Dry Eyes and Lupus: Eye Doctor Tips and Tricks [January 2026 Update]

Dry eyes are very common in lupus patients, especially those with Sjogren’s disease. Around 25% of systemic lupus erythematosus patients also have Sjogren’s. Untreated, it can cause vision problems and eye discomfort. However, there are many things patients can do to help.

This blog post lists tips and tricks to help dry eyes and lupus. If you have dry eyes, do more than just read these and think these are good ideas. Instead, print them out. Read all of them. Highlight each tip you are not doing or did not know you should do. Then, gradually incorporate all of them into your life.

What is new in the DEC 2025 update: I include newer dry eye prescription products, such as Vevye and Tryptyr, and provide practical advice on using the nasal spray Tyrvaya.

NOTE: Johns Hopkins University Press, publisher of The Lupus Encyclopedia, is a nonprofit publisher. If you purchase JHUP books, like The Lupus Encyclopedia, you support projects like Project MUSE.

Common symptoms of dry eyes and lupus

• Dry, gritty eyes
• Foreign object sensation in the eye
• Redness of the white (sclera) of the eyes
• Blurred vision
• Photophobia (intolerance of light)
• Ropey, thick secretions in the eyes, especially when first awakening
• Difficulty opening the eyes after sleeping due to dryness
• Red, tender eyelids (blepharitis)

Tips for caring for dry eyes and lupus

General measures to help dryness

• Stay hydrated but avoid drinking excess fluids, which results in going to the bathroom frequently at night, contributing to fatigue. It also washes away the mucous salivary lining that moistens your mouth.
• Avoid dehydrating fluids like alcohol and caffeine.
• Avoid smoking (dries out the mouth, eyes, and nose).
• Use a humidifier (at 55% to 60% humidity) in each room where you spend significant time.
• A humidifier near the bed is a must (we spend the most time there). Our eyes dry out more when asleep. Turn it on at least an hour before bed.
• Clean and dry out humidifiers daily to prevent mold and fungus.
• A centralized humidifier in the furnace is even better. Consider a central air UV light plus filter, or an air scrubber, to decrease infections.
• Also, use a desktop humidifier at home and work.
• Avoid direct airflow to the eye, including wind and fans blowing directly towards you at night (such as ceiling fans).
• If you use a CPAP mask when sleeping, make sure it seals well so air does not blow toward your eyes. A sleep mask made to fit with a CPAP mask can help. You can buy one over the counter or online.
• Consider using sleep masks overnight or ‘moisture goggles’ (available over the counter and online) for night or even daytime wear.
• Avoid topical medications and lotions that can be irritating (including facial creams with retinol).

Supplements to help dry eyes

Fish oil, flaxseed oil, or omega-3 fatty acid supplements may help. (Natural sources such as fish, flaxseed, walnuts, and olive oil are even better.) Eye experts recommend high-quality brands like Nordic Naturals Ultimate Omega and PRN’s “De 3 Dry Eye Omega Benefits.”

Artificial tears and gels

• Use artificial tears at least once daily (even if the eyes do not feel dry). Use them regularly. Do not wait for your eyes to dry out.
• Use preservative-free brands if you use them more than 4 times a day.
• For severe dry eyes, start preservative-free artificial tears every 1 to 2 hours. After 1 week, slowly back off on how often you use them. As soon as your eyes feel dry, go back to the previous, more frequent application to figure out how often you need them.
• Try different brands and formulations to find the one most suited to you. Some are more viscous and may stay in the eye longer but may blur vision. Some are for people with coexistent Meibomian gland dysfunction.
• Freshkote and Hylo are preservative-free tears in bottles instead of individual vials.
• If you don’t like eye drops, consider an aerosolized spray (such as Nature’s Tears EyeMist).
• An alternative is the prescription Lacrisert, inserted in the lower eyelids to moisten the eyes all day.
• Use artificial tears more often when flying (air is drier in the plane) or when reading or doing computer work (you blink less often).

