Dry Eye Treatment Q&A
With Dr. Sarah DiPonio-Tulchinsky of Progressive Family Eye Care in Plymouth, MI
Dry eye syndrome (DES or dry eye) is a chronic lack of sufficient lubrication and moisture on the surface of the eye. Its consequences range from minor irritation to the inability to wear contact lenses and an increased risk of corneal inflammation and eye infections.
Hi there I am Dr. Sarah and I wanted to go over some common patient questions and concerns regarding dry eye. First is it true that dry eye seems to be more severe in the winter months as opposed to spring and summer? Yes, we do tend to see increased dryness in the winter, there is less humidity in the air, the heat is on, which not only drys out our skin, it also drys out our eye tissues as well. So especially here in Michigan we tend to see that as soon as we start turning our heat on, that dryness becomes more of a problem. Having a humidifier in your house or in your bedroom can sometimes be helpful to address that issue. When should a person come in to see their optometrist for dry eye symptoms, and when is it enough to take care of this problem yourself?
I always recommend coming in to see your optometrist, there are a variety of different types of dry eye, there are a million different treatment options when you go to the store, the shelves are just lined with different eye drops and sometimes it is difficult to make a choice. And not all of those products are the best product for each individual person. So anytime you are experiencing symptoms of dryness which include an actual dry, scratchy, gritty feeling , burning, redness, tearing. You should have that looked at, come on in we will take a look at you, and we will see what we can do. Based on our eye exam findings and your symptoms, we will provide a treatment plan that is appropriate for your particular type of dry eye. What is the examination like to determine if someone has dry eye? We check vision, sometime dry eye can cause fluctuation of vision. We also examine you with a microscope, our slit lamp which is right behind me here. I examine the tear film, I examine the glands on your eyelids that release oils to the surface of your eye which are super important in preventing dry eye .Often times I will put a little dye in your eye, that helps me better evaluate the tear film and how it moves across the surface of your eye. It can also highlight dryness or dry spots on the surface of your eye. So we check vision, we take a good look with the microscope at the front surface of your eye, as well as examining your eye lid.
So one question is, I have a friend whose eyes are frequently overly watery, that isn't dry eye is it?So I mentioned this earlier briefly, watery eyes is a symptom of dry eye. So if your eyes are overly watery, a lot of patients will complain that their eyes tear in the morning or towards the end of the day or after being on a computer their eyes are tearing. They don't think they have dry eye, because they are producing too many tears, however reflex tearing like that is actually our bodies response to dryness. That happens when the surface of your eye gets too dry and your brain realizes that there is a problem and just produces a whole bunch of tears.
The problem is that they are not good thick tears that stick to the surface of the eye and provide the barrier that you need. They are just these wet watery reflex tears that just roll out of your eye. So excessive tearing can absolutely be a symptom of dry eye, and in fact it is one of the primary symptoms of dry eye, and should be evaluated. What are typical treatments used to help people suffering from dry eye?Again this is why it is important to have you come in and have us take a look at your eyes, so I can evaluate exactly what the cause of the dry eye is, and develop a treatment plan for you. Sometimes for mild dry eyes it is just increasing your water intake, making sure you are drinking enough water throughout the day. Sometimes it is adding in artificial tears drop, and again there are a whole range of products available as far a tear drops go. And I will absolutely make a recommendation as to which is the best eye drop or treatment option for you. Sometimes we go a step further, sometimes we need to add in vitamin supplementation or Omega 3 supplementation. Sometimes for severe cases or when we have tried other treatments and we are not seeing results, there are prescription dry eye medications that we can start you on. Sometimes it is hot compresses and massage to get those oil glands working a little bit better, so that we can produce a higher quality tear film for you to make your eyes feel more comfortable. Sometimes it is as simple as adding a humidifier to your bedroom.
Persistent dryness, scratchiness and a burning sensation in your eyes are common symptoms of dry eye syndrome. These symptoms alone may be enough for your eye doctor to diagnose dry eye syndrome. Sometimes, he or she may want to measure the amount of tears in your eyes. A thin strip of filter paper placed at the edge of the eye, called a Schirmer test, is one way of measuring this.
Some people with dry eyes also experience a "foreign body sensation” – the feeling that something is in the eye. And it may seem odd, but sometimes dry eye syndrome can cause watery eyes because the excessive dryness works to overstimulate production of the watery component of your eye's tears.
In dry eye syndrome, the tear glands that moisturize the eye don't produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.
Dry eye syndrome has several causes. It occurs:
- As a part of the natural aging process, especially among women over age 40.
- As a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills.
- Because you live in a dry, dusty or windy climate with low humidity.
If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.
Dry eyes are also associated with certain systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren's Syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis or lupus).
Long-term contact lens wear, incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.
Dry eye syndrome is more common in women, possibly due to hormone fluctuations. Recent research suggests that smoking, too, can increase your risk of dry eye syndrome. Dry eye has also been associated with incomplete lid closure following blepharoplasty – a popular cosmetic surgery to eliminate droopy eyelids.
Dry eye syndrome in is an ongoing condition that treatments may be unable to cure. But the symptoms of dry eye – including dryness, scratchiness, and burning – can usually be successfully managed.
Your eye care practitioner in Plymouth may recommend artificial tears, which are lubricating eye drops that may alleviate the dry, scratchy feeling and foreign body sensation of dry eye. Prescription eye drops for dry eye go one step further: they help increase your tear production. In some cases, your doctor may also prescribe a steroid for more immediate short-term relief.
Another option for dry eye treatment in Plymouth involves a tiny insert filled with a lubricating ingredient. The insert is placed just inside the lower eyelid, where it continuously releases lubrication throughout the day.
If you wear contact lenses, be aware that many artificial tears cannot be used during contact lens wear. You may need to remove your lenses before using the drops. Wait 15 minutes or longer (check the label) before reinserting them. For mild dry eye, contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary. Switching to another lens brand could also help.
Check the label, but better yet, check with your doctor before buying any over-the-counter eye drops. Your eye doctor will know which formulas are effective and long-lasting and which are not, as well as which eye drops will work with your contact lenses.
To reduce the effects of sun, wind, and dust on dry eyes, wear sunglasses when outdoors. Wraparound styles offer the best protection.
Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that's too dry because of air conditioning or heating.
For more significant cases of dry eye, your Plymouth eye doctor may recommend punctal plugs. These tiny devices are inserted in ducts in your lids to slow the drainage of tears away from your eyes, thereby keeping your eyes moister.
If your dry eye is caused by meibomian gland dysfunction (MGD), your doctor may recommend warm compresses and suggest an in-office procedure to clear the blocked glands and restore normal function.
Doctors sometimes also recommend special nutritional supplements containing certain essential fatty acids to decrease dry eye symptoms. Drinking more water may also offer some relief.
If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first.
Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid drops, plus frequent eyelid scrubs with an antibacterial shampoo.
If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until your dry eye condition is successfully treated. Dry eyes increase your risk for poor healing after LASIK, so most surgeons will want to treat the dry eyes first, to ensure a good LASIK outcome. This goes for other types of vision correction surgery, as well.