What are dry eyes?

The Tear Film and Ocular Surface’s recent DEWS II definition of dry eye essentially says that dry eye is a multifactorial disease of the ocular surface characterized by a loss of the normal functioning of the tear film. In the process, the tear film becomes unstable and the hyperosmolar (think of it as being a bit saltier than it should be). Additionally, there is ocular surface inflammation and the nerves may be affected as well. Pretty vague, right? Well, that’s because dry eye is hard to define. It’s considered a large umbrella term.

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Orlando DRY EYE Experts

The term “dry eye” does seem to have some connotation to the general public that it is only a minor nuisance—that it isn’t a big deal. But as thousands of people can attest to, that’s simply not the case and it can be vision threatening. Ocular surface disease may be a better term that gives a better sense of gravitas to the condition.

It can be difficult, if the correct questions are not asked. Symptoms can range from burning, tearing, blurry vision, fluctuating vision, foreign body sensation, itching, etc. We use a questionnaire in the clinic to help track patients’ subjective symptoms.

There are two major sets of tears. One is the baseline tear, produced by the lacrimal glands, which you produce every time you blink. If this is inadequate for whatever reason (e.g. poor quality, poor blink rate or function), then a signal is sent through a neurosensory pathway to the other set of accessory aqueous glands to produce reflex tears. Think of this as the body’s way of trying to solve the problem, similar to the tearing you would experience if you were poked in the eye. Unfortunately, it is an all-or-nothing response so the eye becomes flooded with fluid.

Artificial tears are what most people reach for first, because they are easily accessible over-the-counter. However, because dry eyes are a chronic, progressive, inflammatory disorder, treating with a chronic, anti-inflammatory eye drop make more sense, at least as a primary treatment. Failing that, conservative treatment with omega-3 supplements and hot masks would be the next step. Lastly, procedures are reserved for patients who are still symptomatic or showing signs of more permanent damage to the meibomian glands.

We are not big fans of the Visine get-the-red-out drops. The drops use vasoconstrictors to temporarily shrink the blood vessels but they tend to come back with a vengeance. Additionally, the time spent red-free starts to decrease, making the drop less effective. It is always better to treat the cause, instead of the symptom, so treating the dry eye properly would be preferable. If a temporizing measure must be used, we recommend Lumify drops instead.

There are a few ways of putting in eye drops. Remember that you only need a small fraction of the drop to get into the eye so a little waste is expected!

It is important to be careful when applying ointment to the eyes. Otherwise, you could accidentally poke your eye with the tip of the tube!

The warm compresses need to give off heat at a certain temperature for at least 10-12 minutes to be effective. For this reason, warm washcloths are no match for something that gives off dry heat. There are a number of masks that exist, but this technique is good for many of them. Make sure to carefully read the instructions for your particular brand.

Oh boy, there are lots! Antihypertensives, antidepressants, antihistamines, reflux medications, pain medications, acne treatments, glaucoma eye drops and that’s just the tip of the iceberg! Many of these meds can be found secreted in the tear film as well.

For women especially this is a common problem because of menopause. As the estrogen levels decrease, we can see profound and rapid changes in the tear film. Treatment can restore normal function, but it can be very surprising for patients as it can have a rapid onset.

More than likely, you had some mild, relatively asymptomatic dry eye that decompensated after surgery. Sometimes, it is temporary and goes away within the first 3 months postoperatively. Other times the symptoms are more permanent. We usually give patients three months to recover on their own if they are symptomatic postoperatively unless the symptoms are too great. If it is still present after three months, we typically start treatment.

At the Dry Eye Lounge, of course! If you are not able to see us due to distance, then we advise you to see a reputable ophthalmologist in the area who feels comfortable treating your condition.

We wish we could. While we have treatment algorithms and multiple therapies at our disposal, and the vast majority of patients do really well, there is no guarantee a given treatment will work on a patient. We reserve procedures for patients who don’t respond fully to medical therapy and continue to work our way up the rungs of the ladder depending on the level of severity and resistance to conventional therapy. What we can promise you is we will never give up on you and we will exhaust every effort to make you well again.

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