Ask the Dry Eye Doctor
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Dr. Arthur B. Epstein
Do you have a question about dry eyes? Use the form below to send it to Dr. Arthur Epstein.
Each week Dr. Epstein will answer the best questions submitted, which will be published on this page. Please remember that some questions can't be answered unless an eye doctor sees your eyes in person.
Below are questions that our site visitors have sent in.
To find the Q&As most helpful to you, please click on one of these subjects:
- Dry Eye Causes and Risk Factors
- Allergies and Dry Eye
- Cataract Surgery and Dry Eyes
- Computers and Dry Eyes
- Contact Lenses and Dry Eye
- Dry Eyes Upon Awakening
- Eye Bumps, Eyelid Bumps, and Dry Eye
- Eye Drops and Ointments
- Eye Infections and Dry Eye
- Eye Irritation, Pain, and Dry Eye
- Eye Redness and Dry Eye
- Glaucoma and Dry Eyes
- LASIK/PRK and Dry Eyes
- Medications That Cause Dry Eyes
- Nutrition and Dry Eyes
- Ortho-K and Dry Eye
- Other Diseases and Dry Eye
- Permanent Cures for Dry Eyes?
- Punctal Cautery
- Punctal Plugs
- Vision Problems Related to Dry Eyes
Dry Eye Causes and Risk Factors
Q: I have severe dry eyes. Currently I live in a very dry climate, where it could get as low as 9 percent humidity with over 100-degree temperatures during the summer. My doctor told me that the film of tears that covers my eyes is very thin and evaporates quickly. I also keep getting blepharitis.
I'm a retiree, so moving to another place is not a problem. I'm thinking of moving to a small town by the Gulf, if that would cure my dry eyes. It has low pollution, high humidity, very low elevation and fairly moderate temperatures during the winter. Would that help my situation?
Also, which eye drops would be best for me? My doctor suggested Restasis, but it is extremely expensive. A.J.
A: I live in Phoenix, so I know exactly the kind of environment you now live in. In the hot, dry desert environment, tear evaporation is a major problem. You are fortunate to be able to move so easily. Most folks can't.
The good news is that a move to an area with higher ambient humidity, lower elevation and low pollution should be helpful, but it may not completely alleviate your problems. How much it does depends on the health of your ocular surface and especially the health and function of the meibomian glands. These glands produce a complex oil with every blink that prevents evaporation and helps stabilize the tears.
The best treatment for meibomian gland dysfunction (which from your description I assume you have) is LipiFlow, a procedure developed by TearScience, which clears and restores function to the glands.
Regarding drops, the best contain oils that mimic meibomian gland secretions. These include Alcon's Systane Balance and Allergan's Refresh Optive Advanced Formula. FreshKote is an Rx product that may also be helpful.
I might also suggest that an extended visit to your intended new home would help you decide if the move would make enough difference to justify uprooting yourself from your current home. Dr. Arthur Epstein
Q: I have had dry eyes for more than two months now. Out of those two months there was one week where my eyes were better but not normal. This happens often, and more during the winter months, but I feel that because they are dry for so long, there is a bigger problem than just temporary dry eyes. Could there be something seriously wrong with my eyes? T.D.
A: Dry eye is often a result of one or more protective systems that keep the eyes moist failing to work properly. Seasonal dryness seen during winter heating season or summer air-conditioning season, arid environments typical of the U.S. Southwest, or high altitudes as in Denver, are among the things that can stress ocular surface and tear systems, causing worsened dry eye symptoms.
I suspect your "temporary" dry eye isn't really temporary, but just symptoms of dry eye breaking through. It's likely things will get worse over time, and your symptoms will become more frequent.
For that reason, I suggest you get a full dry eye workup so that therapy can be instituted sooner rather than later, when it may be more difficult to properly manage your dryness. Dr. Arthur Epstein
Q: My wife's eyes seem to water excessively. The tears run down her cheeks and often splash her glasses to the point where she has to clean them very often.
We have tried allergy medications without success. There seems to be little difference between seasons or surroundings, though most big box stores seem to be a bit worse than other environments. Any suggestions would be appreciated. T.F.
A: As odd as it may seem, excessive tearing is often a sign of dry eye. When the surface of the eye becomes irritated, the eye attempts to compensate by producing more tears. Unfortunately, excessive tearing often makes matters worse, as it destabilizes the normal protective tear structure.
I would suggest that your wife try a formulation that helps restore tear balance. Choices include Systane Balance by Alcon or FreshKote by Focus Labs. Both should be available at your local pharmacy. Avoid allergy or eye whitening drops, as these products will often make things worse by irritating the eye's surface.
Finally, much of dry eye is due to excessive evaporation of the tears. If your wife's problem persists, find an eye care practitioner who is dry eye-savvy and have her meibomian gland function evaluated. Meibomian gland oils are key to tear stability and health, and meibomian gland dysfunction may be the root cause of her problem. Dr. Arthur Epstein
Q: My eye care provider told me I have a bit of dryness in my eye, and the cause of it is that I spend about eight hours a day in front of a computer.
I've reduced the time I spend before the computer, and the grittiness is gone. But I still feel dryness, but only a little bit. I'm 16 years old, which is too soon for me to have serious dry eye, but I don't know whether it's chronic or not. Is it possible that I can permanently heal my dry eye? N.
A: The tears and ocular surface work together to keep the eye moist and to insure crisp vision. Dryness usually worsens with age, but it can occur in younger individuals in some cases. Computer use decreases the frequency of blinking, and that promotes evaporation of the tears. That can be either the cause or a factor that contributes to your symptoms.
You might be helped by one of the newer lipid-based dry eye drops that are available at the pharmacy. Because dry eye tends to be both chronic and progressive, if your symptoms persist I would consult with an eye care provider for a full dry eye evaluation. Dr. Arthur Epstein
Q: I traveled to South Africa this past May. My total flight times were 25 hours going and 30 hours coming back. When I came back to the United States I started experiencing extremely dry eyes.
They have recently become so dry that I am able to wear my contacts for only a couple of hours at a time. I have tried over-the-counter drops to try and relieve my eyes but none have helped.
I was wondering if the pressure of the plane is the cause of my dry eyes? Also, what do you recommend to improve my discomfort? L.F.
A: As a fellow traveler who has spent many long hours on international flights, I understand just how eye-unfriendly aircraft cabins can be. In addition to being pressurized usually to equivalent altitudes of 6,000-8,000 feet above sea level the cabins also have very low ambient humidity, typically in the low teens, which can make an otherwise asymptomatic person quite uncomfortable.
For most people, the effects of even a prolonged flight are transient and abate within an hour or two. In your case, I suspect you suffered from marginal dry eye to start with, which became apparent and symptomatic after the long flights.
Without examining you, it is difficult to pin down an exact cause, but my impression is that your primary problem is evaporative dry eye, a condition almost always associated with meibomian gland dysfunction (MGD). Evaporative dry eye may be worsened by some brands of silicone hydrogel lenses, which can attract the lipid that normally serves as a moisture barrier. Lipid attracted to the surface of the lens can disrupt the moisture barrier and often results in worsening discomfort and reduced wearing time.
To properly address your problem, I suggest you consult an eye care professional for a dry eye workup especially looking at meibomian gland function. Your provider can also rule out other possible issues that can cause dry eye that may have coincidentally developed (thyroid problems, for example). If your issue is evaporative dry eye, treatment ranges from dry eye drops containing lipid supplements like Alcon's Systane Balance or Allergan's Refresh Optive Advanced, warm compresses and lid massage, to treatment of MGD with TearScience's LipiFlow system.
From a contact lens perspective, be sure you're wearing a modern, wettable lens material and ask your eye care professional about the proper lens care system to use with your lenses. In my experience, patients suffering from dry eye often do better with daily disposable contact lenses.
With proper diagnosis and treatment, comfort should return, as well as your ability to wear contact lenses. Dr. Arthur Epstein
Q: What are the best areas of the country to live in to avoid dry eyes? I live in Phoenix, which is one of the worst. Are mountain areas better? J.S.
A: Unfortunately, this is a difficult question to answer. For example, Miami has high humidity but we still have a high level of dry eye here. Obviously, Phoenix is very dry because of low humidity, and patients there can be very symptomatic. But another area that has high levels of dry eyes is Colorado. Dr. William Trattler
Q: Sometimes when I cry, tears won't come out of one of my eyes. Why does this happen? S.
A: Sometimes a seemingly simple and straightforward question can be very difficult to answer. This is one of those times. An examiner would need to know your age, how recently this started, if there are any other symptoms or problems you've noticed, and if it always occurs in the same eye. Even with a careful history, proper diagnosis would require a thorough eye exam.
Because some of the causes can be potentially serious, especially if this is of recent onset, I advise that you consult your eye doctor immediately to rule out a serious eye or health disorder. Dr. Arthur Epstein
Q: Can dry eye affect only one eye? S.M.
A: Yes. Dry eye can impact only one eye, but dry eye more commonly affects both eyes, with one eye having more symptoms than the other. Dr. William Trattler
Q: Can dry eye syndrome worsen significantly during pregnancy? I was diagnosed with dry eye syndrome seven or eight years ago. It doesn't bother me too much, and I use over-the-counter eye drops when needed. But I am now in my second trimester and have had red, irritated eyes every day for the past month.
My dry eyes obviously are worse after I read, use the computer or watch movies for long periods of time. I get only temporary relief from the eye drops.
I don't want to go to the eye doctor until January, when my vision benefits go into effect. R.D.
A: The first thing to point out is that dry eye is a medical condition. You would use your medical insurance not your vision insurance for an eye exam.
Regarding your question, I am not aware of any relationship between dry eye and pregnancy. I have a number of OB/GYNs in my office building, and I don't recall any referrals for dry eye from these doctors. So I doubt that pregnancy is a risk factor. But perhaps future research will provide more information on this topic. Dr. William Trattler
Q: Can certain hormones cause dry eyes? In the past, I took prohormones (hormone precursor) for muscle building. Now my eyes burn when I'm around perfume, smoke, etc. Is this due to dry eyes? S.
