Ask the Dry Eye Doctor

Questions were answered by William Trattler, MD

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Each week we will choose the best questions about dry eye to answer. Please remember that some questions can't be answered unless an eye doctor sees your eyes in person.

We are publishing the best Q&As below, so please check there to see if your question has already been asked and answered. (Note: Following each question we use only initials, not full names, to protect your privacy. Read our privacy policy.)

Dr. William Trattler has performed research on dry eye and oil gland problems of the eye and has also lectured widely about these subjects. Below are questions that our site visitors have sent in.

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To find the Q&As most helpful to you, please click on one of these subjects:

Dry Eye Causes and Risk Factors

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. Trattler

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. Trattler

More Info

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. Trattler

Q: I have dry eye syndrome that I control with eye drops. I live in Savannah, where there is plenty of humidity. If I move to to Arizona, will I have more dry eye symptoms with the dry climate? — S.B.

A: Great question. I practice in Miami, which has a high level of humidity. My patients who fly on airplanes and who visit dryer locations (like Arizona) note that their dry eye symptoms become worse. So that could be an issue.

I would recommend that you visit your eye doctor to see if your dry eye can be improved further with treatments like prescription eye drops and punctal plugs. — Dr. Trattler

Q: I was told to put wet, hot compresses on my eyes for five minutes twice a day. Is there a chance the heat could be a problem? Can it cause cataracts? — L.H.

A: Patients with blepharitis or clogged oil glands in the eyelids can benefit from using heat to the eyelids. Of course, clogged oil glands can cause dry eyes.

A heating pad or a warm compress can help warm up the oils in the eyelid and treat the oil gland problem. Obviously, don't use anything that would cause a burn.

To the best of my knowledge, using warm compresses does not increase the risk of cataracts. — Dr. 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. Trattler

Q: When I cry, I have no tears. I asked my doctor about this, and he said it's not possible. — D.B.

A: I have not heard of this. If this is truly the case, then you would have to have severe dry eyes. Please see your doctor to find out more. — Dr. Trattler

Q: What condition of the eye, besides dry eye, would cause extreme redness, dull to sharp constant pain, no discharge, a scratchy feeling, and movement from one eye to the other eye with the first eye becoming almost well? — L.J.B.

A: I can provide general comments on various conditions that could cause the constellation of symptoms you are describing. But my first and more important suggestion is for you to see your eye care provider for an examination to determine the exact cause of your red eye.

The most common causes of red eye are dry eye and ocular allergy. Other common causes include infection, pink eye (viral conjunctivitis), and inflammation of the conjunctiva or eye surface (episcleritis or scleritis).

Treatments of these conditions are all different. This is why it is important for you to get an eye exam to determine an exact cause of your symptoms. Clearly, episodes of redness and dull to sharp pain are abnormal. — Dr. Trattler

[See also: free eye exams for qualifying individuals]

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. 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. Trattler

Q: My eyes were bothering me, becoming blurry and sensitive to light. I went to my family physician, who said it was dry eye. I'm now on drops, and my physician took me off a medication that can cause dryness (Nortryptline). However, another reason for my visit is a gray mass that appears behind my pupil when I look to the left. It stays there temporarily until I blink a number of times. Can you advise? — J.S.

A: I am happy to hear that your dry eye condition is being addressed. As for determining what is causing the sensation of a gray mass, you should go back to your doctor and request a dilated eye exam. The gray mass could be a floater or a retinal problem. — Dr. Trattler

Q: Can night shift work adversely affect eye health, including causing dry eyes? — J.B.

A: No, night work does not affect the eye or cause dry eyes. — Dr. Trattler

Q: My eyes run all the time. The last doctor I saw said my tear ducts were full, and nothing was wrong with me. But my eyes are sore and red all the time. — D.Y.

A: Dry eye is one common cause of tearing. It sounds like your doctor ruled out clogged tear ducts, which is another cause of tearing. Besides tearing, eye redness also can be a sign of dry eyes.

You should return to your doctor and ask for some dry eye tests, such as a measurement of tear production (called a Schirmer's test) and evaluation of the oil glands of the eyelids.

