Dry Eye Problems
Some many patients come in concerned about their red, dry and burning eyes. End of day comfort for patients is at an all time low. What is causing this issue? When I got out of Optometry school 20 years ago, very few people had dry eye problems. With the onset of smart phones and tablets, though, dry eye has skyrocketed throughout the past 15 years. Now with COVID and increased work from home more people than ever suffer. When we are on our screens, our blink rate is half of our rate. When we are not blinking, tears stagnate and break down, leading to thinner tear films and more inflammation in our eyes.
What are the signs of dry eye?
Red, burning and fatigued eyes, especially at the end of the day, are signs of dry eye. Itching eyes is a symptom as well, and sometimes rubbing your eyes produces tears and makes them feel better. Other people notice a fluctuation in their vision: clear vision sometimes, then blurry, then clear again when they blink. Also, patients notice more blurred vision at the end of the day after hours of computer and phone work.
Dry eye is associated with inflammation. Thinner tears break down into inflammatory chemicals. Anyone with an auto immune or inflammatory health condition has an increased risk for dryness. Many people with dry eye have inflamed eyelids, which can damage the tear producing meibomian glands. Others has an increase in the number of bacteria around their eyelids, which can break down their tear layer and cause thinner tears. Demodex, a parasite that lives in eyelashes (most people have some of these) can also contribute to inflamed glands and decreased tears.
How Do I Treat Dry Eye?
Dry eye is a chronic condition, so if you treat it your symptoms will get better, but if you stop treating it they will come back. The fine balance we need to determine for each person is: how little can I do and still feel great. There are many different treatments for dry eye, and we will discuss together how to treat our individual problem. Here are the treatments we use every day:
- Omega Three Fatty Acids: these vitamins are anti-inflammatory. They help decrease the inflammation in the meibomian glands to increase tear production. I usually recommend these as a lifetime vitamin as they have so many benefits. They are also great for brain health and lower cholesterol!
- Lid Hygiene: We use two different formulas to address increased bacteria or demodex around the eyelids: We Love Eyes foaming cleanser and Hypochlor eyelid spray. One of these should be used every day for eyelid health
- Doxycycline: this Antibiotic is a great anti-inflammatory, especially at the eyelid margin. Usually, patients take a low dose for 60-90 days. The doxycycline decreases inflammation and helps heal damaged meibomian glands resulting in better tear production. This is by far the most effective oral we have available, and can cut the healing time for dry eyes dramatically. Many patients are reluctant to take an antibiotic, but this can be a life changer for those with heavy inflammation. Some people have GI upset with the medication (I always recommend a probiotic to help with this) and doxycycline will make you more sensitive to the sunlight, and more likely to get a sunburn.
- Steroid eye drops: These eye drops decrease the inflammation in the eye and help with symptoms. I usually prescribe these very aggressively for 1-2 weeks then to use for 1 or 2 days as a pulse dose when eyes are really dry. They help with symptoms and redness. It is not safe to stay on a steroid eye drop all the time, as they can cause cataracts and increased intraocular pressure. Occasional use is safe and effective.
- Non-preserved artificial tears: many patients come in with dry patches on their corneas or conjunctiva. In these cases, using a non-preserved artificial tear every hour can allow those damaged tissues to heal. Once the corneas are healed, vision and comfort are vastly increased.
- Warm Compresses: I recommend a mask like a Bruder eye mask, one that you can put in the microwave to heat. To be effective, an eyelid needs warm moist heat for more than 5 minutes. This can help soften the tear components in the meibomian glands.
There are many other effective treatments: exercise has been proven to increase the tear film as well as deep belly breathing as you see in Yoga and when singing from the diaphragm. There are instruments that help move and clear the meibum from meibomian glands like Lipiflow, iLux and BlephX. IPL lasers on the eyelids can also decrease inflammation and repair damaged glands. At Premier Vision, we do not offer these treatments, but can refer you to those that do. At your comprehensive annual exam, talk with me about your dryness symptoms and how we can help you have more comfortable and clear vision by treating your dry eye.
Karen Allen, OD