A: You should see an eye doctor for an evaluation to determine whether dry eye is the cause of your symptoms. It is certainly possible that hormones can be related, as this is an area of research. However, in general, there are no dry eye treatments related to hormones. Rather, we treat dry eye based on the severity of the condition. Dr. William Trattler
Q: I've had a weepy right eye on and off for about two years. Sometimes it just pools in the corner of my eye and sometimes it runs down my face. I've had the tear duct reamed out twice.
I got a second doctor's opinion and he wants to send me to a surgeon. They feel the "sac" is plugged just under the eye near the nose (but not the typical tear duct in the corner of the eye). Is there anything I can do "naturally" to unplug it or get relief? A.S.
A: A clogged lacrimal system can result in excessive tearing. However, dry eye and not enough tears also is often associated with tearing. Determining the cause of the tearing requires a visit with your doctor, who can evaluate the level of the tear film as well as whether the lacrimal drainage system is opened or clogged.
In your case, you have mentioned that you have a clogged system, and have had probing of the system twice, but still have symptoms. The next steps would be to see an oculoplastic specialist and have your condition evaluated.
There is unfortunately no "natural" way that I am aware of to get the duct opened. Consultation with your doctor is important to figure out your options. Dr. William Trattler
Q: What eye drop can I use on my eyes after I have looked at a welding arc? My eyes are red, and it feels like I have sand inside them. The light also bothers my eyes. H.
A: It is, of course, very important for you to wear protective goggles when working with a welding arc. If your eyes were unprotected and exposed, you should see your eye doctor immediately because of possible thermal injury. As well, the heat from the welding arc can cause dryness leading to ocular irritation.
You should talk with your doctor about possible treatments to prevent dryness from the heat, which could include lubricating drops or gels. Dr. William Trattler
Q: Why do my eyes well up in tears when I'm either reading a book or on the computer? E.B.
A: There are lots of possible reasons that your eyes tear excessively when you do close work. Decreased blink rate as you concentrate can reduce tear flow throughout the tear drainage system, which can cause tears to well up. More likely, an unstable tear film and deceased blinking will cause reflex tearing.
Many patients who experience this have evaporative dry eye and would benefit from evaluation of their meibomian glands and treatment if appropriate. Dr. Arthur Epstein
Allergies and Dry Eye
Q: I was told I had an allergic reaction to my Claritin, and I was given cromolyn sodium ophthalmic to get rid of it. But I have been using it every night for a month and have seen no results. My eyes are still really irritated and burn all the time, and artificial tears only help so much. I am 13. Why are the medications not helping, and why are my eyes dry? A.M.
A: An allergic reaction to Claritin drops would be most unusual, since the active ingredient in Claritin is ketotifen, which is an antihistamine the primary class of drugs we use to treat allergy. Cromolyn drops are an older mast cell stabilizer formulation used to treat allergy that some studies have shown to be ineffective in the eye.
Both drops contain preservatives, which I suspect is the more likely cause of your irritation. Preservatives are by nature somewhat toxic and can be irritating to the ocular surface. One option is to discontinue your current drops and use a non-preserved tear until your eyes quiet down.
Even though I believe the cause of your problems is the medications themselves, it would still be wise to consult an eye care professional. Dr. Arthur Epstein
Q: Recently I have been using Zaditen. I do have dry eye. Problem is, I can't stop using it. Every time I take myself off it, my eyes get scratchy and itchy. Here in Melbourne it is and has been a bad allergy/hayfever season.
Am I at any health risk by constantly using Zaditen drops (in the vial)? S.L.
A: Zaditen, a brand name for ketotifen drops, is an antihistamine that is usually quite effective for treating eye allergies. It can cause some irritation upon instillation, but that is usually transient.
I suspect the bad allergy season has gotten to your eyes, and the Zaditen is doing its job.
Keep an eye (pun intended) on allergen counts. When they start to drop, you should be able to discontinue the medication. For now, there is no harm in taking it as directed on the vial. Dr. Arthur Epstein
Q: When I am tired or lately it's been happening more often my nasolacrimal duct gets very itchy. Could you tell me why this is happening? V.
A: Itch is usually associated with allergy. You may be allergic to something in your environment. Itch can also be caused by toxins released by bacteria on the lids that often accompany meibomian gland dysfunction, a primary cause or contributing factor in evaporative dry eye. Dr. Arthur Epstein
Q: I'm 26 years old. In 2009, I went to urgent care because it hurt my eyes to have them closed, open you name it. They said that I had an allergic reaction and it would clear up. Well it's 2013 now, and the dry eyes are just as bad. I get allergies where my eyes will stream tears all day and then remain like a desert. I don't take allergy medications because they don't work for me.
I've seen four different eye doctors and one that told me to take doxycycline hyclate 50mg pills twice a day for two months. I followed the instructions to a "T." The irritated bumps and redness inside my eyelids seem to have gone away almost by 60 percent I'd say.
I still have dry eye, and now that I've run out of insurance, I can't afford to go back to see my eye doctor. My dry eyes affect everything: my job, how long I can stare at computer screens, etc. I've done all the omega-3 you can imagine. What can someone like me do? My eyes are either streaming tears from allergies or dryer than the desert. I went to a place to get involved in a trial, and they said I had the lowest oil levels they'd ever seen 38 and 36 in each eye. A.R.
A: I am really sorry to hear about your problems. They sound severe and disruptive. I am not sure you have allergies. Allergy is almost always associated with itching that you don't describe, and excessive tearing is a frequently seen symptom of dry eye. Irritation causes excessive tearing, which disrupts the balance of normal tears.
You mention that you don't have insurance, so my usual advice, to consult an eye care provider with dry eye experience, may not work. From what you describe, it sounds like you have fairly advanced evaporative dry eye caused by meibomian gland dysfunction. This produces a lack of lipid and excessive tear evaporation and instability. LipiFlow, a breakthrough treatment by TearScience, is the most effective and long-lasting therapy for this condition, but it too is not covered by insurance.
You may get some relief using warm compresses applied to the lids (very warm but not hot enough to burn the delicate skin of the lids), followed by massage of the lids. The technique should really be taught by a doctor, though.
Lipid-containing drops like Alcon's Systane Balance or Allergan's Refresh Advanced are also recommended, as they can help restore lipid levels in the tears. Dr. Arthur Epstein
Q: I have extremely puffy eyes. Every morning my top and bottom lid are puffy. During the day the top lid reduces some but never the bottom. They look like sometimes they have fluid in them. What can I do? S.
A: Puffy eyelids can be caused by ocular allergies. Fortunately, numerous topical medications work for ocular allergies.
Of course, another cause of puffy eyelids is aging. With age, the lids become "puffy" and develop a condition called blepharochalsis. When this occurs, the only treatment is a procedure called blepharoplasty, which is performed by oculoplastic surgeons or plastic surgeons. Dr. William Trattler
Q: My son is active in swimming and water polo. He frequently suffers severe eye irritation during and after water polo matches. Players aren't allowed to wear goggles. Symptoms are severe burning, itching, blurry vision and sensitivity to light. Are there any remedies? R.W.
A: Your son's symptoms suggest that he is sensitive and possibly allergic to something in the pool water. Severe burning, blurring and light sensitivity are symptoms typically caused by irritation of the cornea, which justifies your concern. I urge you to have your son examined by an eyecare professional.
Because the surface of the eye heals quickly, the examination should be conducted as soon as possible after he exits the pool. Alerting the doctor's office when you set up the appointment would be wise so they are expecting your son when he arrives. Although goggles aren't allowed, in this case they may be medically indicated and, with your doctor's help, an exception may be possible. Dr. Arthur Epstein
Cataract Surgery and Dry Eyes
Q: I have had dry eyes for 25 years and had punctal plugs put in 20 years ago. My eyes still are uncomfortably dry even though I use prescription eye drops. I'm now 62 and would like to have cataract surgery. Is it safe for me to go ahead, or should I wait until it is imperative to have the surgery? S.P.
A: I would see your doctor and determine the severity of your cataracts. If the cataracts are impacting your vision, you should discuss cataract surgery with your doctor.
Your doctor also will evaluate your level of dry eye and initiate additional dry eye treatments if necessary. It is important to address dry eye before the surgery, since it can become worse afterward. Overall, your dry eye will not affect the success of cataract surgery with regard to having a safe and successful procedure. The only impact of dry eye can be on the selection of the intraocular lens power.
Dry eye is very common in patients undergoing cataract surgery, so I expect that your cataract surgeon will be able to help you. Dr. William Trattler
Computers and Dry Eyes
Q: I am a pharmacy student in Bangladesh, and I have problems with my eyes when I spend a long time in front of the computer. I feel better only when I close my eyes.
My doctor suggested that I use povidone eye drops (10 mg). But the pharmaceutical company where I work is centrally air-conditioned. Could this be causing the problem with my eyes? It's so hard to study. What can I do? S.S.
A: You are exactly correct. The combination of looking at the computer for prolonged periods of time along with central air conditioning can exacerbate dry eye. When people are using the computer, they have a reduced blink rate. So this results in the eyes staying open longer. When the central air is on and the vents are blowing directly on you this can lead to increased evaporation of tears.
This combination can cause dry eye symptoms. Making the effort to blink more often and moving your work station so you are not facing air vents may help you. Dr. William Trattler
Q: My right eye burns if I spend a lot of time in front of a computer or reading. I drink a lot of caffeinated beverages during the day. I also have gout. Can the level of hydration affect my burning, itching eyes? Can gout affect my eyes? J.H.
A: I am not aware of gout affecting one's eyes. I suspect that, regardless of whether you have gout, the cause of your symptoms is related to the extensive time that you spend in front of the computer. There is a condition called computer vision syndrome (CVS), and one of its causes is that people fail to blink enough when working on the computer. This is very common and leads to ocular irritation and burning.
Please see your eye care professional, who can examine your eyes and help you figure out the cause of your symptoms. Dr. William Trattler
Contact Lenses and Dry Eye
Q: I wear Proclear contacts because my eyes are very dry all the time. The contacts feel dry even if I soak them all night. I put them in and my lenses feel dried out after a few minutes. What can I do? Eyes drops help, but not very much. R.J.
