Brinton Vision – Lasik St. Louis

Dry Eye Syndrome – Considerations and Recommendations

One of the most important determinants of clear vision, consistent vision, and eye comfort is a healthy, consistent, moist layer of tears in the eye. By contrast, if the amount or quality of tears is reduced, this can lead to both a decrease in eye comfort and a decrease in clarity of vision. Patients with dry eye syndrome may experience burning, stinging, the sensation that something is in the eye, stringy mucus in or around the eye, fluctuating vision, blurry vision, shadows to the side of letters, halos around lights, nighttime glare, sensitivity to light, eye fatigue, eye redness, difficulty with nighttime driving, difficulty with contact lenses, and other symptoms. At your eye exam our doctors may see a lower level of tears, irregular tears, tears that do not coat the eye well, tears that quickly evaporate, tears with insufficient amount or quality of oil, dry spots on the eye, blocked oil glands on the eyelid, thickened and cloudy oils, or oil and debris buildup on your eyelids.

Our doctors may notice these findings on your eye exam even if you do not experience the symptoms listed above. Some patients with dry eye syndrome do not even feel that their eyes are dry. In fact, one of the classic symptoms of dry eye is an eye that waters frequently. Consider this analogy. If your lips are dry and chapped enough the skin may crack. If you lick them with your tongue they may become temporarily moist, but in reality when this moisture evaporates your lips are still dry. A dry eye is a chapped eye, and the small “cracks” on the eye can scatter light and lead to blurry, fluctuating vision. While there is no pill or cure to fix dry eye, there are strategies which, when applied consistently over time, can help you manage it.

General strategies:

  • Turn off all bedroom fans, even if they are small, off to the side, or pointed away from you. Circulating air can dry your eyes while sleeping. For noise you can use a white noise machine/app. Turn down your thermostat if you are too warm. If you like the sensation of a breeze or circulating air you can use a humidifier, preferably with filtered or distilled water – tap water contains many minerals that can provide a breeding ground for bacteria inside your humidifier.
  • Avoid over-the-counter medications that dry the eyes, including Zyrtec, Allegra, Claritin, Sudafed, etc. For eye allergies we prefer you use a drop such as Zaditor 2x/day.
  • Don’t stare at a computer. Our average blink rate is around 16x/min, however one study showed that if we focus intently on a book, phone, computer screen, etc. our blink rate decreases to an average of 4x/min. This is a common cause of eyestrain when using a computer. To mitigate this issue, stay well hydrated, remind yourself to blink (picture your return key being the blink key), use artificial tears, and follow the 20/20/20 rule – every 20m take a 20s break and look at least 20ft away into the distance.
  • Never rub an eye. If your eyes itch, use an artificial teardrop, stretch the skin over the bones around your eye (with clean hands), or place a clean, cool washcloth over your eyes. Avoid touching your eyelids or eye unless you have just washed your hands.
  • Consider wearing wraparound sunglasses or other protective eyewear. Safety shields on the top and side of glasses can block wind and dry air.
  • Be aware of your environment. The air at high altitudes, in desert areas and in airplanes can be extremely dry. When spending time in such an environment, it may be helpful to frequently close your eyes for a few minutes at a time to minimize evaporation of your tears.
  • Position your computer screen below eye level. If your computer screen is above eye level, you’ll open your eyes wider to view the screen. Position your computer screen below eye level so that you won’t open your eyes as wide. This may help slow the evaporation of your tears between eye blinks.
  • Stop smoking and avoid smoke. If you smoke, ask your doctor for help devising a quit-smoking strategy that’s most likely to work for you. If you don’t smoke, stay away from people who do. Smoke can worsen dry eyes symptoms.

Specific procedures:

  • Take omega-3 fish oil supplements. A common recommendation is to take two capsules twice a day for a total of 400 mg EPA and 200 mg DHA per day. If this leads to an unpleasant taste in your mouth you may freeze the pills. Discuss this with your primary care physician first if you have any medical conditions.
  • Take preservative-free artificial tears that come in a twist-top vial. Artificial tears in a bottle should not be used, even if the bottle is labeled “preservative-free.” The preservative-free vials typically contain 9-11 drops each, and as long as you do not touch the tip, you may re-cap these vials and use them for multiple applications within 24 hours. It is impossible to over-use preservative free artificial tears – think of them more like a lotion for dry hands. For added comfort you may chill the vials in a refrigerator.
  • Take Refresh Celluvisc at nighttime (available at Amazon.com)
  • We may place a punctal plug or “tear-retaining plug” in your eyelid while you are in our clinic. We have plugs that dissolve after 7 days or 3 months as well as permanent plugs that do not dissolve. Placement of a tear-retaining plug takes a few minutes, usually does not hurt, and can be highly effective at treating dry eye.
  • Use two sprays of Avenova to the face with open eyes twice a day. This medication is now available over-the counter and can be purchased online.
  • Take 1 drop of Restasis in both eyes twice a day. This requires a prescription. *Take 1 drop of Xiidra in both eyes twice a day. This requires a prescription.

Additional information about dry eyes, courtesy of MayoClinic.com

Causes – dry eyes are caused by a lack of adequate tears. Your tears are a complex mixture of water, fatty oils and mucus. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eyes from infection. For some people, the cause of dry eyes is decreased tear production. For others it’s increased tear evaporation and an imbalance in the makeup of your tears.

  • Decreased tear production

Dry eyes can occur when you’re unable to produce enough tears. Common causes of decreased tear production include:

  • Aging
  • Certain medical conditions, including diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren’s syndrome, thyroid disorders and vitamin A deficiency
  • Certain medications, including antihistamines, decongestants, hormone replacement therapy, antidepressants, and drugs for high blood pressure, acne, birth control and Parkinson’s disease
  • Laser eye the procedure, though symptoms of dry eyes related to this procedure are usually temporary
  • Tear gland damage from inflammation or radiation
  • Increased tear evaporation

Common causes of increased tear evaporation include:

  • Wind, smoke or dry air
  • Blinking less often, which tends to occur when you’re concentrating, for example, while reading, driving or working at a computer
  • Eyelid problems, such as out-turning of the lids (ectropion) and in-turning of the lids (entropion)
  • Imbalance in tear composition

The tear film has three basic layers: oil, water and mucus. Problems with any of these layers can cause dry eyes. For example, the oil film produced by small glands on the edge of your eyelids (meibomian glands) might become clogged. Blocked meibomian glands are more common in people with inflammation along the edge of their eyelids (blepharitis), rosacea or other skin disorders.

 

Risk factors – factors that make it more likely that you’ll experience dry eyes include:

  • Being older than Tear production tends to diminish as you get older. Dry eyes are more common in people over 50.
  • Being a A lack of tears is more common in women, especially if they experience hormonal changes due to pregnancy, using birth control pills or menopause.
  • Eating a diet that is low in vitamin A, which is found in liver, carrots and broccoli, or low in omega-3 fatty acids, which are found in fish, walnuts and vegetable oils
  • Wearing contact lenses

 

Complications – people who have dry eyes may experience these complications:

  • Eye Your tears protect the surface of your eyes from infection. Without adequate tears, you may have an increased risk of eye infection.
  • Damage to the surface of your eyes. If left untreated, severe dry eyes may lead to eye inflammation, abrasion of the corneal surface, corneal ulcer and vision problems.
  • Decreased quality of Dry eyes can make it difficult to perform everyday activities, such as reading.