Dry Eye - Q&A Page

Dry eye is a common eye problem suffered by many people, and is typically characterized by redness, pain, or an itching/ burning sensation in the eyes. We have answered some of the most popular questions here.

Dry Eye - Q&A Page in Chattanooga

How is dryness in the eyes treated?

Depending on the severity and type of dry eyes (aqueous or evaporative) there are various ways we can treat dry eyes. Initially we would start off the patient to use warm compresses 2x a day for 10 minutes with lid massage and lid scrubs. Along with the use of over the counter artificial tears 2-4x a day in both eyes. Depending on severity we can also add a gel drop or ointment at night. If relief is still not occurring with the initial course of treatment, we can then add prescription eye drops for dry eyes such as Restasis or Xiidra. Other dry eye treatment options are using punctal plugs or other devices like Lipiflow/iLux/IPL etc.

Are there dry eyes home remedies that work?

Some at-home remedies to relieve your symptoms of dry eyes is to apply warm compresses over your eyes for 10minutes. Some ways to achieve this at home is to boil an egg or potato then wrap it in a paper towel to place over your eyes to allow for consistent heat over your eyes. You can also heat up a bag of rice as an alternative warm compress. Taking omega-3 fish oil vitamins can also help. Also, if you stare at a digital device screen for long periods of time remember to take breaks; every 20 minutes look 20 feet away for 20 seconds.

What natural solutions are there to deal with dry eyes?

To help deal with your dry eyes some natural solutions are to apply warm compresses over your eyes twice a day for 10 minutes and then do lid massages with lid scrubs. Also taking omega-3 fish oil supplements or eating foods with naturally high omega-3s as well as staying hydrated can help. Additionally, taking breaks from your digital screen devices is important; every 20 minutes look somewhere far away, like outside of your window, for 20 seconds. Furthermore, If you’re an incomplete blinker, there are different blink exercises to learn how to take more frequent and full blinks, which can help relieve your symptoms of dry eyes. In regards to your environment you can add a humidifier and filter to add moisture to the air.

Is blepharitis caused by mites?

Yes, mites can cause blepharitis. Blepharitis is inflammation of your eyelids, which can then result in swelling, redness, itchiness and irritation of the eyes. If someone has poor eyelid hygiene, this can block the oil glands on the eyelid margin resulting in an inflammatory response causing blepharitis and dry eyes. Demodex is a mite that can be found on the eyelids and lashes. These mites eat dead skin cells, lay eggs and expel waste products in your eyelid glands and eyelash follicles. A small amount of mites naturally can be found on our skin to remove dead skin cells, and typically do not cause any harm or symptoms. But if you don’t have proper lid hygiene these mites can reproduce in large numbers, and can block the oil glands at the bases of the eyelashes causing blepharitis.

How do I clean my eyelids for dry eyes?

There are several different ways you can clean your eyelids for dry eyes, one method is to use OcuSoft lid scrubs (or you can use any other brand lid scrubs). These scrubs are packaged in a pre-moistened pad. First you should wash and clean your hands, then fold the Ocusoft pre-moistened pad over your index finger, close your eyes, and then gently scrub your eyelid with your index finger using side to side strokes. Then rinse your eyes with water and repeat the same for the other eyelid. Another method of cleaning your eyelids is using Avenova Antimicrobial lid and lash Solution. First wash your hands prior to application and be sure to remove any make-up or lotions around your eyes. Apply the spray to a cotton pad (or you can also apply the spray directly onto your eyelids with your eyes closed). Then close your eyes and using a horizontal motion wipe the base of all the upper lid lashes at least 3 times, applying to the base of your eyelashes along the lid margin. Then look up and wipe the base of the lower lashes with a horizontal motion at least 3 times, applying to the base of your eyelashes along the lid margin. Then with a new cotton pad repeat on the other eye.

Is mgd permanent?

Depends on the severity of the meibomian gland dysfunction (MGD). We have meibomian glands on our upper and lower lid margin that help to produce oil, which contributes to the outermost oil layer of our tears and prevents our tears from evaporating. MGD is when the glands don’t work properly. If these glands are blocked, they do not secrete the oils necessary to maintain a healthy tear film, and can eventually die off resulting in various symptoms such as dry eyes, burning, itching, irritation, tearing, foreign body sensation etc. If the glands have already atrophied then there is no way of getting the glands back. However, if the glands are still present but just truncated or tortuous, then there is still a chance to allow the glands to start working properly again with various MGD treatment options.

What causes eyes to feel gritty?