A: Managing contact lens-related dryness can be complicated. First, any existing dry eye issues must be addressed. For most patients this includes a full dry eye workup with particular attention to the health and function of the meibomian glands. Any issues should be treated, especially those causing evaporative dry eye (EDE). EDE can derail any lens wearer.
The Proclear lens is usually an excellent choice for patients who have dryness. New-generation lenses such as Alcon's daily disposable Dailies Total One can make a huge comfort difference for some.
If you stay with Proclear, lens care product choice may also be a factor. Avoid generic store brands and ask your doctor to recommend a product with an advanced wetting formula. I usually suggest Alcon's Puremoist or a peroxide disinfection system.
Keep at it. With modern lenses and lens care products and our better understanding of what causes lens dryness, you should be able to find a solution to your issues. Dr. Arthur Epstein
Q: I wore contacts in high school and started wearing glasses after that. I wanted to switch back to contacts, but my ophthalmologist said my eyes currently don't produce enough tears. About 20 minutes after I put my contacts in they were feeling really dry, and my eyes were just tired overall. He said to just wait six months and see if anything changes.
He also said I might be part of the 5 percent of the population that can't wear contacts. I find that a little weird, since I wore them in high school. I'm only 22. Is there anything I need to be doing to my eyes to keep my tear production going? K.
A: First, if your eyes are so dry that you have been advised that you won't be able to wear contact lenses at your young age, you should have a comprehensive dry eye workup. It's not just concern about your difficulty with contact lenses. If your eyes are that dry at 22, I am concerned about what will happen as you grow older and dry eye tends to worsen.
The first step is to find out why your eyes are so dry. For example, do you have meibomian gland dysfunction and evaporative dry eye, or do you have a disorder that is reducing tear production, or both? Once the cause is understood, in most cases the problem can be managed.
Regarding contact lenses: Once the underlying problem is addressed, there are many new advanced lens materials and lens care products that focus on keeping the eyes moist. A skilled contact lens fitter should be able to find a lens that will provide comfortable wear. Dr. Arthur Epstein
Q: I have worn RGP contact lenses for 13 years. I visited an ophthalmologist who said my eyelids were too red and gave me a sample of Pataday eye drops with a prescription for more to keep me from having dry eye in the future.
I read the warnings on the Pataday and it says the drops are not to be used for irritation caused by contact lenses. I have not used the drops yet, because I'm concerned. D.
A: Since I did not examine your eyes, I cannot tell you whether or not you should use Pataday.
Interestingly, Pataday is not for dry eye but rather for ocular allergies. I would speak with your doctor for further clarification. Dr. William Trattler
Q: A friend's daughter is 9 years old and recently started extended wear contacts. Her eyes get dry in the morning or after a shower with her contacts in, and she puts in contact solution instead of eye drops. Is that OK? M.F.
A: I would recommend that your friend take her daughter to see her eye doctor and confirm that the contact lens is fitting properly.
As well, lubricating drops are a much better option than other types of drops for contact lenses. In particular, contact lens solution typically should not be placed in the eye. Dr. William Trattler
Q: I am 13 years old and wear Acuvue Oasys contact lenses. My doctor told me I could only wear them for eight hours a day. My friends who have the same brand and type can wear them all day. Should I change doctors? B.L.
A: You may not have realized it, but your question actually has a lot to do with dry eye. We know that long-term use of contact lenses can lead to the development of dry eye. As well, if you wear contact lenses for an extended period of time, and especially if you sleep in contact lenses, you are at increased risk for infection.
Your doctor is providing good advice to delay any possible development of dry eye. Also, limiting your contact lens wear time will reduce your risk of infection. Dr. William Trattler
Dry Eyes Upon Awakening
Q: I had cataract surgery last year on both eyes. I'd like to know what kind of eye drops I can use daily to refresh my eyes in the morning. It feels so good to moisten my eyes after a night's sleep and using a CPAP machine.
I've asked my eye doctor, and he recommends drops I just can't afford. I'm a senior, and at the end of month I only have $1.72 left. My daughter helps me with groceries. K.L.
A: I appreciate your budget issues. The best drops tend to be the most advanced and also the most expensive. However, any of the generic dry eye drops should be of some help.
From what you've told me, though, you may actually benefit more from a gel or ointment applied before you go to sleep. If your CPAP is drying your eyes, it's often because your eyes don't completely shut at night while sleeping. This allows escaping air to rush over and dry the exposed ocular surface. In this case a thick gel or ointment may work wonders.
I also recommend that you take a look at the products from Eye Eco. They make an excellent line of protective goggles designed to work with CPAP devices. This may be all you need, and it would be a one-time purchase. Dr. Arthur Epstein
Q: My eyes dry up at night when I am sleeping it's like they run out of lubricants. It doesn't happen during the day. I have tried eye drops, and they don't work. T.C.
A: It sounds like your eyes may not be fully closing during sleep. That's not as uncommon as you may think.
I have several suggestions. First, find a viscous gel like Systane gel, or a petroleum-based eye ointment, and apply to your eyes as directed right before sleep. Try the gel first, and if that doesn't help, use the ointment.
Also, if possible, humidify the room, and if you have fans, turn them off. If your eyes partially open during the night, a fan blowing on them will worsen dryness significantly. This should help.
In any case, seeing an eye care professional is wise. Dr. Arthur Epstein
Q: I have trouble opening my eyelid after a night's sleep. Is this related to a dry eye? V.
A: Trouble opening the eyes in the morning can have many causes. When we sleep, the eyes are designed to stay shut, to maintain moisture and protect the sensitive and vulnerable cornea. Some people sleep with their eyes partially open, which can lead to irritation and light sensitivity, making it hard to open the eyes to the morning light.
Occasionally, excess mucus can partially "glue" the eye shut, which can also happen in the presence of infection.
There are other possible explanations that should be investigated by an eye care professional if this continues to trouble you, especially if it worsens. Dr. Arthur Epstein
Q: I experience dry eyes upon awakening almost half the time. I have no chronic problem. It's just when I wake up. A few times this caused me to scratch my cornea when I blinked. It was so bad that I needed a new eyeglass prescription for that eye. What is the likely cause of this? Would alcohol at night do this? B.M.
A: There are many possible causes of dry eye that occurs only at night, including having a ceiling fan or air-conditioning vent that blows toward your face while you sleep.
Another common cause is related to the position of the eyelids at night. Some people sleep with their eyelids partially open, and this can be very drying.
Another topic that you brought up is whether alcohol can cause your nighttime eye dryness. As far as I know, the answer is no. But this is a great question. You can try avoiding alcohol to see if this results in reduced dry eye symptoms. Dr. William Trattler
Q: Every morning when I get up, my left eye always seems to be red or pink. However, my whole eye is not pink. It is the veins beneath my eye that look inflamed. This causes no pain, itching, or anything. It feels normal but looks different. Do you have any idea what it could be? M.M.
A: Various conditions, from ocular allergies to dry eye, can cause red eye without other symptoms when you awaken in the morning. In my experience, dry eye is the more common cause of this condition, especially if you sleep under a fan or have an air conditioning vent blowing on your eye.
I recommend that you see your doctor, because the exact cause of your problems cannot be determined without an eye exam. Your doctor can determine the cause of your eye redness and prescribe the appropriate medicine. Dr. William Trattler
Eye Bumps, Eyelid Bumps, and Dry Eye
Q: My question is about the small, clear to whitish bumps that have been in my eyes for more than three years. They are located on the inside of the lower eyelid in the corner. I have three to four bumps in one eye and one to two bumps in the other. These bumps have not changed in size or quantity in at least three years. I have no eye discharge or irritation.
An ophthalmologist diagnosed these bumps as allergic conjunctivitis, but that was three years ago and they are still there.
I also have smoked marijuana for about seven years, and I have been trying to detox myself for the past two weeks. This is because I'm starting to think that the marijuana use has caused my eyes to be dry, which could be the cause of the bumps. J.
A: First, I would recommend that you have another eye exam, since you noted that it has been more than three years since your last exam. During that visit, your eye doctor would be able to evaluate your eyes and determine what these bumps are. I cannot figure them out without examining your eyes.
You bring up smoking, and it is important to note that smoking of any kind has been associated with dry eyes. So, in general, dry eye patients should avoid smoking.
I am not aware of any specific studies looking at marijuana use and worsening of dry eyes. But since this is a form of smoking, it is likely that the smoke can irritate the eyes and worsen dry eyes. Dr. William Trattler.
Q: Can chronic dry eye cause a white bump next to the colored part of the eye? H.
A: A white bump next to the colored part of the eye is called a pinguecula. This is caused by UV exposure, although dry eye can cause inflammation that can exacerbate the pinguecula. Dr. William Trattler
Q: I have a white bump on my upper eyelid near where your upper and lower eyelids meet on the side of the eye closer to the ear. The bump looks similar to a pimple. My eye is very dry and it hurts to blink. Help? A.G.
A: A bump on the eyelid is most commonly a stye, but it can be a benign or even a malignant form of cancer. Please see your eye doctor, who can help determine what the "bump" is, as well as the best way to treat the bump. Dr. William Trattler
Q: I have a bump on the white part of my eye. It is a little red and irritating. Is that something serious? J.J.
A: You are describing either a pinguecula or a conjunctival lesion. I cannot know whether this is a benign or serious condition. Please see your eye doctor to determine exactly what this "bump" is. Note that dry eye can irritate bumps on the eye. So lubricating drops are something to consider as well, once you have seen your doctor. Dr. William Trattler
Eye Drops and Ointments
Q: Out of all the artificial tears available at places like Walgreens and CVS, which eye drop might be the most successful at treating any mild to moderate dry eye? J.J.
A: These days, artificial tear supplements are much more complex than they once were. This allows us to target specific problems with different formulations. For most patients with mild to moderate dry eye, I most often recommend Alcon's Systane Balance, which is an advanced formulation targeting all components of the tears. There are many other excellent products on the market as well. Dr. Arthur Epstein
Q: How many types of drops should be taken every day in each eye for dry eye? E.D.
