical corticosteroids are commonly prescribed for those whose dry eye syndrome symptoms may be caused by inflammation and may lead to a small to moderate improvement in dry-eye symptoms when compared to lubricants or artificial tear drop treatment alone. it is not clear if topical corticosteroid treatment leads to an improvement in the quality of the tear film or the quantity of natural tears. there are also risks to consider with long-term use of topical corticosteroid treatment including an increased risk of ocular hypertension, risk of cataract development, and increased risk of eye infections. for people who may benefit from topical corticosteroid treatment for dry eye syndrome, the ideal treatment regime, formulation of the topical preparations, and balance between potential risks of this medication is not clear. ciclosporin (cyclosporin) topical ciclosporin (topical ciclosporin a, tcsa) 0.05% ophthalmic emulsion is an immunosuppressant that is commonly used to treat symptoms of dry eye syndrome. the drug decreases surface inflammation with the goal of increasing tear production. some people find relief and report increased tear production, however, evidence of effectiveness from clinical trials is not strong and although some people may find relief, effectiveness may be inconsistent in different people. ciclosporin a treatment also comes with risks of adverse effects that are generally not serious but include a burning sensation. ciclosporin should not be used while wearing contact lenses, during eye infections or in people with a history of herpes virus infections. side effects include burning sensation (common), redness, discharge, watery eyes, eye pain, foreign body sensation, itching, stinging, and blurred vision. long term use of ciclosporin at high doses is associated with an increased risk of cancer. cheaper generic alternatives are available in some countries. other medications diquafosol, an agonist of the p2y2 purinergic receptor, is approved in japan for managing dry eye disease by promoting secretion of fluid and mucin from cells in the conjunctiva, rather than by directly stimulating the lacrimal glands. lifitegrast was approved by the us fda for the treatment of the condition in 2016. varenicline (tyrvaya by oyster point pharma) was approved by the us fda for the treatment of dry eye disease in october 2021. oral n-acetylcysteine (nac), hyaluronic acid and/or rebamipide-based eye drops may also be effective for dry eyes. conserving tears there are methods that allow both natural and artificial tears to stay longer. in each eye, there are two puncta – little openings that drain tears into the tear ducts. there are methods to partially or completely close the tear ducts. this blocks the flow of tears into the nose, and thus more tears are available to the eyes. drainage into either one or both puncta in each eye can be blocked. punctal plugs are inserted into the puncta to block tear drainage. it is not clear if punctal plugs are effective at reducing dry eye syndrome symptoms. punctal plugs are thought to be "relatively safe", however, their use may result in epiphora (watery eyes), and more rarely, serious infection and swelling of the tear sac where the tears drain. they are reserved for people with moderate or severe dry eye when other medical treatment has not been adequate. if punctal plugs are effective, thermal or electric cauterization of puncti can be performed. in thermal cauterization, a local anesthetic is used, and then a hot wire is applied. this shrinks the drainage area tissues and causes scarring, which closes the tear duct. other microwavable warm compresses for daily treatment. there is evidence that long‐chain omega‐3 supplementation may be helpful, however, fish- flax- and hemp-oil (omega-3) supplements do not appear to be effective in relieving symptoms. surgery in severe cases of dry eyes, tarsorrhaphy may be performed where the eyelids are partially sewn together. this reduces the palpebral fissure (eyelid separation), ideally leading to a reduction in tear evaporation. prognosis keratoconjunctivitis sicca usually is a chronic problem. its prognosis shows considerable variance, depending upon the severity of the condition. most people have mild-to-moderate cases, and can be treated symptomatically with lubricants. this provides an adequate relief of symptoms. when dry eyes symptoms are severe, they can interfere with quality of life. people sometimes feel their vision blurs with use, or severe irritation to the point that they have trouble keeping their eyes open or they may not be able to work or drive. epidemiology keratoconjunctivitis sicca is relatively common within the united states, especially so in older patients. specifically, the persons most likely to be affected by dry eyes are those aged 40 or older. 10–20% of adults experience keratoconjunctivitis sicca. approximately 1 to 4 million adults (age 65–84) in the usa are affected. while persons with autoimmune diseases have a high likelihood of having dry eyes, most persons with dry eyes do not have an autoimmune disease. instances of sjögren syndrome and keratoconjunctivitis sicca associated with it are present much more commonly in women, with a ratio of 9:1. in addition, milder forms of keratoconjunctivitis sicca also are more common in women. this is partly because hormonal changes, such as those that occur in pregnancy, menstruation, and menopause, can decrease tear production. in areas of the world where malnutrition is common, vitamin a deficiency is a common cause. this is rare in the united states. racial predilections do not exist for this disease. research new treatment options are under development. heating systems that try to unblock the oil glands in the eye have some preliminary evidence of benefit. synonyms other names for dry eye include dry eye syndrome, keratoconjunctivitis sicca, dysfunctional tear syndrome, lacrimal keratoconjunctivitis, evaporative tear deficiency, aqueous tear deficiency, and lasik-induced neurotrophic epitheliopathy. other animals among other animals, dry eye can occur in dogs, cats, and horses. dogs keratoconjunctivitis sicca is common in dogs. most cases are caused by a genetic predisposition, but chronic conjunctivitis, canine distemper, and drugs such as sulfasalazine and trimethoprim-sulfonamide also cause the disease. symptoms include eye redness, a yellow or greenish discharge, corneal ulceration, pigmented cornea, and blood vessels on the cornea. diagnosis is made by measuring tear production with a schirmer tear test. less than 15 mm of wetting by tears produced in a minute is abnormal. tear replacers are a mainstay of treatment, preferably containing methylcellulose or carboxymethyl cellulose. ciclosporin stimulates tear production and acts as a suppressant on the immune-mediated processes that cause the disease. topical antibiotics and corticosteroids are sometimes used to treat secondary infections and inflammation. a surgery known as parotid duct transposition is used in some extreme cases where medical treatment has not helped. this redirects the duct from the parotid salivary gland to the eye. saliva replaces the tears. dogs with cherry eye should have the condition corrected to help prevent this disease. breeds with a higher risk of dry eye compared to other breeds include: american cocker spaniel bloodhound boston terrier english bulldog cavalier king charles spaniel lhasa apso miniature schnauzer pekingese pug samoyed shih tzu west highland white terrier cats keratoconjunctivitis sicca is uncommon in cats. most cases seem to be caused by chronic conjunctivitis, especially secondary to feline herpesvirus. diagnosis, symptoms, and treatment are similar to those for dogs.