If you do have dry eyes, there are a variety of treatments that your doctor can recommend. — Dr. 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. Trattler

Q: I've had excessively watery eyes for almost seven weeks now. They just seem to cry all day and fail to stay dry for more than an hour. I have stopped using makeup and anything that could irritate them and nothing works. They get extremely red, also. I've been to my local doctor twice over it and he continues to think it's some sort of conjunctivitis, however neither of the drops he's prescribed have worked. Could it be dry eyes causing an over-production of tears? I'm only 18 and have never had this before. It's really taking over silly things like going out to avoid questions on why I'm crying. Please help! — L.J.

A: You ask a great set of questions. First, dry eye can be the cause of red eyes with tearing (crying).

Conjunctivitis (viral or bacterial) is generally just a short episode — perhaps a week or two. Since your condition has been persisting for seven weeks, one has to consider ocular allergies as well as dry eye and/or blepharitis. If your first doctor has not been successful, you can always consider a second opinion. You may want to look for a corneal specialist. Hopefully, they can find the underlying cause of your condition and figure out the next steps for you. — Dr. Trattler

Q: I noticed that the area around my eyes is continually moist. Yet, when I wipe the area, it's not moist at all. I do wear glasses all the time. I was given drops for dry eye, but it is no better. My eyes do not look irritated. Is this dry eye, or could it be blocked tear ducts? — R.B.

A: It is impossible to know whether dry eyes or a blocked tear duct is the cause of your eye feeling moist. Both conditions can cause the symptom. You should see your eye doctor, who can perform tests to determine the cause. Best of luck. — Dr. 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. Trattler

Allergies and Dry Eye

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. Trattler

Q: I want to thank you so much for this page. A lot of people might find comfort knowing they are not alone with dry eye problems.

I suffer from allergies and dry eye. I know which day it will rain, because my eyes get very itchy some hours before it rains. I am from Costa Rica, and it rains a lot here!

I wake up with red, tired eyes. Frequently (every 20 minutes or so), I have to wipe away mucus that forms in my eyes. This is very annoying, because it affects my social life.

Also, some years ago I used contact lenses, and I stopped using them because I saw a lot of new blood vessels in my eyes. So now, every time my eyes are tired or itchy, the vessels look very conspicuous.

In my country, I have seen many ophthalmologists. They have given me eye drops like Refresh Tears, Tears Naturale, Patanol, Zaditen, etc., and antihistamines like Zyrtec and Flurinol. But honestly, I just experience a temporary relief. I have also tried homeopathy (still trying it), and it helped to a certain extent.

Could you please tell me if I should continue using eye drops like Refresh Tears for my condition? Also, what can I do in order to reduce the formation of mucus in my eyes? — A.V.

A: Dry eye and ocular allergies go hand-in-hand, because dry eye makes ocular allergies worse. Of course, this means that treating dry eye can help reduce the severity of ocular allergies.

You have tried a lot of treatments, all of which can be helpful. I have found one treatment that works best for the itching, redness, and swelling of ocular allergies is topical Epinastine, because it causes less drying than some of the other anti-allergy medications.

As well, you can consider continuing the use of artificial tears that help reduce dry eye and dilute ocular allergens that make it into the tear film. If you feel your eyes are dry despite the artificial tears, you can ask your doctor about punctal plugs or a short course of low-dose topical steroids.

I hope this general information is helpful. — Dr. Trattler

Q: Since moving from the Far East to a European country for three years now, I have been experiencing tearing, red eye, and dry eye problems for quite some time. Initially, these problems started during the summer months only, and now it is a daily affair. What puzzles me is that it happens to my left eye only. I am a contact lens wearer. But even when I wear glasses and put in eye drops, I am not helped much. On most days, I get a lot of mucous discharge. Especially in the morning, my eyes have a lot of dry, waxy stuff that causes my eyelids to get glued together. — J.V.

