It is not
necessary to needlessly suffer . . .
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"; it refers to the
texture and smoothness and health of your skin, not whether or
not you are wet. In the same way
we are referring to the eye surface tissue and whether or not
it is healthy and smooth.
A healthy
eye has to have a certain amount of moisture, but it must be
of the properquality 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 tissue and/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 per day, 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 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 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 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 punctual 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!
Dr. David
Littlefield, O.D.,
F.A.A.O.
Littlefield
Optometry
13014 State
Line
Leawood, KS
66209
913-498-1363
www.drlittlefield.com
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