Dry Eye Treatment in Shelton, WA

Most patients we see for dry eye have already tried artificial tears from the drugstore. They’ve worked through the lubricant aisle, maybe tried a humidifier, maybe their primary care doctor told them to take fish oil. And they’re still uncomfortable.

Here’s the thing: chronic dry eye isn’t one condition. It’s a category of conditions, with several different underlying causes — and the right treatment depends on which cause is yours. Drops alone can’t fix the underlying problem if your tear glands are blocked, your eyelid margins are inflamed, or your tear film is evaporating too fast. That’s why a proper dry eye evaluation matters.

Symptoms of dry eye disease

Dry eye doesn’t always feel “dry.” The most common symptoms include:

The watering-eyes symptom surprises many patients — how can your eyes water if they’re dry? Reflex tearing happens because your tear film isn’t stable; your eyes try to compensate by producing low-quality tears in bursts. The watering is actually a sign of dry eye disease, not the opposite.

Why dry eye happens

The most common causes we see in our practice are:

• Meibomian gland dysfunction (MGD) — tiny oil glands along your eyelid margins get blocked, so your tear film evaporates too quickly. This accounts for around 85% of dry eye cases, but it’s often missed by exams that don’t specifically look at the eyelid margins under magnification. The watery layer of your tears is fine; the oily layer that should keep them from evaporating isn’t getting out.
• Aqueous deficiency — your eyes don’t produce enough of the watery layer of tears. Often related to age (tear production drops significantly after 50, especially for women in or after menopause), autoimmune conditions like Sjögren’s syndrome, or systemic medications. Less common than MGD but more responsive to certain treatments like punctal plugs.
• Blepharitis — chronic inflammation of the eyelid margins. Often involves bacterial overgrowth or Demodex mites (microscopic creatures that live in eyelash follicles — harmless in small numbers, problematic when they overpopulate). Causes flaky crust at the lash line, redness, and irritation that won’t resolve until the lid hygiene is addressed.
• Contact lens overuse — lenses worn too long or in older formulations disrupt the natural tear film. Switching to a daily disposable in a more breathable material often resolves what feels like dry eye.
• Computer and phone use — we blink less than half as often when concentrating on screens, and we tend to blink incompletely. The problem isn’t the screen itself; it’s our blink behavior.
• Medications — antihistamines, antidepressants (especially SSRIs), blood pressure medications, hormone therapy, and Accutane all reduce tear production. Most patients on these don’t realize the connection. We’ll review your meds when you come in.
• Hormonal changes — pregnancy, perimenopause, and menopause can all trigger or worsen dry eye, even in patients who never had problems before.
• The Pacific Northwest climate — counterintuitively, our wet outside air doesn’t help. Indoor heating in winter, wind off the water, screen-heavy work, and the heavy spring pollen seasons that inflame eyelids all contribute.

What a dry eye evaluation looks like

A proper dry eye work-up goes well beyond a standard eye exam. When you come in for a dry eye consult, we’ll typically:

• Take a detailed history of your symptoms, when they’re worst, and what you’ve already tried.
• Examine your eyelids and eyelid margins under high magnification, looking for blocked oil glands, inflammation, crusting, and Demodex mite involvement.
• Evaluate your tear film stability and quality.
• Check your corneal surface for damage from chronic dryness using vital dyes that highlight areas where the surface is compromised.
• Discuss what we found and walk through the treatment options that match your specific cause.

This is typically billed as a medical eye exam, not a routine vision check — which means most medical insurance, including Apple Health and Medicare, will cover it.

How we treat dry eye

The right treatment depends entirely on what we find during the evaluation. Most patients benefit from a stepped approach — we start with the simplest interventions and add more as needed.

