Dry Eye Care: FAQ

What are the most common symptoms of dry eye?

The most common symptoms of dry eye are burning, irritation, foreign body
sensation, intermittent blurry vision, tired feeling when reading or concentrating,
itching, and watering.

My eyes are watering. How can they be dry?

This is one of the most common questions that patients ask. The cornea of the eye
is one of the most enervated parts of the human body. This is why the eye is so
extremely sensitive. One of the jobs of corneal nerves is to monitor dryness in
corneal tissue. If the cornea gets excessively dry it can scar and keratinize (form a
tough insoluble protein) . To prevent scarring and ocular damage, the corneal
nerves will send a message to the brain to increase reflex tearing. Reflex tearing
usually prevents damage to the cornea, but unfortunately doesn’t have the proper
oil or mucin components to comfort the eyes and give clear vision. In addition,
reflex tearing often runs over the lids and down the cheeks, a condition known as
epiphora.

Will over the counter artificial tears help?

Over the counter artificial tears definitely will help most dry eye patients.
Unfortunately they need to be used frequently because they don’t increase natural
tear production. If using artificial tear therapy alone, you will usually need to instill
drops at least four times a day for sufficient overall coverage. For patients that use
artificial tear therapy, we recommend single use preservative free formulations
(single use vials) because of possible allergy and toxicity to preservatives in
traditional eye drops (eye drops that come in one bottle). Most patients with dry eye
have tried artificial tear therapy alone, but still have significant symptoms.

Will warm compresses and lid massage really help?

For many patients warm compresses (a warm compress held in contact with the
closed eyelid for several minutes) and lid massage will help dry eye symptoms
immensely. There are many oil glands in the eyelids called meibomian glands that
secrete oil into the natural tear film. This oil layer helps to keep the tear layer from
evaporating. Many people who have dry eye problems also have a problem with
these oil glands clogging or not secreting appropriately. Thus, your eyes are losing
tears to evaporation at a higher rate than they produce tears. Warm compresses and lid massage have been shown to unclog these meibomian glands and help them
secrete at a normal rate.

Why is Doxycycline sometimes prescribed?

It is prescribed for patients that have significant meibomian gland dysfunction.
Doxycycline has been shown to help oil glands with secretion and keep them from
clogging. It is a antibiotic and should not be taken with dairy products, as they will
neutralize its effectiveness.

What is Restasis?

Restasis is the only prescription eye drop proven to help increase natural tear
production. Restasis works by decreasing inflammation in the lacrimal glands of the
lids. The lacrimal gland is primarily responsible for most of the eye’s natural tear
production. Since this is one of the most effective and successful dry eye therapies,
we use it as one of the first line weapons in the fight against dry eye. We also prefer
Restasis because it has been proven to be safe for long term use, and it increases the bodies natural tear production instead of relying on artificial formulations.

How long will it take for Restasis to start working?

Clinical studies and our experience with Restasis show that it takes about 3
to 4 weeks of continuous use for it to start working. However, we have found that
Restasis used in conjunction with a topical steroid such as Lotemax greatly increases the effectivity of the drops and decreases the time in which you notice a
reduction in symptoms.

How long will it take for Restasis to reach maximum effectiveness?

At least 6 months. At 6 months we schedule an appointment to assess the
maximum effectiveness. We also determine if we need to modify therapy based on
objective and subjective findings, and the patients overall comfort level.

What is Lotemax and why do you prescribe it with Restasis?

Lotemax is a topical steroid eye drop. Like Restasis, Lotemax decreases
inflammation in the lacrimal glands and other ocular tissues. Unlike Restasis,
Lotemax is a fast acting eye drop that instantaneously decreases inflammation. The
combination of the fast acting mode of action by Lotemax combined with the long
lasting effect of Restasis has been shown to work faster than the two medications
independently. Since Lotemax is a steroid and must be monitored if taken long
term, it is typically discontinued after Restasis has started showing therapeutic
progress.