Eye ointment or gel use

• Use a lubricating eye ointment or gel before bed. At first, apply it just to your eyelids and lashes and blink several times to see if it helps. If not, apply one-eighth to one-fourth inch (about a rice grain size amount) under your lower eyelids.
• Expect blurry vision after you blink. It usually clears by morning. If you wake with blurry vision or eyes that are goopy or messy, decrease the amount you apply.
• Any artificial tear ointment is acceptable. The ingredients should be white petroleum and mineral oil. Common brand names include Refresh PM, Lacrilube, Systane Nighttime Ointment, and Genteal Ointment.
• Some doctors prefer vitamin A eye ointments. They lubricate well overnight, soothe the eye, and support goblet cells so the eye can make more mucin and the surface can heal. You can buy them online (Optase Hylonight, Hycosan, and similar brands).

How to put in eyedrops or ointment

• Tilt your head back and pull your lower eyelid down with one finger.
• Apply the drop inside the lower eyelid, but avoid touching the dropper tip to your eyelashes or other surfaces.

Examples of high-quality thin artificial tears

• Systane Ultra, Systane Complete, Refresh Tears, Blink, Soothe, TheraTears, and similar brands.

Thicker lubricants

• Refresh Celluvisc, Refresh Liquigel, TheraTears Liquigel, Genteal Gel, and similar gels.
• Hylo contains hyaluronate, is preservative-free, and comes in a bottle rather than single-use vials.

Lipid-based tears for oil gland dysfunction

If you have oil gland dysfunction, use lipid-based artificial tears. Options include:

• Soothe XP (preservative-free vials)
• Retaine MGD (preservative-free drops in single-use vials)
• Systane Complete
• Refresh Optive Advanced
• Refresh Optive Mega-3
• Hylo-Forte (preservative-free, in a multi-use dispenser)

Dry eye protection

• Decrease air and wind drying by wearing moisture chamber glasses, moisturizing goggles, or wrap-around sunglasses (Eye Eco, Ziena, and Wiley X brands).
• If light bothers your eyes, wear sunglasses or have the lenses in your eyeglasses tinted with FL-41 (a rose-colored filter).
• Avoid fans, drafts, and air vents. Air movement dries out eyes.

Blink more often to help dry eyes and lupus

• When reading, watching TV or movies, using a smartphone, or doing computer work, do blinking exercises every 20 minutes. Close your eyes, squeeze hard, hold for a few seconds, open, and repeat a few times.
• Have your computer screen about an arm’s length away and lower, so that your eyes gaze down slightly.
• Follow the 20:20:20 rule: every 20 minutes, stand and look at something at least 20 feet away for at least 20 seconds.

Tips for blepharitis and meibomian gland dysfunction

Blepharitis is eyelid inflammation. It often occurs with meibomian gland dysfunction.

• Warm compresses open the meibomian glands, warm the thickened oil, and increase oil flow onto the eye’s surface. That improves surface lubrication and limits tear evaporation. Warm compresses can also soften crust, scales, or discharge if present.
• Warm compresses can be moist or dry. Your doctor will instruct you based on your condition. However, moist heat conducts warmth to the meibomian glands better and may be more effective.
• Aim for heat that feels comfortable, not too hot, for around 5 to 10 minutes, up to 1 or 2 times a day. Overuse, or compresses that are too hot or left on too long, may irritate the eyelids.
• You can use a clean, damp washcloth run under hot water or heated in the microwave. As the cloth cools, refresh it with warm running water. Once the water feels warm but comfortable, leave the temperature there. The thin skin on the eyelids scalds easily.
• You can use an over-the-counter warming eye mask such as the Bruder Medibead Eye Compress or the Thermalon Dry Eye Moist Heat Compress. Heat these reusable compresses in the microwave. Be careful not to get them too hot or to scald your skin. An electric heated eye mask may be more convenient for some patients.

