Dry Eye

Dry Eyes have probably been around for as long as man has roamed the earth but it seems like lately I see it more and more in practice. I can attribute this to several things; the overuse of our eyes on computers (computer vision syndrome), poor hydration, poor diet (low in a proper balance of essential fatty acids, oils, and vitamins), smoking, living/working in climate controlled environments, and certain medications to name a few. It seems to me that most of my patients over the age of 40 have some level of symptomatic dry eye. Recent studies have shown that the actual prevalence of dry eye among people aged 20-91 may be somewhere between 14-33%. That’s a wide range, but I will tell you that in our experience, it’s about right for those under 40, but for those over 60, we think it’s higher.

So, what do we do about it? Well, that depends upon the problem. There are two basic types of dry eye.

First, and most common, is an under-production of the watery layer of tears. This problem is usually accompanied by the classic symptoms of red, gritty, sore eyes. For this problem, it’s important to address any underlying issue (see above causes) but is usually helped through the use of supplemental artificial tears. It’s important to know that not all artificial tears are the same, so ask your eye doctor which might be best for you. Most importantly, don’t use any of the artificial tears that have a medicine “to get the red out.” For our patients, we recommend either Systane Ultra, Optive, Optive Advanced or Theratears artificial tears for this form of dry eye. I would caution that if you use one of these drops and it doesn’t fully relieve your symptoms for AT LEAST 2 HOURS, then you are better suited for full medical treatment of your dry eyes. We have also recently had very good success with the use of a “medicine” called Freshkote. This is an eye drop that is essentially a different type of artificial tear, one that not only replenishes but binds the tears to the eye. I call it a “medicine” because there really is no real “medicine” in it, but rather an agent that consists of large molecules that can attract and hold tears in place as well as help to bind the tears that are already present. Further, the use of punctual plugs work well when the dry eye is treated early. The strategy that works best for people with this type of dry eye, however, is the use of Restasis. When implemented, this drug can work to improve the cell density that produce tears dramatically. I recommend this treatment daily to patients. In addition to Restasis, Xiidra, a new prescription Dry Eye drop was recently approved for use by the FDA. It works a little bit differently than Restasis and offers patients with Dry Eye the first new medication in over 15 years.

The second type of dry eye is related to a poor consistency of the tear film. This is usually seen in people that have “oily” tears and skin, especially those with Rosacea. These eyes produce an inconsistent oil layer to their tears which, in turn, causes eyes to poorly bind tears to the eye. Often times these people have an underlying eyelid infection. You’ll know if you’re one of these people because your eyelids are often crusty and the rim of the lids are frequently light red. This indicates chronic infection. The treatment for this type of dry eye often involves the use of warm compresses (to open the tear pores and evacuate the stuck oil) and lid cleansers (to physically clean away the stuff that can clog tear ducts). We often prescribe a very low dose of oral antibiotics to help clear the infection and maintain the optimal milieu. In practice, I think that these types of dry eyes are the easiest to treat, provided that the patient adhere to the strategy of using the warm compresses, using the lid scrubs and taking their medicine. If not, then it’ll all invariably come back again.

There is a lot more that can be said about dry eyes, it’s causes and it’s treatments. Fortunately it’s a well-researched topic that produces new strategies for us to adopt all the time. For instance, there has been more and more research done lately about the use of nutritional supplements to help alleviate the problem. Companies like Biosyntrx and Theratears Nutrition produce well-researched supplements that will, when taken properly, help. Omega 3 fatty acids have also recently undergone rigorous scientific testing and have been shown to be very helpful. The catch is, you need to take the right O3′s. Not all are designed the same. Products from Carlson and Nordic Naturals have been shown to be effective. Recently, PRN has developed an enhanced version of fish oil that they have received 2 patents for. Their formulation is readily absorbed by the body and has been clinically shown to help with dry eye and the cardiovascular system.

As always, we’re happy to answer any questions about your eyes. If you think you have dry eyes or you would like to make an appointment to discuss this further please contact the office at info@ourtowneyecare.com or call 603.924.9591.