A: You are describing a combination of ocular allergies and dry eye, which is being exacerbated by your contact lenses. You should discuss a variety of treatment options with your doctor, including treatment of your ocular allergies with topical anti-allergy medications. As well, punctal plugs can increase the tear film and make your eyes less sensitive with contacts. Finally, you can consider low-dose topical cyclosporine, which can be very helpful in increasing contact lens tolerance. Please see your doctor to confirm what your e-mail suggests and to develop a treatment plan. — Dr. Trattler

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. Trattler

Q: I've been diagnosed with cataracts and dry eye syndrome. I'm being treated for dry eye, and my symptoms have gone on for over one year. How long will my cataracts have to develop before they can be surgically removed? Is there anything else I can do to improve my ability to drive my car until that time? I still need to work and need my car for my job. — F.G.

A: Visual degradation can occur from both cataracts and dry eye. Because both dry eye and cataracts can decrease quality of vision, it is important to differentiate the degree of vision loss from dry eye versus cataract.

One helpful way to determine underlying cause is to look at the degree of visual fluctuation. Because visual fluctuation is caused by dry eye, you can temporarily improve quality of vision with blinking. If the degree of dry eye can be improved further, then the visual fluctuation can be reduced and quality of vision improved.

Of course, cataracts also can reduce visual quality. Only your own doctor can determine the severity of your cataracts. Your doctor would be the one to advise you regarding the time it might take for your cataracts to progress to the point where surgery would be helpful. — Dr. 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. 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. Trattler

Contact Lenses and Dry Eye

Q: I wear contact lenses. When I take them off at night, my eyes start getting dry and they stay dry the rest of the night. I was wondering if this is because of wearing contact lenses? — E.

A: Contact lens wear is a major risk factor for dry eyes. But a variety of different treatments are available that can help reduce dry eye in people who wear contact lenses.

For example, you can speak with your eye doctor about punctal plugs to increase your tear film. This will result in a higher level of your own tears, and help reduce dry eye symptoms.

You can, of course, also use artificial tears. Research also has found that oral omega-3s can help improve the quality of tears.

Hopefully, working with your doctor will help you find a solution to treating your dry eye condition and reducing your dry eye symptoms. — Dr. Trattler

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. 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. Trattler

Q: I was recently told by a friend that contact lenses can make my vision problems worse. Is this true? — P.S.

A: One of the challenges is that contact lenses can cause some degree of dry eye symptoms. Patients who use contact lenses may report dry eye symptoms of pain, foreign body sensation, or ocular irritation. Contact lens wearers also may complain of blurring or fluctuating vision, both of which also are signs of dry eye.

Patients who wear contact lenses may therefore feel that the contact lenses are responsible for changes in their vision, or fluctuation of their vision. However, treatment with over-the-counter or prescription medication can also reverse these signs and symptoms, thus eliminating the sensation of blurry or fluctuating vision.

It is important to point out that many patients will have progression of their myopia, hyperopia, and astigmatism regardless of whether or not they wear contact lenses. — Dr. 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. Trattler

Dry Eyes Upon Awakening

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. 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. Trattler

Q: I woke up this morning, and all of sudden, I can't tear up. I can't cry. What may be my problem? — J.M.

A: This is a complex question, and not easy to answer. I am not aware of any conditions where you can suddenly not make tears. You should see your eye doctor to determine the degree of lack of tears that you have actually developed. From there, your eye doctor can make recommendations to help. — Dr. 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 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. Trattler.

Q: For 20 years, I have had an artificial eye and suffered from dry eye in that eye only. My eye socket is pretty much always irritated, and I can see little white bumps on the inside of my upper eyelid when I remove my prosthetic.

Often I get a crystal-like covering on the surface of my prosthesis, and this makes it very difficult for my upper eyelid to close properly. I have tried many artificial tears, but relief is only very temporary. — L.G.

A: Unfortunately I do not have an answer as to why you are developing a crystal-like substance on your prosthesis.

I recommend that you speak with the person who helped create your prosthesis.

You also may want to see an oculoplastics specialist for an evaluation of your eye to help determine what the bumps are. They may be due to allergy. — Dr. 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. Trattler

Q: I believe I have dry eyes, because they are red and dry all day. Lubricant drops provide temporary relief. I wake up to red and irritated eyes even with sufficient sleep. Sometimes I see little white bumps on my upper lids. Can this be more than dry eyes? I am at a loss about what to do. — V.G.

