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Dry and Itchy Eyes?

Our modern age and environment can be challenging for our eyes. Dry Eyes is now a recognized eye disease marked by either decreased tear production or increased tear film evaporation. Typical symptoms include dryness, burning and a sandy-gritty eye irritation that gets worse as the day goes on. There may also be a feeling that something that feels like as a speck of dirt, is in the eye. 

Interview with Your Dry Eye Expert

We spoke with Dr. Trey Gerdes of Eye Fashion Optical of Waco, TX, a dry eyes expert serving greater Mahoning County to find out what can be done about this problem.

Q: Dr. Gerdes, what are the common symptoms of Dry Eye, and when would you recommend that a patient come into the practice for these symptoms for an exam?

Dr. Gerdes:  Common symptoms of dry eye include burning, itching, excessive tearing (or lack of tearing), light sensitivity, a granular sensation, and scratchiness or foreign-body sensation in your eye. Decreased vision or changes in visual clarity may occur due to poor tear film.  Your eyelids may stick together and your eyes may be red or crusty when you wake up. A patient should come into the practice for an examination when any one or a combination of these symptoms appears so that we can intervene before the condition deteriorates preventing a longer treatment regimen. 

Q: Many people seem to consider Dry Eye to mean that they are experiencing discomfort in their eyes. How is Dry Eye really categorized? Is it considered to be an actual medical disease?

Dr. Gerdes:  There is a severity index that we follow based on severity signs and symptoms:
1. Mild to moderate symptoms; no signs. Mild to moderate conjunctival signs.
2. Moderate to severe symptoms. Tear film signs, mild corneal punctate staining, corneal staining, visual signs. 
3. Severe symptoms. Marked corneal punctate staining, central corneal staining, filamentary keratitis.
4. Severe symptoms. Severe corneal staining, erosions, conjunctival scarring. 
Dry Eye syndrome is considered to be a medical disease.  It is a disorder of the tear film on the surface of the cornea caused by tear deficiency or excessive tear evaporation that results in damage to the ocular surface and is often associated with eye discomfort.

Q: Why should a patient come into the office as opposed to treating themselves by purchasing over the counter artificial drops?

Dr. Gerdes:  Typically over the counter artificial eye drops have a vasoconstrictor (decreases blood flow) as part of the contents to whiten the eye or the lubricants contain preservatives the patient may be allergic to. The redness is the result of an underlying issue that has to be resolved. Tests should be performed to find the cause of the redness and proper treatment prescribed. 

Q: What types of tests or examination is conducted in the office when checking for Dry Eye?

Dr. Gerdes:  The following procedural test should be performed when examining for Dry Eye: 
I examine the lid margins. I pay special attention to the tear layer during the examination. I will examine the tear meniscus height and tear film break-up time (TFBUT). I also examine the tear consistency, looking at thickness, debris, oil and sebaceous secretions. 
Lastly, I like to look beyond the eyes. Look for signs of acne rosacea by examining the nose and forehead of men and the cheeks of women for signs of telangiectasia. I also look at the patient’s hands for typical changes suggestive of rheumatoid arthritis or osteo-arthritis. 

Q: What treatments are available and most commonly used to treat Dry Eye? Do you recommend fish oil to patients?  Do you use punctal plugs, and in what scenarios?

Dr. Gerdes:  Environmental management is very important. I recommend that patients use hypoallergenic products, increase their water intake, and increase their nutritional support with omega 3 oil.  In more severe cases: I may prescribe a course of systemic anti-inflammatory therapy, oral cyclosporine, moisture goggles, acetylcysteine, punctal cautery, or in the most severe cases, surgery.
We do recommend omega 3 fish oil over the omega 6 or omega 9 due to omega 3 having more liquid properties to help thin meibomian gland secretions.
Punctal occlusion is a procedure that helps retain tears on the ocular surface. We know anecdotally that some patients respond favorably after punctal occlusion is performed, reporting that their eye feels “more comfortable,” while others respond with increased dry eye symptoms. We have learned that those patients who respond poorly are likely to have a certain level of inflammation which is retained on the ocular surface. These inflammatory factors will then exacerbate signs and symptoms that escalate with punctal occlusion. The logical course for treating patients with dry eye is to decrease the inflammatory component and, once the inflammation has been resolved, to implement punctal occlusion.