A: Asking how many drops you should take is like asking, "How much is enough?" The number of drops will vary depending on the product, the severity of your dry eye, ambient humidity, the cause of your dry eye and dozens of other factors.
As a general rule, you should use tear supplement drops no more than recommended on the package labeling or six times a day whichever is greater. If you find you need to use them more frequently, I urge you to consult with a eye care provider with expertise in dry eye management. Too many drops can actually "wash away" healthy tears and compound your problem. Dr. Arthur Epstein
Q: What is the best eye drop that I can buy over the counter for red eyes? I'm working in TV production and am surrounded by spotlights. That is why my eyes are dry and turn red. V.
A: I wish I had a good answer, but it's hard to make a recommendation without knowing the cause of your red eyes. Redness usually occurs as a sign of an underlying problem. Taking a drop to mask the redness will not address the issue.
Some over-the-counter drops can actually make redness worse over time. Also, the more often you use many red eye drops, the more often you will need to use them to reduce redness, creating a vicious cycle.
I suggest that you have an eye examination to find the cause of your problem so an effective treatment can be found. Dr. Arthur Epstein
Q: I was recently diagnosed with inflammatory dry eyes and was prescribed Restasis. However, my insurance does not cover it. Is there anything else that is going to work as well for me? S.
A: Currently, Restasis is the only anti-inflammatory product approved for treating dry eye. Other products are in the FDA pipeline, but their timing for approval is uncertain.
You might discuss this with your eye care provider. There are other strategies that may help, including limited use of topical steroids, nutritional support and possibly ways of improving the quality of your tears that can help reduce inflammation. This can be determined after an examination. Dr. Arthur Epstein
Q: I get extremely dry eyes during the winter. Sometimes it's from using a computer, but not always. I use Systane eye drops, but they haven't helped a lot. What would you suggest I use? T.
A: It's not uncommon to have dry eye when heating season begins, as the air inside dries out. Also, computer work decreases blink rate, which can make your symptoms worse.
Systane is an excellent line of dry eye products; however, there are several types that target different aspects of dry eye. From your symptoms, my thought is that you may have more of an evaporative form, and Systane Balance would be first choice in that case.
It's also important to remember that drops are only one part of effective dry eye therapy. If your symptoms persist or worsen, I suggest you consult with an eye care provider who focuses on dry eye. Dr. Arthur Epstein
Q: I use Restasis intermittently for dry eye. My eyes burn and have pain almost constantly. I will experience burning and pain in one eye for several days, and then it will stop and the other eye will start burning with sharp pain.
Should I be daily consistent with the Restasis? Perhaps that will help? Or is there something else I should be addressing? J.G.
A: Dry eye can cause pain, but what you are describing is unusual and should be evaluated by an eye care professional. If you are taking Restasis, or almost any other medication for that matter, consistency and following labelled or doctor's instructions is important for the medication to be effective. This is especially true for Restasis, where the effect can take time. Dr. Arthur Epstein
Q: Every morning I use artificial drops to relieve my dry eyes. Can I use water instead of drops? It would make life easier. L
A: Many patients think that using water as drops is okay. In actuality, it makes the eye dryer. Let me explain.
The natural tears of the eye are made up of three layers:
- Mucin, which rests against and helps moisten the surface of the eye.
- A watery layer above the mucin that contains nutrients, antibodies to fight off infection, etc.
- Tears made of lipid (oil), which is the topmost layer.
The lipid layer acts like an oil slick and locks in the tears, reducing their evaporation.
If you just add water, then you would wash out all of these good layers. This would lead to a worsening of dry eye.
So please use lubricating drops, which are designed to help protect these layers of tears. Dr. William Trattler
Eye Infections and Dry Eye
Q: I've been wearing monthly contact lenses for 10 years now and have had a few eye infections. Recently I've been struggling with dry eyes. Could this be due to using soap to wash my face and clean off eye makeup? L.W.
A: When removing eye makeup, select products that are eye-friendly. Not only are harsh soaps irritating, they can strip the skin around the eyes of essential oils and cause drying and irritation, which can worsen dry eye. Speak to a specialist contact lens fitter about the dryness. There are ways to address your discomfort. Also inquire about these infections.
Frequent eye infections are a serious concern. Are you replacing your lenses as directed? You must also replace your case every three months and make sure that you never, ever top off old solution. Pour out used solution and use fresh every day.
Finally, make sure your hands are clean before you touch your lenses or your eyes. If you have another infection, please consult an eye care practitioner. Dr. Arthur Epstein
Q: I always have dry, red eyes. Occasionally when I blow my nose, liquid squirts out of the tear duct. It looks like mucus and is off-white in color. It only happens in my right eye, but the tissue does not look inflamed or swollen. Does it sound like an infection? R.E.
A: I cannot diagnose your condition over the Internet. Please see your eye doctor to figure out whether or not you have an infection. From your description, it is suspicious. Dr. William Trattler
Q: I have a dry eye condition. Why do I get eye infections often? E.A.
A: Dry eye predisposes to ocular allergies and eye infections, because the tear film quantity is too low to effectively wash out allergens or infectious organisms.
As well, a healthy tear film has a large number of antibodies present to fight infections. However, when dry eye is present, the tear film is often deficient in proteins and antibodies that help fight infection. Dr. William Trattler
Eye Irritation, Pain, and Dry Eye
Q: How do you know if you have dry eyes? Almost every day my eyes drip tears. It lasts most of the day, and sometimes there is burning. J.W.
A: What you are describing are classic signs of dry eye. Excessive tears dripping out of the eyes is called epiphora, and it is very common in dry eye patients. It's your tear system trying to correct for the dryness. The burning in the evening is often caused by meibomian gland dysfunction (MGD).
Both are signs of fairly advanced dry eye, so professional help would be a good idea. Please consult a dry eye-knowledgeable eye care professional. Dr. Arthur Epstein
Q: I have dry eye syndrome. Why does this make my eyes want to close all the time? R.
A: If your dry eye is severe enough to be causing irritation to the eye's surface, it can make your eyes want to close. It also cause light sensitivity. If this persists, you should consult with an eye care professional. Dr. Arthur Epstein
Q: I have been diagnosed with dry eye symptoms but now am experiencing an involuntary closing of the eyelid (one more than the other). Do you think this is a "habit" created by eye irritation, or is something else going on? J.H.
A: Dry eye is a chronic condition. With significant ocular irritation, patients may notice that they start to close or favor their eyes. And of course, the most irritated eye will tend to close more. However, it is very important to rule out other potential causes of a droopy eyelid, including nerve palsy or neurological conditions. As well, conditions like neuromuscular disease (myasthenia gravis), thyroid disease, and even eyelid cancers can cause drooping eyelids.
I hope this basic background provides enough information to convince you to see your own eye doctor to carefully evaluate your conditions. Dr. William Trattler
Q: Can having dry eyes cause pain in the head and around the eye? Sometimes it's a shooting pain; sometimes a dull ache. T.C.
A: Non-specific pain in and around the eye can be caused by many factors. A common cause is sinusitis, which is associated with aching of the eye, and sharp pains or a foreign body sensation can be caused by dry eye.
But obviously the only way to determine the cause of your eye pain is for you to visit your eye doctor and have an eye exam. Dr. William Trattler
Eye Redness and Dry Eye
Q: Can you have dry eyes in just one eye? My left eye has two blood vessels that have been red for four months. P.D.
A: Dry eye signs and symptoms can vary somewhat between the eyes. Sometimes the more involved eye can make the less affected one feel comparatively normal.
While redness is a common sign of dry eye, your description of two isolated dilated vessels in the left eye is not typical. It would be wise to consult an eye care professional to make sure it is not something more serious. Dr. Arthur Epstein
Q: I'm using Visine Maximum for redness and dry eyes. Starting recently, when drops run down my face I am getting a breakout on my face. What else can I use for redness and dry eyes? T.C.
A: What you are describing sounds like you are sensitive or allergic to one of the ingredients in the eye drop. That isn't uncommon, and you should discontinue that drop.
Eye redness is usually not the problem, but more typically a sign of something else wrong. Patients with dry eye should avoid products with whitening agents, as they further disrupt the tear structure and worsen dry eyes. The next step is to consult with a dry eye-savvy eye care professional to better understand the cause of your dry eye.
Often, dry eye patients with red eyes have meibomian gland dysfunction, which can be treated effectively. Once the cause is discovered and an effective treatment initiated, the redness should fade. Dr. Arthur Epstein
Q: My eyes are always so red and dry. I can't cry, and they hurt so bad. It's like a burn, not a sting. I've tried eye drops, but nothing's helping! A.
A: It sounds like your dry eye is fairly severe. With only this information to go on, it is impossible to properly diagnose the cause or suggest a treatment. However, because dry eye tends to be chronic and progressive it is unlikely to get better on its own.
I strongly urge you to seek professional assistance from an eye care professional with dry eye focus. Sorry I could not be more specific. Dr. Arthur Epstein
Q: I wear contacts, and it is the dry season here and very dusty. I also recently went swimming in a river but didn't open my eyes underwater. One of my eyes is a little red, and both have felt very dry for the past two days.
I was using over-the-counter eye drops but may have used them too much (more than 20 times in one day). My eye doesn't seem to be getting better. Should I use medicated drops? If so, what kind? Otherwise, should I just keep using the over-the-counter drops but less frequently? B.
A: As is often the case, it is very difficult to know what the cause of your dryness and irritation is. Even though it is the dry season there, whenever someone mentions contact lenses and swimming, especially swimming in river water, I worry about the possibility of infection. Also, taking over-the-counter medications excessively may be causing your problem, but it could be more serious.
My suggestion is to discontinue lens wear until the problem resolves, and stop taking the eye drops you have been using. If your eye does not feel better in a day or two, and especially if the redness or irritation worsens, I would urge you to seek an eye care specialist for a full examination. If it is an infection, delay will only make matters worse.