A: You should not be at a loss. Your next step is very simple. You should see your eye care professional and undergo a complete eye exam, including testing for dry eye. Your doctor will be able to diagnose your degree of dry eye and make treatment recommendations.

Your symptoms are common for patients with dry eyes. Waking in the morning to red, irritated eyes even with sufficient sleep is a common complaint. Your symptoms of dry eye may be exacerbated by an overhead fan or an air conditioning vent pointed at you. You can consider stopping the use of your fan or repositioning the air conditioning vents, if these situations are present.

Since your symptoms do improve with the use of lubricant eye drops, your doctor may recommend topical cyclosporine eye drops that may be able to increase tear production.

Regarding the white bumps, it is important for you to see an eye doctor for an evaluation. Often these bumps are meibomian gland secretions at the opening of the oil glands of the eyelids. These secretions can harden, and appear as white bumps. This condition, called meibomian gland dysfunction, is often treated with warm compresses as well as prescription eye drops.

Of course, because I have not had the opportunity to examine you, I can only discuss your situation in a general way. You need to have an examination with your own eye doctor, who will be able to examine your eyes and make the appropriate treatment recommendations. — Dr. 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. 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. Trattler

Eye Drops and Ointments

Q: Which eye drops are low, medium and high viscosity? What are the differences between popular items like Refresh, Blink, Systane and TheraTears? — B.E.

A: Artificial tears have many attributes, including thickness. I recommend that you try each of these artificial tears and see how the "thickness" of the drops feel. Some patients like one product, while others like a different product.

In general, most of my patients feel that Systane is a little thicker than the others. On the other hand, you could try Blink Liquigel or Refresh Liquigel, which are even thicker. — Dr. Trattler

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. Trattler

Eye Infections and Dry Eye

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. 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. Trattler

Eye Irritation, Pain, and Dry Eye

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. 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. Trattler

Eye Redness and Dry Eye

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. 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. 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. Trattler

Q: Are permanent red veins in the eyes caused by dry eyes? Can anything be done to eliminate the red veins? — S.S.

A: There are multiple reasons for enlarged veins in the white part of the eye. Any type of inflammation can cause redness of the eye. Therefore, the underlying cause needs to be determined.

Please see your eye doctor to figure out the cause and discuss treatment. Proper treatment typically can improve the overall amount of redness in eyes with very prominent veins. — Dr. 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. Trattler

Q: Please help me! Every day, my eye is always dry, and it seems like my eye does not produce enough tears. My eye is constantly dry, burning, and red. I use eye drops to remove the redness, but that does not cure the problem. I think the dryness is what causes the redness every day, because I'm not sure what other cause it could be. This condition makes my life so miserable. — P.X.

A: You are describing dry eye syndrome, and clearly you need to see your eye care professional. Your first step is to stop the use of drops to remove redness. These drops, called vasoconstrictors, work only temporarily. Worse, extended use of these drops can lead to a rebound phenomenon where redness actually becomes worse.

Your eye care professional will probably discuss a variety of excellent treatment options, from punctal plugs to prescription therapy. These treatments can have a tremendous positive impact on your dry eye symptoms. — Dr. Trattler

Q: My left eye has been feeling itchy and red for the past two days. I put in some Visine eye drops to relieve the itching and redness. But my eye started burning even more and feels heavier than my right eye. I don't know if I should go to the emergency room, because I don't have health insurance, and I don't have a primary care doctor. What should I do? And do you think I have pink eye? Also, I was wondering if someone can get pink eye from hugging and kissing someone with pink eye? — A.

A: It is impossible to know if you have pink eye without an exam. Pink eye, or viral conjunctivitis, can be transmitted via contact. For example, you could shake the hand of a person who has pink eye and potentially be exposed. If you place your own exposed hand to your eye, then you could transmit pink eye.

As far as what to do, you will need to see a doctor to figure out if you have pink eye or another condition such as dry eye. Then you can receive appropriate treatment. Other common conditions that can be similar to pink eye are bacterial conjunctivitis or allergic conjunctivitis.

All of these conditions require separate types of treatment. Of course, dry eye also can cause a red and irritated eye. So you should see your doctor to figure out what is going on. — Dr. Trattler

Q: The inside corner of my right eye has been red for two days. Can pink eye infect only one side of an eye? Or is it something else? — C.C.