Q: Are there certain people, whether it be because of profession or gender who are more prone to have Dry Eye issues?

Dr. Gerdes:  Many factors can cause dry eye, or exacerbate an existing dry eye condition. These include:
  • Extended visual tasks, such as prolonged computer use. 
  • Systemic medications that have drying side effects, including antihistamines, hormone replacement therapy, diuretics, antidepressants and antianxiety medications, cancer treatments and some sleep aids. 
  • Excessive consumption of alcoholic beverages. 
  • Long-term exposure to dry air, as found in the desert Southwest, for example, or windy climates. 
  • Extreme use of forced-air heat or air conditioning. 
  • Air pollutants, such as tobacco smoke, smog or excessive exhaust fumes. 
  • Contact lens wear and refractive surgery. Dry eye symptoms may adversely affect contact lens wearing time (and often is the most common reason for discontinuing lens wear) or corneal healing, respectively. 
  • Dietary considerations, such as the reduced intake of omega-3 fatty acids, increased omega-6 consumption, reduced water intake (individuals should drink at least eight glasses of water daily) and increased intake of soft drinks and/or caffeine (caffeine itself is a drying agent).

Q: What recommendations can you give people in order to enhance their surrounding environment and avoid Dry Eye issues?

  • Avoid too much caffeine. Some studies have shown that small amounts of caffeine help with dry eye and act as a tear stimulant. But excessive amounts could have diuretic effects. 
  • Get enough sleep. Sleep is a major factor for dry eye disease and is perhaps the main contributor. 
  • Keep alcohol consumption to a minimum. A possible contributing factor for 20-somethings. 
  • Proper contact lens wear. Contact lens wear usually starts in teens or early 20s, and compliance can worsen during college years, which can lead to dry eye issues. 
  • Avoid vaso-constricting topical drops. Many teens and college-age individuals want ‘white eyes,’ so they may overuse vasoconstrictors. 
  • Watch for allergies and antihistamines. Allergic conjunctivitis can overlap with dry eye disease and to make matters worse, taking oral antihistamines can further dry the eye.” 
  • Be aware of hormonal changes: women approaching menopause may be more prone to dry eye. 
  • Take breaks from prolonged computer work: To much computer work without appropriate breaks to give your eyes a rest can reduce blink rate. 
  • Welcome new parents: lack of sleep and excessive caffeine can be part of the problem. 
  • Drugs/medications: Please make note of the medications you are taking when coming to the optometrist. Side effects of many of these drugs can cause dryness. 
  • Be aware of autoimmune or other systemic disease: These too can cause dryness. 
  • Improve your nutrition

Q:  Following treatment, do you find that patients are excited about their new-found comfort? Can you recall any particular instances or stories?

Patients are excited about having eyes that are comfortable and moist throughout their waking hours. There are plenty of good stories but the most common are the ones working on computers that can work all day in visual comfort and the contact lens patient that can now wear their contact lenses with clarity and comfort.

Q: Are there any new and exciting treatment approaches or technologies on the horizon?

Dr. Gerdes:  There are several emerging strategies for dry eye treatment to look forward to in the future, such as natural hormonal controls, secretagogues, mucomimetics, anti-evaporatives, new anti-inflammatories and other improved polymers for use with dry eye patients.

Q:  What are the most common misconceptions that people have about Dry Eye?

Dr. Gerdes:  When some patients present with a watery eye they are surprised to learn the condition is caused by a dry eye. This typically results from a lack of gland secretions which retain the watery middle tear layer from evaporation. 
Patients do not associate their environment, what they eat or drink, and meds they take with dry eyes. These associations come quite surprisingly to them.

Q: Any further comments or take home messages about Dry Eye?

Dr. Gerdes:  The one ounce of simple advice that will give a pound of return, in my opinion, is doing lid scrubs during morning showers. The warm shower water will soften the residue on the eyelid margins and the shower spray along with gentle eyelid massage with baby shampoo will help remove it.