If it gets better, wait at least a few days, then carefully clean and disinfect your lenses (or replace your lenses if they are disposable), replace your case, and you can then try to wear lenses again. If you encounter the same issues, dryness may be the culprit, and a professional exam is your best course of action. Dr. Arthur Epstein
Q: I am plagued with very red eyes when at work. On weekends, my eyes are much less red. They do not feel particularly dry, but they look awful.
I do a fair amount of computer work. Could this be the culprit? A.S.
A: There are so many causes for red eyes that the differential diagnosis fills a book. Dry eye may be a cause or contributing factor, and your thinking is logical computer work decreases blink rate, which can worsen dry eye; however, other causes need to be ruled out.
If this has been ongoing, it makes sense to consult an eyecare professional. Your red eyes clearly concern you, and the solution may be quite straightforward. Dr. Arthur Epstein
Q: I want to know what causes my eyes to be red continuously every day, especially in the morning. It's the eyelashes on the bottom they get very itchy, and if I rub them at all they go very red. What could I take to get rid of this for good, as I have had this problem for quite a while? J.
A: Eye redness is a sign of trouble. The lids play very important roles in eye function and protection. What you are describing sounds like blepharitis, an inflammation and/or infection of the lashes and glands in the lid. This is often accompanied by dry eye and sometimes infection.
I advise you to consult an eye specialist, as the diagnosis must be confirmed and treatment prescribed by a licensed practitioner. Dr. Arthur Epstein
Q: My eyes are dry and I wear Night & Day Lenses on a 30-day basis. I have a red ring around my iris, and I haven't worn my contacts in four days. Is this red eye ring also considered dry eye? S.B.
A: There are many causes of a red ring around the eye. The usual cause is a subconjunctival hemorrhage, which is a common, painless condition where a blood vessel breaks in the conjunctiva, leading to either a patch or a circle of red. An eye care professional would easily be able to determine if this is the cause.
A more serious cause would be an infection of the eye, such as keratitis and/or conjunctivitis. These conditions can be associated with a red area in the white part of the eye, but would also cause ocular irritation, pain and perhaps even loss of vision and photophobia (sensitivity to light). Please see your eye doctor. Dr. William Trattler
Q: Is there a link between dry eye and subconjunctival hemorrhages? I recently had my punctal plugs removed and my eyes feel more dry than usual, and I have had two subconjunctival hemorrhages in the same eye within two months. N.B.
A: I am not aware of any specific link to dry eye and subconjunctival hemorrhages. However, if your eye is itchy or irritated, you may be rubbing your eyes, and this could lead to subconjunctival hemorrhages. Dr. William Trattler
Q: I have chronic redness and inflammation in my left eye and my ophthalmologist prescribed TobraDex. Although it appears to help, the inflammation has continued for the last year. More recently, I noticed that my left eyelid is drooping compared with my right eye. Although there is no noticeable difference in vision, I am very concerned about the condition. C.C.
A: Ocular inflammation can cause both ocular redness and eyelid drooping. I would recommend that you see your doctor. Or you might consider a second opinion to better understand the underlying cause of the inflammation so that it potentially can be treated. Dr. William Trattler
Q: My eyes sometimes look bloodshot. They feel dry and burn. And when I drive, it really bothers me such that I don't want to drive at all. The outside movement from the car messes up my eyesight. Could you please tell me what this might be? K.F.
A: There are many causes of bloodshot eyes. Certainly, dry eyes are a common cause, but by no means are they the only cause.
One common issue for people with dry eyes is that their symptoms and redness will worsen when they are in a car. The air conditioner blowing on the eye or air coming in through the window or over a convertible windshield all cause tear evaporation.
It is, of course, impossible to diagnose you over the Internet. So my first recommendation is for you to see your eye care professional to find out whether your problem is dry eye or something else. Dr. William Trattler
Q: I'm only 17, and I was wondering if I'm old enough to get laser surgery. My eyes are always red, but I don't have any other problems besides that. So can I get laser surgery or any kind of treatment for red eyes? C.
A: First, you need to determine the cause of your red eyes. Dry eyes and ocular allergies are two of many potential causes. Once you figure out the cause, you can also work on treating your red eyes. We typically wait until age 18 for laser vision correction. Note that laser vision correction can worsen dry eyes. So, again, get checked first. Dr. William Trattler
Glaucoma and Dry Eyes
Q: My husband has glaucoma, and he is taking prescription eye drops to keep eye pressure down. However, the drops cause him considerable eye irritation and dry eyes. Sometimes, he can't get his eyes open in the morning. Are these eye drops doing more harm than good? R.R.
A: Excellent question. The chronic use of glaucoma eye drops can lead to dry eye. But if you do not treat glaucoma, blindness can develop.
Many other options also are available for treating glaucoma:
- Your husband can ask about laser therapy for glaucoma. This technology can help lower eye pressure typically for about three years. This can give your husband a "break" from the glaucoma eye drops and allow the dry eye to improve. However, eye pressure may not go down enough for him to get off the eye drops.
- A preservative-free formulation of Timoptic eye drops for glaucoma is available. This version would be less likely to cause ocular irritation. Obviously, your husband would need to speak with his doctor to see whether he could use this type of medication to control eye pressure.
- A few glaucoma medications with milder preservatives also may make a difference. One is Travatan Z, and another is Alphagan P. Milder preservatives may mean less ocular irritation. Again, your husband should ask his eye doctor about this.
I also recommend that your husband ask for an evaluation to determine if dry eye is present. If so, he can be treated with punctal plugs and topical dry eye therapies. Dr. William Trattler
LASIK/PRK and Dry Eyes
Q: I had LASIK surgery just over a year ago. It was very successful, if not painful! I had stopped using lenses due to discomfort and decided to take the plunge. I would rub my eyes a lot to produce tears when my lenses dried out; sometimes they would fall out from lack of lubrication.
I work in front of a computer for 10 hours a day. I notice that some evenings or in the mornings after a late night my eyes are dry and need drops, as sometimes tears are not produced adequately to stop the dryness, accompanied by slight blurriness. Are these symptoms of chronic dry eye as a result of the surgery? Or is it me being more sensitive to the state of my eyes as a result of my fear of regression? S.C.
A: LASIK is often associated with dry eye after the surgery, but for most, the condition is temporary and improves within a few months. That doesn't mean that you will not develop dry eye that has little or nothing to do with the surgery.
If your symptoms persist, consider a dry eye drop that contains a lipid supplement Systane Balance by Alcon being a good example. If this fails to resolve your problems, it would be wise to consult with an eye care professional to see what other treatment may be helpful. Dry eye is usually progressive and better treated early. Dr. Arthur Epstein
Q: I had LASIK surgery about 10 years ago. I am 60 years old and have also had cataract surgery in one eye. I have severe dry eyes.
I am on Restasis twice a day, have tear duct plugs, and use Systane drops several times a day. There are times that all I want to do is close my eyes to get temporary relief. Nothing seems to work. What else can I do? I am miserable! C.R.
A: Sorry to hear about your problem. You are not alone: many people are downright miserable because of dry eye. You have a number of factors that predispose to more severe dry eye. Eye surgery, especially LASIK, can cause or worsen dry eye, as can cataract surgery. Usually this improves over time, but in your case, it sounds like it hasn't.
Without actually seeing you and judging only by your description, I suspect you have evaporative dry eye or EDE. It's the reason you close your eyes to get relief. EDE is usually caused by meibomian gland dysfunction. Restasis often will be of little benefit to patients with EDE. Also note that Restasis and punctal plugs do not function synergistically.
The most effective way to treat EDE is using the new LipiFlow system. You can find a doctor near you by searching for Lipiflow online. Dr. Arthur Epstein
Q: I had LASIK eye surgery six months ago, and now I have a dryness problem. I am using artificial eye drops. Do you think they are harmful to my eyes, and can I use them for a long time? Also I am using a computer for seven to eight hours a day, so how can I protect my eyes from dryness? H.P.
A: LASIK surgery often causes dry eye, usually lasting several months after the procedure and sometimes longer. While drops can be helpful, modern drops target different causes for dry eye. Because other factors, beyond the LASIK procedure, may be contributing to your dry eye, it would be wise to discuss this with your surgeon or eye care practitioner. But in general, most drops will not cause significant harm, provided you use them as directed. Dr. Arthur Epstein
Q: I had PRK laser eye surgery performed six months ago and I've recently noticed my eyes have become increasingly dry. Even with my daily dosage of drops, at least 10 a day in each eye, they are still dry. My eyes are so dry the sclera bunches up by the tear duct when I look from left to right. Silly question, but do I need to be worried? D.M.
A: Dryness is not uncommon after refractive procedures, including PRK. In most cases, the symptoms begin to abate about six months after surgery. For some, a return to normal can take longer, so your symptoms may yet resolve. However, your frequent use of drops and your description of the surface of your eyes suggest a dry eye workup at this point would be wise.
What you describe as bunching up of the sclera is more likely conjunctival chalasis a bunching up of excess loose conjunctival tissue, which is clear and overlies the sclera. This is fairly common in adults and may be associated with irritation similar to the symptoms of dry eye. The excess tissue may also disturb normal tear flow, which can worsen existing dry eye. A thorough examination will help pinpoint the cause so that effective treatment can be initiated. Dr. Arthur Epstein
Q: I had laser eye surgery in December 2008, and then had a second surgery for my right eye in June 2009. When it's sunny, I cannot open my eyes because they are very sensitive. The eye doctor tells me this has nothing to do with the treatment, because my pupil isn't involved. After looking at my eyes, she said I have a "dry spot" in my right eye, and eye drops will resolve this. She explained it as if a Band-Aid has been ripped off. Can you help me out here? M.M.
A: Sensitivity to light is a common symptom of dry eye. Also, dry eye is known to occur in some patients after LASIK.
Many excellent treatments are available for dry eye. Your first step is to see your surgeon and have him or her determine whether you have dry eye.