A: There are multiple causes of a red eye. Dry eye, of course, is a common cause. But viral conjunctivitis (pink eye) is another common cause. A third common cause is called epi-scleritis, which is an inflammatory condition and requires treatment. There is no way that someone on the Internet can know which condition you have. So your next step is to see your eye doctor. — Dr. 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. Trattler

Q: I've noticed a thin red vein across my eye, from the outer corner towards my iris. And when I shift my left eye towards my nose and look in the mirror, there are tons of red veins there now. Why would these suddenly show up? My eyes do feel a bit dry, and I blink a lot.

My eye doctor said my eyes weren't "clinically dry." I haven't been to see him in a while, but the red veins showed up a few days ago. Do these veins ever go away once they show up? — A.

A: Inflammation inside the eye or on the outer surface of the eye can lead to eye redness, which you have noticed. While dry eye is a common cause of eye redness, other inflammatory conditions of the eye can also cause increased redness, including uveitis and epi-scleritis. You should see your eye doctor, so he or she can determine the cause of your eye redness and recommend the appropriate treatment. — Dr. 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. Trattler

LASIK and Dry Eyes

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. 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.

A: Dry eyes are one cause of blurry vision. But other causes include cataracts and problems involving the cornea and retina.

Obviously I cannot diagnose your condition over the Internet, but I can give you some suggestions for treating dry eye.

You will need to see your eye doctor for a follow-up. I recommend requesting a corneal topography to verify that the shape of your cornea has remained stable since your LASIK procedure.

Other recommendations:

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. 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. Trattler

Q: For as long as I can remember (I'm now 29), I never could produce tears in my left eye. Plus, I always have this discharge in my eye. What could this be? Can it be corrected through LASIK surgery? — N.

A: LASIK will not solve this problem! You need to have an eye exam to determine why you do not produce tears. Once the reason is determined, your doctor can provide artificial tears, punctal plugs, etc. Note that eye discharge can be related to ocular allergies, which are exacerbated by dry eye. So treating your dry eye may be very helpful. Please see your doctor. — Dr. 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. Trattler

Q: I recently had a cosmetic procedure, where Radiesse was injected sub-muscularly (under muscles) under and around my eyes and cheeks. Two days after the procedure, I started experiencing noticeable dry eye. The surgeon (who is board certified and someone I certainly trust and have known for several years) hadn't heard of anyone experiencing dry eye after injections. The symptoms seemed to improve slightly five days later, but remained the same after 14 days.

Should I be concerned that, although this injectable substance isn't permanent, something might have been damaged during the injection? Or that the injected substance is obstructing ducts in some way? What are the possible complications of injections and dry eye? — I.W.

A: Great question. First, I am not familiar with Radiesse, and I am not aware of any reports of it causing dry eyes. But there may not be reports yet.

Dry eyes can be treated, regardless of the cause. I would see an eye care professional first and have your dry eyes analyzed. Are your dry eyes due to lack of tear production, or due to clogging of the oil glands of the eyelids (called blepharitis)? The treatment is different depending on the causes. Once your doctor initiates treatment, your symptoms should resolve.

Thank you for sharing your situation. I will watch out for any other cases like yours. — Dr. 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. Trattler

Q: Does calcitonin salmon nasal spray cause dry eyes? — A.P.

A: I am not aware of any reports that this medication, which is used for osteoporosis, is linked to dry eye. I have not seen any patients in my own office who reported that they started taking this treatment and developed dry eye, and I am not aware of any reports in the medical literature. — Dr. Trattler

Nutrition and Dry Eyes

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. 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. 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. Trattler

Q: Is any nutritional supplement treatment for dry eye effective? — J.B.

A: Omega-3 fatty acids are nutritional supplements that are believed to help improve the quality of the tear film, and thus improve a patient's dry eye condition. Flaxseed oil and fish oil supplements both are high in omega-3 fatty acids. As well, there are a number of nutritional supplements designed specifically for dry eye. — Dr. Trattler

Q: What other nutritional supplements besides omega-3 fatty acids can be taken for dry eyes? I have been trying to drink more water and take two flaxseed pills a day. How long does it take to notice improvement from taking flaxseed oil? — M.Z.

