Q: I have several patients with severe dry eye. Traditional treatments have provided some success, but I’m also considering goggles or moisture chambers for nightwear and sometimes during the day. Do you have any suggestions or recommendations?

A: When a patient presents with severe dry eye, most optometrists first will turn to the standard, tried-and-true therapies such as artificial tears, ointments, punctual plugs, cyclosporine or mild steroids. However, for some patients, these just aren’t enough. At that point, you’ll want to begin considering alternative treatments.

“This is often a mental adjustment for patients as they realize that there is not a ‘magic’ eye drop that is going to fix their problem,” says Eric Polk, O.D., clinical director of TLC Vision, in Chesterfield, Mo. “These patients will often seek second or third opinions before coming to this realization.”

Moisture chamber goggles work well for a number of patients but must be fit properly to the eyes, Dr. Polk says. The replaceable foam pads fit snugly across the orbit to trap the moisture around the eye. Any gaps between the pads and the eyes will make them less effective. “I have found that refractive surgery patients will often reject this mode of treatment,” Dr. Polk notes. “They consider any type of spectacles or goggles a crushing step backward in their quest to become less dependent on glasses.” In these cases, the patient might be more open to nighttime goggles.

Scleral lenses provide another option for patients with severe dry eye. They vault the corneal surface, providing a bath of tears on the ocular surface.
Photo: Greg DeNaeyer,O.D.
A nighttime moisture chamber— such as Tranquileyes (Eye Eco), 7Eye (Panoptx) or Wiley X Climate Control (Wiley X Eyewear)—could be very helpful if you suspect nocturnal lagophthalmos, according to Douglas Devries, O.D., co-founder of Eye Care Associates of Nevada. He always makes sure to first ask patients how their eyes feel upon waking. “If they answer that it’s a bad time for them, then it’s important to rule out other conditions such as blepharitis or Demodex mites, which can also cause discomfort at night or in the morning,”   he says.

In the absence of those conditions, night moisture chambers as well as daytime protection are useful. “During the day, a good place to start would be a pair of sunglasses with seals, such as Eyessentials sunwear. It’s possible to obtain these with a plano clear lens and it’s Rx-able as well,” Dr. Devries says. “The key to this protection is a proper fit so the orbit is sealed sufficiently.”   

Scleral lenses provide another option for severe dry eye patients. A scleral lens vaults the corneal surface, providing a bath of tears on the ocular surface. “When fitted properly, the lenses can provide significant relief to the patient,” Dr. Polk says. “The drawback is that the lenses can be cost prohibitive for some patients, and they can be challenging to fit for the practitioner.” However, a number of manufacturers now provide diagnostic lens fitting sets to aid in the fitting of scleral lenses, such as DigiForm Scleral (Truform Optics) and So2Clear Scleral (Art Optical).