Assuming that the answer is yes, then the next step would be to initiate treatment. Your surgeon may recommend topical cyclosporine eye drops or punctal plugs. Oral omega-3s (fish oil) can also be helpful for dry eye, along with lubricating drops. Please see your doctor so that you can solve your condition. Dr. William Trattler
Q: I had LASIK surgery on both eyes 12 years ago. Recently I started having difficulty with blurred vision in both eyes and was diagnosed with dry eyes. It has been two months, and I am still having blurred vision after using prescription eye drops and Tears Naturale Forte. Will this condition improve, or will it lead to blindness? L.M.
Obviously I cannot diagnose your condition over the Internet, but I can give you some suggestions for treating dry eye.
- Speak to your doctor about placement of punctal plugs, which can raise the tear film.
- Ask about a short course of topical steroids, which may help speed up the improvement of dry eyes.
You also might consult with your doctor about the possibility of inflammation of the oil glands in your eye. This condition is called blepharitis. If you have blepharitis, you may benefit from warm compresses, oral omega-3 supplements and topical azithromycin (antibiotic) eye drops. Dr. William Trattler
Q: I had LASIK surgery two weeks ago. The left eye had almost completely recovered within two days, and was seeing 20/20. The right eye was foggy after two days, with around 20/80 vision.
The doctor who performed the surgery noticed a few very fine wrinkles on the right eye. Four days after the original surgery, the doctor re-lifted the flap and installed a contact lens for one day. When the lens was removed, the right eye was still 20/80 after one day.
Now over a week later when I first wake up in the morning, the right eye feels like it has sand in it and my vision is completely blurry. When I put a couple of "Refresh Plus" (artificial tears) drops in it, it begins to feel better. But the vision is still blurry. The vision then slowly begins to clear over the next four to eight hours, but never gets close to the clarity of the left eye. Then, the next morning, the same process begins again with no apparent improvement.
Could this be a dry eye issue in the right eye since the flap was lifted twice? If so, is this something that should get better over time? My eyes were not dry prior to surgery. I couldn't wear contacts comfortably after about eight to ten hours. But without contacts, my eyes never felt dry. R.J.
A: Based on your description, it sounds like you have more than just dry eye. Please see your surgeon. Since I have not examined your eyes, I cannot know for certain what is going on. But I am concerned that the wrinkles on the eye may still be present based on your description. If they are still present, then you should talk to your surgeon about further treatment such as flap suturing or relifting and stretching the flap.
Dry eye is certainly common even in non-dry eye patients. So it is not uncommon for you to have some dry eye symptoms early on after surgery. Since dry eye may also be an issue, you should talk with your doctor about increasing your dry eye treatment. Dr. William Trattler
Medications That Cause Dry Eyes
Q: What medications can contribute to dry eyes? R.C.
A: There are numerous classes of medications that can cause or exacerbate dry eyes. The most common group is oral antihistamines, from Benadryl to Claritin. Another group is antidepressant medications. Dr. William Trattler
Q: I was diagnosed with dry eye syndrome a year ago. Now I have punctal plugs in the lower lacrimal ducts but still have dry eye. At night I use eye ointment and have a humidifier in the bedroom. I take Hyzaar 100/12.5 (high blood pressure medication) and flush-free niacin. Can either of these be the culprit? Q.
A: Certain high blood pressure medications are thought to contribute slightly to dry eye, but you obviously need to be on some type of high blood pressure medication.
You may want to speak with your doctor about additional treatments to treat the underlying cause of your dry eye. Dr. William Trattler
Q: Before I went on active duty service in Iraq, my eyesight was 20/20. Now, two years later, my eyesight is 20/40 and I have been experiencing constant dry eyes. I also have been diagnosed with hypertension (high blood pressure). Could my hypertension medication be causing my dry eye syndrome? G.S.
A: Thank you for your question, and I personally want to thank you for your service in Iraq.
Dry eyes can cause a reduction in vision, and treatment of your dry eye may result in improved vision. Please see your eye care professional, who can prescribe various treatments for your dry eye.
Although some medications for hypertension can affect dry eye, many do not. I would focus more on the possibility of treating your dry eye with available options such as artificial tears, topical cyclosporine, and punctal plugs. Dr. William Trattler
Q: Recently my dentist gave me an antibiotic for a toothache. I notice that every time I take the antibiotic, I have itchy, gritty eyes and vision problems. For example, it's hard to watch television. Is this caused by the antibiotic? J.
A: I am not aware of any antibiotics causing dry eyes. In fact, certain antibiotics, like doxycycline or azithromycin, can help treat certain forms of dry eye. There may be other factors contributing to your dry eyes, so I would recommend that you visit an eye care professional for an evaluation to determine the severity of your dry eye. Your doctor will then be able to prescribe treatments. Dr. William Trattler
Q: I have been diagnosed with dry eyes. I purchased a microwave compress for my dry eyes. After using it, my eyes became quite blurry, and it frightened me. It lasted for several minutes. Is it good to do this home treatment? B.
A: We now recognize that much of dry eye is caused by dysfunction of the meibomian glands, small glands in both upper and lower lids that produce a complex oil with each blink. In many patients these glands become obstructed and do not produce enough of these oils to maintain a stable tear structure or prevent evaporation.
From your description it sounds like you or your doctor was trying to address this issue. Application of heat helps melt the thickened oils, and massage helps get the now liquified oils flowing. What you are most likely experiencing is a sudden inrush of oil causing temporary blurring.
However, be careful. Recent evidence suggests the combination of heat and vigorous massage of the eyes can damage the collagen structure of the cornea. Also, excessive heat can burn the thin skin surrounding your eyes.
While a little temporary blurring is probably a sign of your efforts working, if the blurring worsens or you remain concerned about it, see your eye care professional. Dr. Arthur Epstein
Q: I have dry eye and have had it for several years. Now I also seem to be having problems producing oils. I have had swollen oil glands in the past and tried LipiFlow, which helped some. I have been cleaning my lids with mild soap that has helped a lot.
What other steps should I take? It seems apparent that my meibomian glands are tending to stop up. My eyes are driving me nuts. R.H.
A: Welcome to the club. The overwhelming majority of patients who suffer from dry eye have dysfunction of the meibomian glands. Lipiflow is, in my opinion, currently the best and most effective means we have of treating this condition. As you note, the complex oil produced by these glands in both upper and lower lids are essential to a healthy and stable tear film.
I am not sure how long ago you had the LipiFlow treatment, but if it has been more than five or six months you might consider returning for lid debridement. This simple procedure helps the meibomian glands produce oils by clearing any external blockage.
Also, blink exercises are important post-treatment. The blink drives emptying of the oils in the glands, and poor or partial blinking can undo the benefits of the treatment. Apps are available to assist with proper blinking.
You also should be taking a quality EPA-based fish oil supplement. Continuing warm compresses and gentle massage after treatment may help. And the use of lipid emulation drops like Systane Balance or FreshKote may also help.
If it's been a year since your treatment, it may be time for another, although many patients experience longer-lasting relief from LipiFlow. Dr. Arthur Epstein
Q: My doctor told me today that I have tear drops in my eyes. It happens in the latter part of the afternoon. Could you please explain, and tell me what can be done about it? S.F.
A: Your question raises a great point. I truly do not know what your doctor is referring to. Virtually everyone has tears, and I have no idea what he meant by "tear drops."
It is very important that everyone make sure they fully understand what their doctor is telling them while they are in the office. Perhaps the most important part of caring for patients is communicating with them. I suggest you call your doctor's office and ask if they could call you to explain what he or she meant. Sorry I can't be more helpful. Dr. Arthur Epstein
Q: I have had what seems like chronic dry eyes for over a month now. Is that long enough to damage my vision? I don't have any health insurance. I don't know when I'll be able to see an eye doctor for this problem. I'm only 37 years old, and this is really affecting my life right now. D.
A: Sorry to hear of your problems. Dry eye is typically a slowly progressive problem, but some patients transition from asymptomatic to very symptomatic very quickly.
Dry eye can lead to damage of the front surface of the eye and cause reduced vision, but this isn't something that happens suddenly, so I wound not worry about it at this point.
I understand your situation, and there are a number of things you can do to treat your dry eye yourself. First, drops that supplement the natural tears. My first choices include Systane Balance and FreshKote. Systane Balance is available over the counter. To get FreshKote, which is not an Rx product, you may have to ask the pharmacist, as it is usually kept "behind the counter."
Make sure you are drinking sufficient water. Guidelines for water intake are available on the Internet. Nutritional supplements containing EPA may also be helpful.
I realize you do not have health insurance coverage, but if this gets much worse, it would be wise to consult an eye care practitioner to make sure that something more serious isn't contributing to your symptoms. Dr. Arthur Epstein
Q: What under-eye cream do you recommend for eyes that are very dry and sensitive? S.
A: As long as you don't get any of these creams directly in the eye, I do not believe they will adversely impact your dry eye. A brief Internet search will reveal a number of products designed for sensitive skin, which makes sense given your history. Be especially careful around the eyes, as products designed for skin may be irritating to the eyes, even if formulated for sensitive skin.
One other recommendation is that if you have also been diagnosed with blepharitis or meibomian gland dysfunction which affect the lids and lid scrubs using detergent pads or baby shampoo have been recommended, this may be removing too much natural oil from the skin around the eyes and can be causing drying and irritation.
If you wish to cleanse your lids, I recommend a soft terry cloth with no soap, only gentle rubbing to clear debris. If your eyes continue to bother you, a dry eye-friendly eye care provider may be able to help make you more comfortable. Dr. Arthur Epstein
Q: I really appreciate you taking the time to answer questions like this! Hopefully it's something simple, but it's become quite a bothersome issue for me. For the last year or so, my left eye has been extremely dry. My right eye is fine, but the left eye is to the point where I'm going through more than a half-ounce bottle of lubricating eye drops every couple of days.
Not sure if it's a result of the dryness, but I have also noticed a red, raised area on the inner corner of my eye that is starting to budge into my iris. I can send you pictures if you would like when you reply. A.G.