A: Omega-3 fatty acids are nutritional supplements with various health properties. Studies have found that oral omega-3 fatty acids help reduce dry eye symptoms. The theory is that omega-3 fatty acids improve the quality of oils present in glands of the eyelids. These oils are an important part of the tear film and provide improved quality of a person's tears. Some people do not have good oils in their oil glands, and therefore they produce a poor quality of tears.

For patients with dry eye, oral omega-3 fatty acids are often recommended as a dry eye treatment. In reality, omega-3s are helpful, because they can improve the quality of a person's tears, although they require a few months to really work. But for most patients, oral omega-3 supplements are not sufficient to eliminate dry eye symptoms.

Instead, we recommend oral omega-3s as part of a comprehensive treatment plan for dry eye. I am not aware of any other oral nutritional supplements that would improve dry eyes. Other important components of a comprehensive treatment plan include lubricating drops and topical cylcosporine eye drops (available by prescription). — Dr. Trattler

Q: I was recently diagnosed with blepharitis. My eye doctor encouraged me to increase my consumption of omega-3 fatty acids, which as you know are most commonly found in fish oil. I am severely allergic to all seafood. What is the amount of flaxseed oil I would need to consume daily to gain the omega-3 benefit for this condition? — J.B.

A: Oral omega-3 fatty acids are thought to help patients with blepharitis by improving the quality of their meibomian gland secretions, which are comprised of oils. In blepharitis, the oils become thick and the oil glands start to clog. Omega-3s may help improve the quality of the oil glands, so that the oil secretions are more liquid — and therefore flow better.

There is no compelling data on the exact amount of oral omega-3 fatty acids that should be consumed, so I cannot answer your question regarding the appropriate amount of flaxseed oil (which is a form of oral omega-3). I recommend that you speak with your doctor to get his or her recommendation. — Dr. Trattler

Q: I am 57 and have suffered from dry eye for a couple of years. My eyes are dry and red, sometimes a lot worse than other times.

I have tried many things, but two, I would say, have helped: fish oil (one tablespoon a day) and putting ice cubes wrapped in a paper towel on my eyes alternately for about five to 10 minutes. After that my eyes are not so red and feel better for several hours. Is using a cold compress in this way harmful to my eyes? Or is it OK, maybe even beneficial? — B.H.

A: Oral omega-3 fatty acids are thought to help improve the quality of tears in patients with blepharitis and dry eye, and I am happy to hear that you have had a good response to them. What is interesting is that the mechanism for oral omega-3s to help improve the condition of dry eye patients is thought to be related to the improvement of the oil gland secretions.

In some patients, the oil gland secretions of the eyelids are thick, resulting in reduced flow into the tear film. One treatment that is commonly used is heat, as warming the eyelids can help improve the flow of the oil secretions.

Conversely, you have found that chilling the eyes is helpful. This is not commonly done, but ice/cold can obviously help by reducing inflammation/swelling.

I personally do not recommend this to my patients, so I would speak with your own doctor and see what he or she thinks (since I cannot examine your eyes). Your doctor may recommend additional treatments, including lubricating drops and gels, topical anti-inflammatory eye drops, and possibly punctal plugs. — Dr. Trattler

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. 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. Trattler

Q: I just had cataract surgery. At the same time, I also had narrow-angle glaucoma, and those "angles" were opened up. My doctor said both procedures were successful. But I have had pain behind my eye, with pressure and then draining as though my sinuses were affected. My eye also is red. — P.D.

A: Your question is a little complicated. First, removal of cataracts is typically very helpful for patients with narrow angles causing glaucoma.

Pain behind the eye often is related to sinusitis. You should see your medical doctor to determine if this is the case.

Regarding red eyes, this may be residual inflammation from your cataract surgery. Other conditions, such as dry eye, also can cause eye redness.

We need to understand exactly what has caused the redness in your eyes. Then you and your doctor can discuss treatment options. — Dr. 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. Trattler

Q: I am female, 22 years old, and have keratoconus. Can you tell me something about this? — E.S.

