Dry Eyes

                                                                                                              DRY EYE PROBLEMS

    Here in Naples I often encounter patients with dry eye problems. We have an older population base and dry eyes are definitely a condition that increases with age.
If you are suffering dry eye problems, let me offer some simple suggestions that can help alleviate this problem:

1. OMEGA 3

 Yes, those "fish oil" gel caps that you can buy at your local pharmacy or health food store. Taking these every day can alleviate dry eye problems. While they also offer other health benefits to the body, taking a couple of these every day can over time reduce the incidence of dry eye problems and reduce their severity. How so? Our tears aren't just salt water. There are also oils and mucous in our tears that play an important part in inhibiting evaporation of the tear film. Omega 3 gel caps help maintain that tear composition. Patients of mine have reported back to me marked improvement in their dry eye problems after taking Omega 3 gel caps on a regular basis. Now make sure when you buy these you are getting "OMEGA 3" gel caps and not "FISH OIL" gel caps. "Fish oil" has OMEGA 3 in it, to be sure...but the active ingredient is omega 3. You are better off getting the concentrated ingredient. Fish oil is less expensive but not as potent.


    Underneath your eyelids are small glands that secret oils and mucous onto the eye. These glands can often get clogged and pasty. This is due to factors like hormones and diet. 
Sometimes these glands can become so clogged that they form a "sty" that requires prescription medication or even surgery to remove. Applying heat to the eyelids on a daily basis causes these 
pasty oils to liquify and flow out, restoring the glands. When you apply heat to the lids, try and get as much heat to the lids as you can stand. You might have to do this twice a day for a week before you start seeing results.
As time goes on, you might be able to roll back the frequency of these treatments as your symptoms subside.


     While oils are essential to maintain healthy tear balance, too MUCH oil around the eyes can also throw the chemistry out of balance. People who wear eye makeup that thee remove with baby oil.... (and my patients
who are cautious about getting soap near their eyes) can sometimes acquire an oil buildup. Eyes are especially vulnerable to this at the lid margin where the eyelashes meet the eyelids. In extreme cases the lids can become so inflamed 
as to cause the eyelashes to fall out. The simple remedy for this is to create a dilute solution of baby shampoo and water and to cleanse the lid margins using a face towel or q-tip. This is another therapy that you might have to do from time to time to maintain 
eye health. It's not a cure so much as ongoing maintenance.


     Perhaps you've seen commercials for a medication called Restasis. This is a prescription eye drop that is classed as a cyclosporine. Cyclosporine  is an immunosuppressant that can increase tear production if it has been reduced by inflammation in the eye. Restasis eye drops are used to treat chronic dry eye caused by inflammation. One important thing to note is that not all dry eyes are caused by inflammation. As such, Restasis may not be a cure-all for all forms of dry eye. This treatment is most often useful fighting dry eyes associated with auto-immune inflammation throughout the body like arthritis. When the triad of arthritis, dry eye and dry mouth occur in a patient, it is called "K-sicca" or "keratoconjunctivitis sicca" Another treatment some dry eye specialists are using along the same lines as cyclosporine (for treating inflammatory dry eye) is low-grade steroids. Cyclosporine (Restasis) is thought to have fewer side effects than mild steroid eye drops. These side effects are mostly an increase in eye pressure, cataracts, and reduced immune response with chronic use. Some doctors believe these side effects are minimal with the lower concentration steroids and cortizone is more cost effective. Typically a doctor will try an anti-inflammatory for 2 months to see if the patient responds. Be aware that it sometimes takes a month or two before most patients see results from anti-inflammatory therapy. And some may not see improvement at all.


     In the nasal corner of each eye on the eye lid there is a tiny hole where the tear fluid drains into the nose. This is why when we cry the nose runs. This little hole is called the puncta. There are actually two holes for each eye. One in the top lid and one in the bottom for a total of four. These holes can actually be plugged with a silicone plug that prevents the fluid from draining out of the eye just like stopping up a sink drain.
The bottom two holes are responsible for draining about 80% of the tear fluid, so doctors may plug the bottom two first and monitor the success before plugging all four.  This can be expensive and the plugs can work their way out over the years and have to be replaced...but they can be quite effective as a treatment for severe dry eye problems.


     Visit any drugstore and you'll see various products known as "artificial tears". These are eye drops that replace the natural components of your tears with man-made chemicals to replicate the natural chemistry of your tears. Usually they will have a pH buffer, a preservative, saline, and a proprietary chemical to replicate the mucin and oil components of your tear fluid. Some common brand names are Systane, Hypo tears, Celluvisc, and Tears Naturale. There are also ointments available. Be aware that the more viscous formulations last longer, but may obscure vision more. The best strategy here might be to try a few different ones to choose which works best for you.

7. Drink more water. Sounds simple enough but dehydration for alcohol consumption, high sodium diet, strenuous exercise and other factors can effect tear production. Mild dehydration often makes dry eye problems worse. This is especially true during hot, dry and windy weather. Simply drinking more water sometimes reduces the symptoms of dry eye syndrome.

8. Be aware that some medications can exacerbate a dry eye problem. Antihistamines can often do this because they dry up mucous production and that's an essential component of the tear film. Thyroid medications can as well. If you are noticing a recent onset of dry eye problems in association with a new medication, check for side effects.

Jason Eugenides O.D. Jason Eugenides O.D. is a board certified optometric physician practicing in Naples Florida since 1993. He is the owner and CEO of Vanderbilt Optical.