A: Thank you for the kind words. I really enjoy being here to answer questions and helping out as much as I can. I wish your question was an easy one to answer, but it's not. As you can imagine, it's sometimes very difficult to figure out what's going on with a patient's eye from a written description. And while a picture may be worth a thousand words in some cases, photos in the absence of a physical exam can sometimes be difficult to interpret.
In your case, the dryness you're experiencing may be caused by a number of problems. The reddish raised area you describe is of more concern. It may be as simple as irritation caused by dryness, it may be the cause of your discomfort, or it could be something more serious.
In any case, whenever something new or unusual appears on your eye and seems to be increasing in size, you need to have it checked by an eye care professional. It may be nothing, but with an examination, you can make sure it's not serious and get professional help for the dryness you're experiencing at the same time. Dr. Arthur Epstein
Q: Can I have dry eye in one eye not the other? And can one eye hurt and be red more than the other? J.
A: Having a problem affect one eye is usually more disruptive than when it occurs equally in both. For many people, dry eye affects both eyes more or less equally; for others, as you describe, it can affect one eye more than the other. For example, asymmetric tear production or increased tear drainage in one eye compared with the other can result in unequal discomfort.
Treating dry eye, whether in one or both eyes, first requires finding the cause. That will allow your eye care professional to treat the problem successfully. Dr. Arthur Epstein
Q: How high should the percentage of humidity be in the room when dealing with severe dry eye syndrome? P.
A: Higher humidity generally translates into less evaporation from the eye's surface. That's why many people have difficulty when moving to arid environments like Arizona, or during the winter when heating systems dry the air. It is also the reason why moisture goggles are prescribed for some patients with severe dry eye.
Also, its not just the ambient humidity, but the shock that occurs when transiting between high and low humidity environments for example, the low humidity air-conditioned indoors and the hot and humid outdoors that occurs in many areas throughout the world during the summer months.
One last thing: The eye has a natural barrier to evaporation and environmental dryness. Meibomian glands present in both upper and lower lids produce complex oils that adhere to the tear film, creating an effective moisture barrier. If you are experiencing issues with dryness, it would be wise to have your eye care professional evaluate your lids and meibomian gland function. Dr. Arthur Epstein
Q: I have severe dry eye. I've tried every eye drop and gel and still no relief. I would love to have surgery, but my insurance does not cover eye care unless it is for a medical reason. The insurance carrier said it needs to be put under a certain medical code. K.M.
A: Dry eye is a medical condtion, and most insurance covers examinations and most, but not all, treatments for the disorder. For example, LipiFlow therapy for meibomian gland dysfunction is very helpful for many, but is not yet covered by most plans.
Speak to your eye care provider about what would work best to treat you and if insurance will cover it or if it is out of pocket. Dr. Arthur Epstein
Q: Could you tell me if it's safe to use sulphonated castor oil as eye drops? Thanks so much great website! J.R.
A: Thanks for the kind words. As a general rule, you should avoid putting anything in your eyes that isn't specifically indicated and approved for that purpose. Non-sterile products can lead to infection or cause other problems.
Normal tears do contain complex oils that serve a variety of functions, including enhancing tear stability and preventing evaporation. Lipid-based tear supplements specifically formulated for the eyes are commercially available. Examples include Alcon's Systane Balance and Focus Lab's FreshKote. Dr. Arthur Epstein
Q: I have chronic dry eyes. I've been to three eye doctors, and nothing has worked. I wear sunglasses all the time to ease my eyes. What do you suggest? J.H.
A: Sorry you are having so much difficulty in having your problems addressed. Without actually seeing a patient it is very difficult to tell what's going on or what has been tried previously and failed. From your note, its obvious that you are very uncomfortable.
The field of dry eye and ocular surface disease is evolving and expanding very quickly, and new approaches in technology have been recently introduced. For that reason I am hopeful that your issues can be resolved. My suggestion is to seek a clinician who focuses exclusively or extensively on dry eye. TearScience markets a device that indicates a strong commitment to managing dry eye. A visit to their website may be helpful in locating a practitioner who focuses intensely on dry eye. Dr. Arthur Epstein
Nutrition and Dry Eyes
Q: Is it okay to take omega 3 fatty acids if you have a subconjunctival hemorrhage? M.C.
A: That is an excellent question. For many years omega-3 supplements were thought to increase bleeding. While some clinicians still hold to that belief, current thinking is that there is little risk of increased bleeding with these supplements.
Since conjunctival hemorrhage resolves quickly, if you are at all concerned, discontinue the supplements until the hemorrhage fades away. An isolated conjunctival hemorrhage may be visually alarming, but it is generally nothing to be concerned about. However, if you are experiencing recurring conjunctival hemorrhages, you should consult your physician to determine the cause. Dr. Arthur Epstein
Q: I have been taking the TruNature brand lutein and zeaxanthin supplement and would like to know if this should help with my dry eye condition. Also, I wonder if the titanium dioxide ingredient in this supplement is dangerous. E.B.
A: Lutein and zeaxanthin are antioxidant carotenoids that are present in fruits and vegetables. Supplementation is thought to promote the health of the central area of vision known as the macula.
To my knowledge, zeaxanthin and lutein have little to no effect in ameliorating dry eye signs or symptoms, although I do not believe they would be harmful when taken in recommended amounts.
The use of titanium dioxide is somewhat controversial, with some data suggesting it may be carcinogenic when inhaled. I am unaware of any benefit or therapeutic value of this ingredient. Dr. Arthur Epstein
Q: I've been experiencing dry eyes for about three years now. Recently, I discovered a lack of omega-3 fatty acids in my diet to be a possible cause. Taking fish oil capsules seemed to improve my condition greatly for about two weeks, after which my dry eye syndrome returned again. Is it possible dry eyes only temporarily benefit from increased omega-3 consumption, or should I look for another cause? J.D.V.
A: Omega 3s are one of a group of essential fatty acids (EFAs) that serve a variety of important functions in the body. For many dry eye sufferers, omega-3 supplementation can be helpful, but it may not benefit everyone. Your only temporary improvement from omega-3 supplements suggests there are other possible factors that are contributing to your dry eye. I agree that further investigation is warranted. Dr. Arthur Epstein
Q: I read that liquid vitamin E or omega-3 eye drops are the best for dry eyes. I have seen liquid vitamin E in the store, but not liquid omega-3.
Is it safe to put this liquid vitamin directly in your eye? K.B.
A: Vitamin E and omega-3s work when you ingest them. Using a liquid of this type directly on the eye is not considered a useful treatment for dry eye. So you should ingest these, but do not apply them topically to the eye. Dr. William Trattler
Q: I've had dry eye symptoms for a year, and eye doctors referred me to a holistic practice after conventional treatments didn't help. For a month, I've been taking an omega-3 fatty acid liquid, progesterone supplements, Adreset and Juice Plus+ supplements. There has been no improvement. Am I wasting my time and money with all the nutritional supplements? K.
A: Oral omega-3s have been shown to help with dry eyes. However, the other agents that you mentioned have not been proven to help dry eyes, as far as I am aware.
By the way, Juice Plus+ is supposed to be excellent nutritionally, but it is not designed as a dry eye treatment.
I recommend that you see if some of the traditional treatments for dry eye are effective. They include closure of the drainage ducts (which keeps more tears in the eye), as well as topical anti-inflammatory drops. Dr. William Trattler
Q: For my dry eyes, my ophthalmologist has prescribed flaxseed extract with omega-3. Is there a difference between the oil and an extract? D.E.
A: I am not aware of the difference between oil and extract. However, some recent studies have suggested that fish oil may have more benefits for the treatment of dry eye than flaxseed oil.
I would return to your doctor and ask the question that you have posed here, because maybe there is a reason that he or she is making this distinction.
Interestingly, oral omega-3s (fish oil and possibly flaxseed oil) have been shown in recent studies to also reduce the risk of developing macular degeneration, which is the number one cause of blindness in the elderly in the United States. Dr. William Trattler
Ortho-K and Dry Eye
Q: Greetings from India. Kindly clarify whether dry eye patients can use ortho-K lenses. S.V.
A: Thank you for the excellent question. Technically, dry eye is a contraindication to contact lens wear. However, many dry eye patients are still able to wear contact lenses successfully, provided that their ocular surface is healthy and their dry eye is not severe or has been successfully managed. This is especially true for ortho-K designs that are typically worn overnight.
You may also need to be followed more closely to insure that your eyes remain healthy. Your contact lens fitter should be able to determine your suitability for lens wear during the initial examination and fitting. Good luck! Dr. Arthur Epstein
Other Diseases and Dry Eye
Q: I have had bad dry eyes and sinus problems for years. Do dry eyes and sinus problems go hand-in-hand? M.D.
A: There is no relationship that I am aware of between sinus issues/sinusitis and dry eye.
However, there is a connection between dry eyes and the antihistamines that some people with sinus problems use. This is because antihistamine medications are drying to the eyes. Dr. William Trattler
Q: Is a connection between Lyme disease and dry eyes? G.H.
A: I am not aware of a specific relationship between Lyme disease and dry eye. I do know that Lyme is a very challenging condition to treat. Also, it is important to point out that dry eye is extremely common. I wish you luck! Dr. William Trattler
Q: Are dry eyes, ocular hypertension, and headache related? My eye pressure is at 21, and I am experiencing pain around the left eye. I have a headache on the left side. R.P.
A: Elevated eye pressure and dry eyes are not related. However, as we get older, we have an increased risk of both dry eyes and elevated eye pressure.
Interestingly, there is also no relationship between elevated eye pressure and headaches. You should see your medical doctor to determine the underlying reason for your headache, because there are many potential causes. Of course, if the pain is localized to the orbit (eye socket) or eye, your doctor will have to rule out a variety of conditions, including sinus disease.
So please see your doctors, and let us know the outcomes. Dr. William Trattler
Q: I have developed severe dry eye after completing months of chemotherapy. I am told I have no moisture at all in my eyes. Different prescriptions of tears and gels have not helped. The pain in one eye has become debilitating, but none of the doctors I have seen are familiar with this pain. W.R.