A: Keratoconus is a condition where the eye's clear front surface (cornea) is warped, resulting in reduced quality of vision. Patients often must wear contact lenses, because vision quality with glasses is poor.

Contact lens intolerance, often due to dry eye, is one of the big issues with keratoconus. I have found great success in treating my keratoconus patients with cyclosporine eye drops, a prescription medication that improves tear film quality as well as increases the quantity of tears. These improvements allow for improved ability to wear contact lenses and also help reduce the chance of becoming intolerant to contact lenses.

Depending on the severity of your condition, there are other treatments for keratoconus. These treatments range from implants known as Intacs to, in rare cases, a corneal transplant. — Dr. 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. 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. Trattler

Punctal Cautery

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. Trattler

Punctal Plugs

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. 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. Trattler

Q: In the Orange County area of California, what doctor can put in permanent plugs for dry eyes, and how much does it cost? — J.Q.

A: Punctal plugs come in two basic types: dissolvable and plastic. The plastic ones are sometimes called permanent plugs, but they are not necessarily permanent.

The plastic plugs are placed in the tear drainage duct, such that the tops of the plugs are visible. These plugs typically can be removed at any time. Sometimes they will fall out on their own.

A second type of "permanent" plug is placed entirely within the tear drainage duct, such that the plug is not visible at the opening. Typically they last a long time, but they can cause inflammation, and it can be impossible to tell if they migrate out of position.

Virtually any eye care specialist can place permanent plugs in the eye and tell you the cost. I would contact your regular doctor and request a referral. — Dr. Trattler

Q: I am considering getting punctal plugs for my dry eyes. I did have them for a short period and I thought they were a bit uncomfortable. Which option is best? Getting the plugs again or taking a supplement in pill form? I am a 68-year-old female in very good health except for the dry eyes and mild osteoporosis. My ophthalmologist said my corneas were in terrible shape. I will be taking artificial tears four times a day. I don't have any redness and my eyes don't bother me except I am sensitive to sunlight. — M.B.

A: Some patients find that punctal plugs are uncomfortable. But for many patients, the discomfort will improve with time. If the discomfort does not resolve, one option is to consider replacing the punctal plug with a design called an "internal" punctal plug. The internal punctal plugs are inserted in the puncti (openings that allow drainage) and do not have an external portion. Although some forms of internal punctal plugs led to occasional problems in the past, the newer generation internal plugs seem to be relatively safe. I use them quite a bit for patients in my own practice. Besides considering punctal plugs, you should also talk with your doctor to see whether prescription dry eye medication would be an option for you. — Dr. 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. Trattler

Vision Problems Related to Dry Eyes

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. 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. Trattler

Q: Why is it that I see clearer when my eyes are watery than when they are dry? Do I need some type of eye drops? — N.

A: Dry eye causes irritation to the surface of your cornea, which leads to reduced quality of vision; so you are potentially describing dry eye. You should see your eye doctor to confirm the diagnosis and to determine the best treatment options. — Dr. Trattler

Q: Sometimes my left eye is blurry as hell. If I close that eye, everything looks fine through my right eye. If I close my right eye, I can't see clearly and can't focus on anything. This usually happens for about a day. When I wake up the next morning, my left eye seems fine again.

Sometimes this happens for several days in a row. Sometimes it doesn't happen for several weeks or months or even a few years. This is why I haven't seen a doctor, because most of the time I can see great. — C.

A: First, your description of episodes of blurry vision in just your left eye is concerning. I recommend that you see an eye doctor for a complete exam.

Second, occasional dry eye can cause temporary blurry vision in one eye. This can be improved with a lubricating eye drop.

But I highly recommend that you see a doctor to figure out what's going on. — Dr. Trattler

Q: Can erratic double vision in one eye be a symptom of dry eye syndrome? Also, is a humidifier a good appliance to help prevent dry, burning eyes? — J.H.

A: Dry eye cannot cause double vision. You should see your eye doctor ASAP to figure out the cause of your intermittent double vision. Humidifiers can be very helpful for dry eye. But you may also need to consider lubricating drops and gels to treat your dry eye symptoms. — Dr. 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. Trattler

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