Step 1: Foundational at-home care

For mild cases, the first line is consistent at-home care done correctly:

• Preservative-free artificial tears used regularly, not just when symptomatic
• Warm compresses with a heated mask (not a damp washcloth, which cools too fast) to soften blocked oil gland secretions
• Lid hygiene with foam cleansers like OCuSOFT or hypochlorous acid sprays for blepharitis
• Omega-3 fatty acid supplements, which have decent evidence for tear film quality
• Identifying and reducing environmental triggers — ceiling fans aimed away from the bed, screen breaks, allergy management

Step 2: Prescription medications

When at-home care isn’t enough, we can prescribe medications targeted to the underlying cause. Common options include:

• Restasis or Cequa — cyclosporine drops that gradually increase your eyes’ own tear production. These work best for patients with reduced tear production rather than evaporative dry eye, and they take 1-3 months to reach full effect.
• Xiidra (lifitegrast) — targets a different inflammatory pathway than cyclosporine. Some patients tolerate it better, and it can work faster.
• Tyrvaya (varenicline) nasal spray — stimulates the trigeminal nerve pathway to increase tear production. A great option for patients who can’t tolerate eye drops or whose hands struggle with putting drops in.
• Topical steroids — short courses for inflammatory flares. Used carefully because long-term steroid use raises pressure and cataract risk.
• Doxycycline or azithromycin — oral medications used at low doses for stubborn meibomian gland dysfunction. These work as anti-inflammatories at the doses we use, not as antibiotics.

The right choice depends on what we find during your evaluation. Cyclosporine for an evaporative dry eye patient often disappoints; the same drop for an aqueous-deficient patient can be transformative. Diagnosis first, then treatment.

Step 3: In-office procedures

For moderate to severe dry eye, in-office treatments can address the underlying cause directly. The two we use most often in our practice:

• Punctal plugs. Tiny biocompatible plugs placed in the small drainage openings in your eyelids. By slowing tear drainage, they help your existing tears stay on the eye longer. The procedure takes about 5 minutes per eye, is essentially painless, and is reversible. Most patients notice a difference within days. This is often a great option when aqueous deficiency is the main issue.
• Amniotic membranes. A small disc of preserved amniotic tissue placed on the eye like a bandage contact lens. Amniotic membranes have powerful anti-inflammatory and healing properties, and they’re especially useful for patients with significant corneal surface damage from chronic dry eye. The membrane dissolves over several days, and most patients see substantial improvement in both symptoms and corneal health.

There are also several technology-driven dry eye treatments available in the broader field — LipiFlow thermal pulsation, iLux gland expression, Optilight intense pulsed light therapy (IPL), MiBo Thermoflo, low-level light therapy, BlephEx exfoliation, and TearCare among them. These can be excellent options for the right patient. We’ll let you know whether any of them might be appropriate for your situation, and refer you to a colleague who offers them if needed.

Dry eye and contact lenses

Dry eye is the single biggest reason people quit contacts. The frustrating part is that it usually doesn’t need to happen — most contact lens dropouts are fixable. The trick is figuring out which problem you have:

• The lens is wrong for your eyes. Older monthly lenses, lower-water-content materials, and ill-fitting lenses dry out the cornea. Switching to a daily disposable in a more breathable material often solves the problem in a single visit.
• You’re wearing them too long. The classic story: lenses that were fine when you wore them for 8 hours are miserable now that you wear them 14. We may shorten your wear schedule or switch you to a backup pair of glasses for evening.
• You have underlying dry eye disease. The contacts aren’t the problem; they’re the symptom. We treat the underlying dry eye and your existing lenses might suddenly work fine again.
• Allergies or blepharitis. Inflamed lids and an irritated cornea make any contact lens uncomfortable. Address the underlying inflammation and tolerance comes back.

If you’ve been wearing the same lenses for years and they’re not comfortable anymore, schedule a contact lens consultation along with your dry eye evaluation. We fit daily disposables, monthly soft lenses, toric lenses for astigmatism, and multifocal lenses for presbyopia.

When to come see us

Dry eye rarely resolves on its own, and it tends to progress slowly — you may not notice how bad it’s gotten until you stop and think about it. Some signs it’s time to be seen:

Call us at (360) 427-8324 to schedule a dry eye evaluation. If you have medical insurance — including Apple Health, Medicare, or any major plan — the visit is typically covered. We’ll verify your benefits before your appointment and let you know what to expect.