Dry eye handout update 2.wps

Dry Eye is a multifactorial disease of the ocular surface caused by reduced tear quality and or
quantity causing symptoms of burning, foreign body sensation, grittiness, light sensitivity, ache,
pain, and transiently blurred vision, and possibly reflex tearing. Dry eye can be intermittent and
mild, to chronic, severe and debilitating causing visual loss and corneal scarring. There are many
factors that can contribute to dry eye including environmental, medications, hormone balance,
contact lens wear, age, and excessive visual tasking. Trying to optimize the tear film and heal
the ocular surface often involves a multifaceted approach, including environmental modifications,
use of artificial tears, gels, and ointments, nutritional supplements, medications, and tear drain
(punctal occlusion) occlusion with collagen, silicone plugs or cautery. This therapy can vary
depending on symptoms and signs . Often dry eye dramatically improves with therapy in the
short term only to worsen months later and require more intense therapy. Everyone is different so
often therapy between individuals varies quite a bit.
Artifical tears: Artificial tears are needed to supplement the natural tear volume. Tears without
preservatives are best when you need to use them more then 4x per day. Environmental
conditions and intense visual tasking can necessitate the need for increased use. Tears to have
some therapeutic value, though it is somewhat minimal. Along with providing some temporary
improvement in ocular comfort, artificial tears do help “dilute” the tear film. In dry eye, the
concentration of salts and other minerals increase, this causes increased “concentration” of the
tear film, or osmolarity., which eventually causes and increase in inflammatory mediators.
Artificial tears can help reverse this increase in “concentration”, or osmolarity….somewhat.
Gels and Ointments: Moderate to severe dry eye can be aided by more viscous lubricants, like
artificial tear gels and even thicker ointments. Gels can be used throughout the day or before
bedtime. Thick ointments are usually used right before bedtime to provide lubrication while
sleeping. Preferred ointments are Systane Nightime, or Blink gel.
The Eyelids: The eyelids contain three kinds of oil glands which are vital in that they provide the
oily components of the tear film which provide stability and prevent evaporation between blinks.
Commercial eyelid scrubs like Steri-Lid and Ocusoft are very good at keeping the eyelids clean
and healthy. Hot/Warm-moist compresses (wash rag laid over the eyes for 5 minutes or so) are
also good at heating up these oils to lower the viscosity of the oils. Omega-3 fatty acids (Fish oil)
is believed to be very beneficial for the eyelid oil glands. Take 3-5 pills (3000-5000mg) of highly
refined, purified, pharmaceutical grade fish oil. (OmegaRx from zonelabsinc.com is my preferred
form of fish oil). Azasite is often prescribed over the short term to help control inflammation at
the eyelid margin.
Medicines: Anti-inflammatory medications (Lotemax and Restasis) are beneficial in reducing
inflammatory mediators which are prevalent in dry eye and restoring the ocular surface. These
often need to be used initially with severe dry eye, and then occasionally when flare ups occur.
Restasis is approved to use on a chronic basis, but typically is not “as strong” as Lotemax or work
as quickly as Lotemax does. Oral medications like Doxycycline can help underlying inflammation
as well as the eyelid oil glands. Azasite is a great medication to help control underlying eyelid
inflammation as well and help promote better production of quality oils to provide stability to the
tear film.
Nutrition: Stay hydrated, limit caffeinated beverages. Please don’t smoke, it is much harder to
treat and “cure” dry eye symptoms in smokers. Eat lots of fish, better yet, take 3-5000mg of
purified, refined fish oil daily. (OmegaRx from zonelabsinc.com is my preferred source for fish oil)
Environment: Take frequent computer breaks, use artificial tears during long sessions of
computer work., instill tears before starting. Redirect air vents away from the eyes. Don’t use an
overhead fan. Set your computer monitor below your line of sight, so you are looking in a slight
downward gaze.
If you travel a lot, consider wearing your glasses during flights if you are a contact lens wearer,
planes maintain an extremely low humidity and are very dry. Instill artificial tears often during
long flights. Redirect overhead air vents on airplanes away from your face on long flights.
Consider a room humidifier at home or at the office.
Systemic medications: Many systemic medications can cause dry eye or make it worse,
including hypertensive medications(Atacand, Coreg, Cardura, Norvasc, Lotrel, Ziac, Toprel), anti
depressants (Effexor, Prozac, Paxil, Elavil, Zoloft, Wellbutrin), hormone replacement (Prempro,
Premarin,Ogen,Estrace),diuretics (Bumex, Lasix, Lozol), Anti-cholinergic (Detrol, Ditropan,
Oxytrol, Atrexa, Urispas, Sal-Atropine) Anithistamines like Clariten, Zytec, Allegra, and others.
Limit daily intact of anti-allergy medications unless needed.
OTC Eye drops : Another cause of ocular surface irritation and dry eye is constant, chronic use
of some OTC “red-out” drops with vasoconstrictors, like Visine, and Cleareyes. These drops
have preservatives that irritate the ocular surface over time, and the effect of the vasoconstrictors
wear off over time, so the eye becomes increasingly more red, with constant use.
TEARS:

GELS:
OINTMENTS:
LID HYGIENE:
MEDICATIONS:
FOLLOW UP:

Disclosure: I have no financial interest in any product mentioned in this handout.

Source: http://www.drcarterjohnston.com/portals/0/forms/dryeye.pdf