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Dry Eyes Q&A by Dr. Caryn Nearnberg

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Q: Is it true that Dry Eye symptoms seem to be more severe in the winter than in the warmer spring and summer months?

Winter is the most common season that people feel dry, itchy, and watery eyes. With the cold temperatures and low humidity also comes harsh winds outside and dry heat inside. These cause tears to evaporate quickly, causing irritation.

Q: When should a person come in for a professional evaluation of Dry Eye symptoms and when is it enough to take care of this problem yourself?

It is best to schedule an in-office evaluation if you are experiencing irritation, redness, a burning sensation, grittiness, watering, or fluctuating or blurred vision. If you use artificial tears often or are not able to wear contacts for an extended time, you may also have dry eyes. It is important to come for an evaluation so one of our doctors can determine if you do not have enough water (known as aqueous tear-deficiency) or not enough oil (known as evaporative dry eye or meibomian gland dysfunction). The most optimal treatment plan will then be initiated.

Q: What is the examination like to determine whether someone is suffering from Dry Eyes?

We will first ask you questions about symptoms of irritation, contact lens wear, and artificial tear usage. We will then measure the volume and determine the quality of your tears. Special dyes allow examination of the corneal surface and measurement of tear evaporation time. Your doctor may also swab your tears to test for inflammation and osmolarity (concentration). Non-invasive and quick Meibomian Gland imaging will be performed to futher analyze the health of these oil producing glands.

Q: I have a friend whose eyes are frequently overly watery. That isn’t Dry Eye, is it?

It sounds counterintuitive but yes, watery eyes may be a symptom of “dry eyes.” Overly watery eyes often accompany a low tear volume. Reflex tearing is a response to too rapid tear evaporation as a result of insufficient natural oils.

Q: What are the typical treatments used to help people suffering from Dry Eyes?

Typical treatments include: over-the-counter artificial tears to lubricate the eyes during the day and/or nighttime gels, which can help moisten the eyes and provide temporary symptom relief. Prescription medication such as low-dose steroids or Restasis (cyclosporine ophthalmic emulsion 0.05%) and Xiidra (lifitegrast ophthalmic solution 5%) decrease ocular inflammation, increasing the eyes’ ability to produce their own tears. Small punctual plugs inserted in the tear ducts prevent drainage of the tears.

Warm compresses help open up clogged oil glands, preventing tear evaporation. It has been shown, though, that microwavable products such as the Bruder mask and Tranquileyes mask (which can be purchased in our office) remain at the correct heated temperature for the suggested time of 5-10 minutes. The LipiFlow thermal pulsation treatment performed in our office, however, is the most effective way to express the glands to restore function.

Q: Are some people more prone to having Dry Eyes than others?

Those more at risk for having dry eyes include those over 50 years old, who have diminished tear production. Women are more at risk due to hormonal changes with birth control pills, pregnancy, or menopause. Contact lens wearers and people who work on the computer all day do not blink as much and are more at risk for having evaporative dry eyes. Frequent travelers are also at risk due to the harsh recycled air in planes. People with medical conditions such as diabetes, rheumatoid arthritis, lupus, Sjogren’s syndrome, thyroid conditions, and vitamin A deficiency are more likely to have dry eyes. Also, systemic medications including antihistamines, antidepressants, hormone replacement therapy, chemotherapy as well as drugs for acne, birth control, and blood pressure dry the body out, including the eyes. Ocular surgeries such as LASIK or cataract surgery can cause or increase dryness as well.

Q: Do you have any recommendations for people to help them avoid Dry Eye issues?

The easiest ways to avoid dry eyes are to point heat vents away from your eyes and hydrate by drinking plenty of water regularly. Avoid smoking and protect your eyes from wind and dust with sunglasses. Use a humidifier in your home. Eating foods that contain omega-3 fatty acids or taking supplements can help you produce better quality tears. We recommend avoiding waterproof eye makeup that is hard to remove and requires abrasive makeup remover: this can strip natural oils from the eye.