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What I Tell My Patients When They Have Dry Eye
Have you been told that you have dry eye or do you think it is a possiblility? The term "dry eye" can be misleading because you may have excess tears in your eye and you would think that "wet eyes" or "teary eyes" would be more descriptive. However, we call it dry eye because we are using the term in the same way as if we said you had "dry skin"" Obviously you can have dry skin even if you are "dripping wet" since it refers to the texture and smoothness and health of your skin. In the same way we are referring to the eye surface tissue and how smooth and healthy it is.
A healthy eye has to have a certain amount of moisture, but it must be of the proper quality as well as quantity.
This allows your eyes to be comfortable and not irritated. They are then more able to resist eye infections and give stable vision. You also will have a better appearance.
Sometimes you will be very aware of the irritation to your eyes. They may feel dry and scratchy (as you would expect) or they may be watery as described above. Commonly you will not realize that anything is amiss, but a comprehensive eye examination by a qualified eye professional reveals the presence of the problem because we evaluate the tissues of the eye to determine their health and moisture level. The testing reveals the presence of abnormally dry eye or abnormal eyelids.
There are several causes of dry eye.
A common cause is that the glands in the eyelids become inflamed and thereby secrete bacteria and toxins onto the surface of the eye which then causes irritation. This damages the surface of the eye and the resulting irritation often causes your eye to tear. Unfortunately the tears are unable to get rid of the bacteria and the inflammation.
The meibomian glands in the eyelids are responsible for providing an oily tear film to the eye which helps keep the surface healthy and moist. Sometimes the glands become plugged with hardened fatty deposits and therefore do not provide the eye with the oily film it needs. One goal of dry eye treatment is to loosen up the plugged glands and get the proper secretions to flow again.
There are seven kinds of tear secreting glands in the tissues around the eye and anything causing a disruption of any of the glands can cause trouble. The lacrimal glands secrete the main watery component of the tears. Obviously if enough moisture is not secreted onto the surface of the eye it will tend to dry out.
Dry eye treatment depends upon the cause. Often we will start with one or two treatments and then evaluate the results. If we have success we can then leave it at that.
However, often we need to add additional steps to the treatment program.
A common first step is the eyelid scrub. The purpose of eyelid scrubs is to clean off the eyelid margin where the meibomian glands are emptying their damaging contents. There are commercial products available at the drug store without a prescription (such as OcuSoft lid scrubs) which are small pads moistening with a cleaning solution and they are easy to use. However, even a clean washcloth moistened with hot water is almost as good. Pull the eyelid away from the eye as you scrub the upper and the lower lid for about 30 seconds each and then repeat for the other eye. This amounts to basic eyelid hygiene and is equivalent to flossing your teeth and therefore should be done EVERY day.
Often times the addition of a little heat will aid in the process.
Use a moderately hot washcloth folded up into a pad and keep it against your closed eyelids for several minutes. Then do the eyelid scrubs as described above. Don't overdo it or you may cause additional complications.
Sometimes I prescribe a kit (Alodox) available at the drugstore that combines the above products along with a prescription medicine (low dose doxycycline tablet) that you use for a few months. This is beneficial in more severe cases and can really make a difference in the comfort of your eyes.
Another initial treatment is the use of omega 3 oils.
They help to loosen up the clogged hardened fatty secretions blocking the meibomian glands and assure that you have the proper oily tear film. These oils (also known as fish oil or flax seed oil) are also good in helping prevent macular degeneration of the eyes.
Omega 3 oils are beneficial for almost everyone and are recommended by cardiologists for your heart. They are good for your joints and nearly every tissue of your body because they reduce inflammation. I recommend at least 1000 mg of the active ingredients in fish oil, DHA and EPA. Most commercially available fish oil capsules have only 300 mg in each 1000 mg capsule so it would take approximately 3 or more of these a day for the beneficial effect.
(I have a super potent formulation that supplies almost 700 mg of EPA and DHA in each 1000mg capsule available for a very economical price. It is also pharmaceutical grade and is free of mercury and other contaminates.)
There are several kinds of non-prescription eye drops that are helpful for dry eye. I recommend Systane, Refresh or Soothe-XP or TheraTears. They are much better than Visine. The purpose of these eye drops is to replace your tears with a scientifically formulated tear substitute and they often work quite well. Their disadvantage is that their beneficial effect may not last long so you will need to constantly put the drops in your eye.
Prescription eye drops
Prescription eye drops may be used to reduce the inflammation of the eye lids (AzaSite) or on the surface of the eye (Lotemax). We will only use them for a month or two at the most and then will discontinue them. A prescription called Restasis can be used to increase the secretion of the watery portion of the tears. Restasis takes a month or two to work so it is usually combined with the other eye drops for the first month or so until it" kicks in", but it needs to be used long term.
A completely different treatment for dry eye is to use punctal plugs. They are small inert silicone plugs that close the opening to the "drain" in the corner of the eyes. They are semi-permanent as they will usually last for a year or two. The purpose of the plugs is to keep your own tears in your eyes. We have to make certain first that your tears are not contaminated with bacteria and toxins, as discussed above.
Yours for healthy eyes!