A: Severe dry eye can be a challenge to treat. Reducing any inflammation that may be present typically is the first step. For this purpose, your doctor may prescribe topical steroids along with topical cyclosporine. After inflammation is reduced or perhaps even during treatment, your doctor will consider occluding (blocking) all of your tear drainage ducts. This procedure can be performed with punctal plugs or punctal cautery.
These two approaches closing the eye's drainage system and decreasing inflammation should help reduce the severity of dry eye.
Of course, your doctor may also need to provide additional treatments that can include topical lubricating drops during the day and ointment at bedtime. Oral omega-3 fatty acids, like fish oil or flaxseed oil, may also be beneficial.
I hope you see your eye doctor in the near future, and that he or she can help you treat your severe dry eye condition. There is hope! Dr. William Trattler
Permanent Cures for Dry Eyes?
Q: Is there any permanent cure for dry eyes without using eye drops? I also would like to know the cause and long-term adverse results of dry eyes. Does the condition damage the cornea of the eye? Does it reduce vision? I have tried everything, but I'm not getting any relief. V.S.
A: Dry eye is a chronic condition that requires treatment with various types of drops. Oral omega-3 fatty acids are a nutritional supplement that may be all that is needed for mild dry eye treatment. Otherwise, treatments for dry eye are typically in drop form. So it would be difficult to avoid the use of drops for treating dry eye.
As far as what happens if dry eye is not adequately treated, chronic dry eye over time can be progressive and can lead to fluctuating vision and loss of quality of vision. For severe chronic dry eye, treatment is important to avoid visual problems down the road. So please see your doctor to figure out your next steps for treating your condition. Dr. William Trattler
Q: I have dry eyes. Yesterday, my doctor inserted a trial plug in my right eye. I go back in two weeks to have the permanent plugs done. He said they would be cauterizing those into my eyelids. I am scared and about to back out. Won't this be very painful even with drops in my eyes to try to help with the pain? Also, can this procedure be reversed if it does not work or if I am uncomfortable and want them out? J.D.
A: Punctal cautery is an effective method of closing up the lacrimal (tear) drainage system, but it is considered a permanent procedure. The procedure typically is not painful, because it's relatively easy to anesthetize the area.
If you have severe dry eyes, then punctal cautery is an option. On the other hand, if you have mild to moderate dry eyes, you can consider permanent punctal plugs because these are easy to reverse. Dr. William Trattler
Q: I have lower punctal plugs in both my eyes, and my dry eyes have not improved at all. I cannot take fish oil supplements, because I am allergic to them. My eyes are constantly red 24/7 and hurt.
Is there anything else you can recommend I do to alleviate my symptoms, especially my red eyes? I was on Restasis for a year before the punctal plugs were inserted, and it didn't seem to help. Should I try Restasis again with the punctal plugs? L.K.
A: Without examining you it is impossible to accurately diagnose your problem; however, based on your symptoms and history, I would suspect meibomian gland dysfunction is either a cause or a contributing factor. The labeling on Restasis clearly states that it will not help patients who have undergone punctal occlusion. I do not think retrying it will help.
Since this has gone on for so long, I would urge you to find a dry eye-savvy eye care provider and have a complete dry eye workup. Dr. Arthur Epstein
Q: I had tear duct plugs put in my eyes a few years ago. I suffered a head injury, and somehow it affected my tear production. The plugs helped my right eye, but not my left. This time of year, it being so cold and dry outside, my eye really bothers me. Is there anything else I can do besides using artificial tears to help my eye? M.
A: Over the past few years our understanding of dry eye and the ocular surface has increased tremendously. There are now many ways to approach dry eye beyond artificial tears and punctal plugs.
Given your complex history, I would suggest that you consult with an eye care professional who is dry eye-focused. Your state has a number of excellent dry eye specialists. Dr. Arthur Epstein
Q: What is the success rate of comfort plugs for dry eye relief after LASIK eye surgery? M.
A: By comfort plugs, I assume you are generally referring to punctal plugs used to reduce tear drainage in cases of insufficient tear production or excessive or rapid evaporation. LASIK can reduce tear production in some patients. Although this typically resolves with time, treatment is often necessary, at least initially.
Unfortunately there is no way to know how you would respond to punctal plugs without understanding the underlying cause of your dryness or what factors may be contributing to it. Plugs are used less frequently these days, reflecting a better understanding of the causes of dry eye, the contribution of meibomian gland dysfunction to dryness, and a more targeted approach thanks to advances in therapy. Dr. Arthur Epstein
Q: I was diagnosed with dry eyes, and it is killing me day by day. I have had the plugs, but they do not help. Seems like nothing helps. What can I do? M.
A: Dry eye can turn your life upside down. Punctal plugs don't work for everyone, so please don't get frustrated just because they didn't work for you.
Since this is a major problem for you, a systematic approach is essential. Starting with a complete health history, you need a thorough workup of your eyes to determine the cause of the dryness. With a targeted approach, most dry eye problems can be eased if not mostly resolved.
Find someone in your area who is dry eye savvy and focuses a good part of their practice on dry eye. Solutions today range from advanced drops to prescription medication to state-of-the-art therapies like the Lipiflow by TearScience. I believe that there is a solution to your problem. Don't give up. Dr. Arthur Epstein
Q: I have severe dry eyes, which required the tear duct plug. Now I have noticed that the tear duct looks as though it ruptured. Is this normal? Could this be something else? S.S.
A: I don't think your tear duct can rupture. I would recommend seeing your own doctor so that you can be examined. This is the only way for you to determine what is going on. Dr. William Trattler
Q: I have had dry eyes for 15 months, and drops aren't helping. Can you give me a ballpark figure on the costs of punctal plugs? I am on Medicare. E.S.
A: Punctal plugs are an excellent treatment for dry eye. They work by reducing the outflow of tears from the eye so there is a higher level of tears.
Medicare does cover punctal plugs. Dr. William Trattler
Q: I suffer from puffiness under my eyes and always have. I also have slight dryness of the eye. Can the tear duct plug surgery actually help puffiness? J.S.
A: Tear duct surgery, which involves closing the ducts that drain the tears from the eye to the nose, works great for patients with dry eyes. However, the surgery typically will not solve the problem of puffiness under the eyelids.
Please see your eye doctor to determine the cause of the puffiness under your eyelids, so that the appropriate treatment plan can be developed. Dr. William Trattler
Vision Problems Related to Dry Eyes
Q: I have an extremely dry eye (right, dominant, astigmatism in left), which seems to have mucus on one spot and which gets very disturbing, because my vision gets blurred. And since my right eye is the dominant one, I am in trouble. What can I do? I put drops in all day long I have them all over the house. Nothing seems to help. M.M.
A: The eye will often produce excess mucus as a protective mechanism to prolonged irritation. In your case, chronic dry eye would seem the likely culprit. Tear evaporation caused by meibomian gland dysfunction is a likely cause or contributing factor.
Since regular drops aren't working and this sounds extremely distressing to you, you should consult an eye care professional. There are a number of new things available to treat dry eye that should be able to help you. Dr. Arthur Epstein
Q: Is seeing glare normal for a person who has dry eyes? J.C.
A: Dry eye affects the tear layer, which in turn can cause disturbed vision. Glare is not a common complaint associated with dry eye in my experience, but depending upon the cause of your dry eye, glare may occur. However, it can also be caused by other eye conditions, like cataract, corneal irregularity and scars, and retinal problems.
So it would be wise to consult an eye care professional to confirm the cause and ways to treat the problem. Dr. Arthur Epstein
Q: Can dry eye or eyestrain reduce the eyes' power? M.
A: That is a wonderfully perceptive question. The tears are quite complex. Among their primary functions is to provide a smooth and clear optical surface to focus light for the eye. Dry eye usually disrupts the tear structure, which can negatively impact vision and lead to eye strain. Treating dry eye is important not just to insure comfort and health but to provide the sharpest and most comfortable vision. Dr. Arthur Epstein
Q: I have been suffering mild dry eyes for the past two years. Every six months my lens power keeps increasing. Does it relate to my dry eye problem? I am 21. K.H.
A: While dry eye, and in particular evaporative dry eye (due to meibomian gland dysfunction) can impact quality of vision, it is unlikely to be a significant factor in myopic progression (increasing nearsightedness).
Most experts believe that myopia is generally associated with excessive near work and computer tasks. Approaches that halt the progression of myopia are being extensively investigated, but presently no truly effective approach has been found. Dr. Arthur Epstein
Q: I have been diagnosed with dry eyes. I also wear spectacles. I would like to know if dry eyes affect the computerized reading of the eyes that determines the eyeglass prescription. D.G.
A: Dry eye can affect the test to measure one's prescription for glasses. So dry eye should be under control that is, adequately treated before you are given a new prescription for glasses. Dr. William Trattler
Q: I have dry eyes and have been wearing contacts more lately. I also have been having trouble getting a good night's sleep because of various interruptions. Could this be the cause of ghost images and if so, what is the best thing to do for it? B.B.
A: Although dry eye could potentially cause ghosting, there are many more likely causes. One important and common cause is cataracts. Another cause is the development of irregular astigmatism of the cornea. Have you seen any eye care professionals recently, and have they looked for cataracts or any issues with your corneas?
Lastly, the contacts may be the wrong power, and this could lead to ghosting. Again, please see your eye care professional. Dr. William Trattler
Q: Can dry eye cause vision problems over time? I have Sjogren's Syndrome, and I am having some changes in in my eyesight when I drive at night. Although problems are mild, they are noticeable. M.S.
A: If left untreated, moderate to severe dry eye can lead to visual problems over time. Specifically, chronic irritation of dry eye can damage the ocular surface. This can lead to poor quality of vision.
As well, dry eye is a cycle. Dry eye leads to poor quality of tears and ocular surface irritation, which results in further dry eye.
The key point is that dry eye is treatable. Patients with Sjogren's Syndrome should see their eye doctor to determine their degree of dry eye. From there, their doctor will make treatment recommendations to keep the dry eye that occurs with Sjogren's Syndrome from progressing. Dr. William Trattler
[Page updated February 24, 2014]
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