Daily routine

• Consistency is essential. Warm compresses every day support oil gland health over the long term.
• Clean sore, irritated eyelids daily with baby shampoo. Use warm, moist cloths on the eyes, and gently massage the eyelids.
• Use products that clean the eyelid edges, such as Cliradex pads, tea tree and coconut oil eye wipes, and Avenova.
• Apply a warm, moist washcloth to the eyes before sleeping and upon awakening for 5 minutes.
• Carry a wet washcloth in a zip-lock bag when you travel, and apply it to your eyes when needed.
• Keep makeup and lotions away from the eyelids.
• Eyelid scrubs can improve blepharitis, an inflammatory dermatitis of the eyelid margins. It often follows a reaction against Staphylococcal bacteria, which live on normal skin and eyelids. Tiny mites called Demodex can also cause blepharitis.
• Regular eyelid scrubs may improve dry eye symptoms by clearing debris, excess bacteria, and Demodex buildup. Gently scrub the eyelids to increase oil flow to the eye surface. Then apply a warm compress. This helps most after an eyelid massage (see above).
• Put a little baby shampoo on clean fingertips, a clean washcloth, or a cotton pad. Then clean the base of the eyelashes with your eyelids closed.
• To clean the eyelid margins, you can use commercial eyelid cleansers, foams, or lid wipes (Alcon, Ocusoft, and similar brands).
• For Demodex blepharitis, consider tea tree oil lid cleaners such as Cliradex, Oust Demodex Swabstix, and TheraTears SteriLid.
• You can also try hypochlorous acid solutions such as Avenova and Ocusoft HypoChlor, available over the counter or online.

Meibomian gland dysfunction

• For Meibomian gland dysfunction, massage your eyelids after a moist, warm compress for one minute.
• Wash your hands well with soap and water first, then rinse well. The meibomian gland openings sit on the edges of your eyelids. The glands are long and thin, and they run perpendicular to the lid edge. Squeeze the thickened oil out by placing a finger on the eyelid opposite the edge of the lid. Then gently roll or slide your finger downward on the upper eyelids and upward on the lower eyelids. Repeat this 5 to 10 times on each eyelid.

Contact lenses and dry eyes

• If you wear contact lenses, use only daily replacement lenses made for dry eyes, such as Acuvue Oasys and Alcon’s Dailies Total-1.
• Therapeutic scleral contact lenses can help with severe dry eyes.

Prescription treatments for dry eyes and lupus

Anti-inflammatory eye drops

• Ask your doctor whether you would benefit from medicated dry-eye drops such as Restasis, Cequa, Vevye, or Xiidra. These anti-inflammatory drops reduce inflammation and help the tear glands produce more tears. Restasis, Cequa, and Vevye are brand names for cyclosporine eye drops. Cequa works faster and better than Restasis. Xiidra contains a different anti-inflammatory drug and can help patients who do not respond to cyclosporine.
• Vevye is the newest version of Restasis and Cequa. It penetrates the clear part of the eye (the cornea) better, and many believe it works better.
• If Restasis or Cequa irritates your eyes when you first start it, keep it in the refrigerator. Also, apply it 10 to 15 minutes after artificial tears.
• Restasis comes in single-use vials and a large multidose vial. If you want to save money, ask for the small vials. Do not touch the vial’s wet edges while using it. Twist the cap back on to reuse it. Get two doses out of each vial (a 3-month supply can last 6 months).

Tryptyr

• Tryptyr (twice a day) is another new treatment for dry eyes. It stimulates the nerves that cause tear production. You can use Tryptyr with the anti-inflammatory drops above.

Tyrvaya nasal spray

• Ask your doctor for Tyrvaya (varenicline) nasal spray to help dry eyes. Use one spray in each nostril twice a day. It can take 4 weeks to work. The first sprays burn a lot. Close your eyes and work through the burn. Do this each time. The burning gradually improves or goes away. If you put the top back on the vial, you can use it several times and stretch a 1-month supply to 3 months. If you have trouble getting this medication, ask your doctor to send it to PhilRx. There you can get your first 60 vials free, a 90-day supply if you use it as I instructed above.

