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Dry eyes FAQ

Q: I have very dry eyes from rheumatoid arthritis. What are the best eye drops to use?

A: There are a variety of over-the-counter artificial tears. There are proprietary brand names and generic brand names. Try them one brand at a time and see which works for you. After a while, if one stops working, try a different one.

An artificial tear preparation that works for one person doesn't necessarily work for the next. Trial and error is the best way to go. — Dr. Slonim

Q: I have dry eyes. Is the treatment called punctal plugs covered by insurance?

A: It depends on your insurance. Usually yes, as implantation of punctal plugs in the tear drainage ducts of the eyelids is a medical procedure to correct a medical condition. It usually works great, too! — Dr. Dubow

Q: What can I do for excessively dry eyelids? They are cracking open. Also, I am experiencing puffiness under my eyes.

A: Cracking eyelids can be a sign of a blepharitis (inflammation of the eyelids), especially when the cracking occurs at the outer corners of the eyelids. If the cracking is really scaling, this could represent a type of psoriasis of the skin of the eyelids. If it is just dryness, try an eyelid moisturizing cream found at a makeup counter. See your eye doctor for a definitive diagnosis and treatment. — Dr. Slonim

Q: I’ve been diagnosed with dry eyes but would still like to continue wearing contacts from time to time. Is it true that a lens lower in water content is better for me?

A: Some contact lens practitioners find that, in fact, lenses with lower water content can sometimes be better for people who have dry eyes. But some patients actually do better with high-water content lenses. It has long been felt by some practitioners that the thicker the lens, the better, as well.

To increase your comfort with contact lenses (regardless of the type of lenses your eye doctor recommends), first have your dry eye condition evaluated and treated. Ask your doctor about the possibility of lacrimal or punctal occlusion, which plugs up the tear drainage system to keep more moisture on your eyes. — Dr. Dubow

Q: I wore contact lenses about four years ago. I have dry eyes from prescription Premarin, which I must take for the rest of my life. Have there been any updates since that time to ensure a longer contact lens wearing period?

A: You bet! There are several dry eye contact lenses on the market. Ask your eye care practitioner about CooperVision's Proclear lenses. These contacts have been approved by the U.S. Food and Drug Administration (FDA) for the claim, "may provide improved comfort for contact lens wearers who experience mild discomfort or symptoms relating to dryness during lens wear," according to the company. There are other contact lenses that your eye doctor might recommend for people with dry eyes as well.

I highly recommend you also use non-preserved contact lens care products. Ask your practitioner about hydrogen peroxide-based contact lens care systems or the chemical-free Purilens Plus system.

There also is a procedure called punctal occlusion whereby your eye doctor can block some of your tear drainage, keeping more of your tears on your eyes. This is a simple procedure taking only a few minutes and done right in your doctor's office. It can work wonders for folks with dry eyes. — Dr. Dubow

Q: I've worn soft contact lenses on and off for 15 years, and I chronically have red, bloodshot eyes. I've gone for periods of weeks and months wearing only my glasses and avoiding contacts, but honestly my eyes seem less bloodshot when I wear my contacts. What can I do to clear up my red eyes? And does the fact they are chronically bloodshot indicate any eye health problems or disease?

A: There are many causes of red eyes. It sounds like you need to obtain a diagnosis for your condition so that the appropriate treatment can be prescribed.

Eye allergies and dry eye syndrome are probably the two most common causes of red eyes. Wearing contact lenses on top of an already inflamed eye can only lead to further problems. See an ophthalmologist or optometrist to determine the cause of your red eyes and the best treatment. — Dr. Slonim

Q: Why do some contact lenses feel more dry than others? Is it better to go with lower water content or higher?

A: This is a very technical question. Contact lenses are made from a number of different plastic materials that have different characteristics. Some have more water content than others.

All contact lenses are subject to evaporation while on the eye. In other words, the environment pulls water out of the lenses. The rate of this happening depends on many factors, including: humidity, wind, temperature, your health, what medicines you are taking, how much you blink, the lens care system you use, how clean your lenses are, etc.

Some eye care practitioners believe that high water content lenses perform better for those with dry eyes, while others believe just the opposite. A few lenses are specially made from plastics that resist dehydration and evaporation to increase comfort for wearers with dry eyes. 

I suggest trying silicone hydrogel contact lenses, such as Air Optix (Alcon), PureVision (Bausch + Lomb) and Acuvue Oasys (Johnson & Johnson Vision Care). For a contact lens solution suitable for someone with dry eyes, I recommend Clear Care (Alcon).

Also, a simple in-office procedure called punctal occlusion can help keep more of your natural tears on your eyes instead of draining into your nose and throat. The procedure is very safe and often will make your contact lenses more comfortable. — Dr. Dubow

Q: Why do my eyes water all the time, especially my left eye?

A: This is actually impossible to know without examining you. But you should consider two major things: your tear drainage system may be plugged, or you may have dry eyes. Although this seems contradictory, these two conditions are the most common for causing watery eyes.

If your eyes are constantly watery, with tears dripping onto your face, I would suspect a blockage of the tiny ducts in your eyelids that drain tears away from your eyes. This can usually be alleviated by having your eye doctor flush out these drainage ducts, which are located near the inner “corner” of your eyes.

If your eyes water primarily when you are in wind or cold or when your eyes are irritated, I would suspect dry eyes as the cause. This problem often can be alleviated by intentionally blocking the tear drainage system to keep more tears in your eyes, thereby eliminating the reflex “watering” of your eyes when they get too dry.

I recommend you see an eye doctor to determine which of these (or possibly other) problems are the cause of your watery eyes and to obtain relief. — Dr. Dubow

Q: Lately I’ve been experiencing excessive tearing from both eyes, but with no eye allergy symptoms (no red, swollen, or itchy eyes). I’m five months pregnant. Could excessive tearing be a symptom of pregnancy? What can I do to stop the tears?

A: Yes, sometimes watery eyes can occur during pregnancy. It may be caused by a problem with the tiny ducts in your eyelids that normally drain tears away from your eyes and into your nose.

As long as there is no infection and none of the symptoms you mentioned, wait until after your baby is born to see if the excess tearing goes away. If you are concerned, check with your eye doctor. — Dr. Slonim

Reviewed by Gary Heiting, OD

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