Should I still use artificial tears with Restasis?

It is fine, and many times beneficial, to use artificial tears while using Restasis.
However, it is our hope that as Restasis starts working, dependence on artificial
tears will be decreased or eliminated. In general, artificial tears can be used along
with any drop therapy and still be subjectively beneficial.

What are punctal plugs and how do they help?

Punctal plugs are a mechanical way to help dry eye. Toward the nasal part of your
eye, you have a drainage duct called the punctum that drains tears from your eye.
Simple occlusion of this punctum, by a small removable plug, blocks this drainage
system and allows more of the natural tears to stay on the eye for longer periods of
time. Because medication and artificial tears don’t drain from the eye as rapidly,
punctal occlusion also helps medical therapy by allowing instilled drops to have a
greater effect on the surface of the eye.

Punctal plugs are very small acrylic or collagen inserts that are painlessly placed in
the punctal opening of the eye. When deciding if punctal plugs will help your
symptoms, we usually first insert temporary plugs that dissolve in approximately 5
days. If you notice significant decrease in your dry eye symptoms for that trial
period, permanent plugs will be inserted. Permanent plugs can be removed at any
time in the office.

What is a therapeutic scleral lens?

Therapeutic scleral lenses are also a mechanical way to treat dry eye. The scleral
contact lens takes advantage of new advances in high oxygen permeable contact
lens materials. The scleral lens is a large diameter rigid contact lens that rests on
the white part of the eye (the sclera), and vaults over the cornea. This vaulting
creates a large tear reservoir that is filled with a sterile saline solution, which keeps
your eye lubricated throughout the day. This treatment can be very rewarding for
severe dry eye patients that have not had success with other therapies. It has also
been successful in patients that have become hypersensitive (allergic) to medical
therapy over years of treatment.

Is a therapeutic scleral lens hard to handle?

Because it is larger and more rigid than regular contact lenses, the scleral lens is
actually easier to keep track of and manipulate. The insertion removal process can
be challenging at first. The secret to a successful scleral lens insertion and removal
is patience. Just like any contact lenses, insertion and removal training will take
time and effort for the doctor, technician, and patient. If this treatment is right for
you, rest assured that you will get the time and training necessary to successfully
handle your lenses.

Will a therapeutic scleral lens help me see well?

The primary goal of the scleral contact lens is to keep a tear film on your eye and in
essence improve your overall corneal health by keeping it lubricated. For many
patients this has a healing effect on the cornea and increases vision. For all patients
the scleral lens should increase quality of life by decreasing the sometimes
debilitating symptoms of severe dry eye. Any patient thinking about this modality
should be aware that the primary goal of the lens is to decrease dryness to the
cornea. Glasses may still be needed to achieve optimal vision over scleral lenses.

What should I expect from a dry eye evaluation?

A dry eye exam will usually consist of a detailed slit lamp exam (microscopic exam
of the front of the eye) to determine the cause or causes of the specific condition.
There are many factors that can cause or exacerbate dry eye syndrome. These
include a decrease in the quality of the production of oil in the lids, a decrease in the
production of aqueous in the lacrimal glands, problems with eyelid closure or
coverage, current medications, hormonal changes, aging, blepharitis, rosacea, or a
combination of all of these things. There are also several measurements of tear film
effectivity that are taken during your examination. It is our goal to determine the
cause of your dry eye and give recommendations to best treat the cause.

What is a tear flow test?

A tear flow test measures how much aqueous your lacrimal glands produces in a
certain amount of time. This is a very beneficial test in not only determining the
severity of your dry eye syndrome, but also objectively determining the
effectiveness of our treatments.

So are my eyes going to get better?

Dry eye syndrome is typically a chronic disease with remissions and exacerbations.
Fortunately, there are many new treatments that can greatly reduce and even
eliminate dry eye. The key is to properly diagnose the condition and choose the
correct treatment. For many patients this becomes a constant battle, and we are
dedicated to giving them the best specialized treatment available today.