Tear-duct plugs, steroid drops, and saliva medicines

• Add NSAID eye drops to your drug intolerance list. They can harm dry eyes.
• Ask your ophthalmologist to insert tear-duct plugs to decrease tear drainage.
• Your eye doctor may prescribe topical corticosteroid drops such as fluorometholone or loteprednol for a short time, or longer in some cases, to calm inflammation that can reduce tear production. Use these steroid drops with caution. Without monitoring, long-term use can raise eye pressure or cause cataracts.
• Oral pilocarpine (Salagen) or cevimeline (Evoxac) may modestly increase both tears and saliva, but they help dry mouth most.

In-office procedures

• Blepharoexfoliation (BlephEx): This cleaning procedure removes excess bacteria, biofilm, and buildup at the eyelid margins. An eye care provider performs it in the office. Repeat treatments every 6 to 12 months make home lid scrubs more effective.
• Thermal pulsation treatment (LipiFlow, Systane iLux MGD, and similar devices): This in-office procedure applies heat and therapeutic pressure to each of the four eyelids. That clears the blockage and improves meibomian gland function. Repeat treatments every 6 to 12 months make the warm compresses you use at home more effective.

Autologous serum eye drops

Lacrimal glands make natural tears by filtering blood. When your eyes no longer make enough tears, autologous serum eye drops often work well for severe dry eye. Your clinic draws your blood and processes the serum into drops at the strength your eye doctor recommends (20% to 75%). That serum contains growth factors and biochemicals that also occur in natural tears. Artificial tear products do not contain them.

Platelet-rich plasma (PRP) eye drops

PRP is a blood product similar to autologous serum eye drops. The lab prepares it with an anticoagulant that separates plasma and platelets from the rest of the blood. Plasma and platelets play an essential role in tissue repair. PRP eye drops contain growth factors, proteins, and anti-inflammatory cytokines. Doctors use them to treat severe dry eye.

PROSE and scleral contact lenses

Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) is a medical treatment system that restores vision, promotes healing, reduces symptoms, and improves quality of life for patients with severe dry eye. A scleral contact lens is a large, rigid, gas-permeable lens that treats severe dry eye.

These lenses are larger than typical contact lenses. They rest on the sclera (the white of the eye) and vault over the cornea (the clear front window of the eye, and the most sensitive area in severe dry eye). These lenses hold a reservoir of saline in the vaulted area over the cornea. They give very sharp vision and can correct refractive errors. Most critically, they bathe the cornea in saline all the time. That eases dryness and keeps the eyelid from rubbing the cornea.

Amniotic membrane products

Manufacturers make amniotic membrane products from processed human amnion, the innermost layer of the placenta. Eye doctors use them to speed healing on the surface of the eye, and the same products help diabetic skin ulcers and other wounds. On the eye, they mainly help large surface defects heal. The membrane gives surface cells a scaffold, so those cells can move across the defect more easily.

Eye doctors also use them for severe dry eyes. Self-retained cryopreserved amniotic membrane (Prokera) is a ring with amniotic membrane stretched over it. Your doctor places it on the eye in the office and removes the ring after the membrane dissolves, usually in 5 to 7 days. Some patients do better with a dehydrated amniotic membrane (AmbioDisk). Your doctor places it on the cornea under a large-diameter contact lens and then hydrates it.

Drugs that stimulate tear production

Systemic drugs that stimulate saliva and tear secretion, such as bethanechol, pilocarpine (Salagen), and cevimeline (Evoxac), help.

Attributions

The above list comes from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers” and a group of international Sjogren’s experts and researchers called SjoNet. Image designed by www.freepic.com

For more in-depth information on Dry Eyes and Lupus: Eye Doctor Tips and Tricks [January 2026 Update]:

Read more in The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

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