There are a variety of eye conditions that can cause your eyes to feel gritty. Such as, dry eyes, blepharitis, allergies, Sjögren’s syndrome, various medications, infections, foreign body stuck in your eye etc. If your eyes feel gritty contact your eye care provider to get the proper diagnosis and treatment.

Are my dry eyes a symptom of menopause?

Menopause can cause dry eyes. Sex hormones, estrogen and androgens, play a role in the production of all the components of the tear film, and contribute to the homeostasis of the tear film. During menopause, there is a disruption/change in the hormonal status, which can result in an unstable tear film causing dry eyes.

What causes meibomian gland dysfunction?

There are a variety of factors that can play a role in causing Meibomian gland dysfunction (MGD). Some causes are, age, environmental factors, genetics, ethnicity, hormonal changes, medication usage, lifestyle risk factors like certain diet, contact lens wearing, and cosmetics.

How does an optometrist unblock oil glands?

One of the main ways to unblock oil glands is to apply heat to the oil glands so that they can melt like butter, and then with massage and mechanical force stimulate the oil to come out. The simple way to do this is with warm compresses, manual lid massage and lid scrubs. However if this initial method does not provide much relief or is too tedious for the patient to be compliant with, then there are other treatments that your optometrist can perform. One treatment option is LipiFlow, this is a thermal pulsation system which is a 12 minute in-office procedure that applies heat and pressure to melt the waxy oily deposits that are clogging the Meibomian glands, allowing then the glands to express the oils healthily. Another in-office treatment is iLUX, this uses a LED heat source to unblock the oil glands and then the optometrist will apply pressure to help express the clogged glands. Another option is TearCare, which uses adhesive heating patches that connect to a small heating unit to warm the oil glands, and then forceps are used to press on your lids to unblock the glands, and allow them to be properly expressed. Another treatment is Intense Pulsed Light (IPL), which shines intense flashes of infrared and visible light on the eyelid over 20 minutes to unblock the glands. Another option is Blephex, which is a hand-held instrument with a small rotating sponge attached that applies pressure and scrubs the eyelid margin to exfoliate and remove the inflammatory biofilm that clogs your glands, essentially unblocking them. Other than these treatment options your optometrist may also prescribe various eye drops to restore proper Meibomian gland function such as Restasis, Cequa, Xiidra, antibacterial eye drops as well as omega-3 supplements.

How can I reduce dryness in my eyes?

There are various ways one can reduce dryness in their eyes, depending on the severity and type of dry eyes (aqueous or evaporative). One way is to apply warm compresses 2x a day for 10 minutes over your eyes with lid massage and lid scrubs. Also using over the counter artificial tears 2-4x a day can reduce your dryness. If your dry eyes are more severe, you can also add a gel drop or ointment at night, and/or add prescription eye drops for dry eyes, such as Restasis or Xiidra. Dry eye is a multifactorial disease of the ocular surface, and one component that causes dry eyes is ocular surface inflammation and damage; so Xiidra and Restasis work by regulating the inflammatory processes in the eye that can affect tear production. Other ways to reduce dryness in your eyes is to have your eye doctor insert punctal plugs, which partially closes one of your tear ducts to allow your tears to stay longer on the front surface of your eyes and keep your eyes lubricated. There are also other in-office devices such as LipiFlow, iLUX, TearCare, Intense Pulsed Light, or Blephex that your eye doctor can use to reduce your symptoms of dryness. Furthermore, changing your environment can also help reduce your dry eyes, such as adding a humidifier to your room or taking frequent breaks from your digital devices.

Can my eye discomfort be a symptom of medication that I am using?

Yes, there are various medications that can increase your symptoms of dry eyes and eye discomfort. Some examples are anxiety medications, antidepressants, antihistamines, antipsychotics, anti-muscle spasm medications, Accutane, beta blockers, contraceptives, as well as certain diuretic medications. However, before discontinuing any medications be sure to talk to your primary care physician, as the benefits from these certain medications can outweigh the side effects.

My eyes are always burning and tired, what is causing this and what can I do about it?

If you are on a digital screen device for a majority of your day this can cause your eyes to feel tired and result in digital eye strain. Normally in one minute people usually blink about 18 times, and when we blink this naturally refreshes and lubricates our eyes. However when we stare at our computer screen we tend to blink only half the normal amount we’re supposed to, thereby decreasing the amount of times our eyes are refreshed and lubricated, causing our eyes to feel dry and tired. Some things you can do to help relieve your symptoms is to follow the 20/20/20 rule which is every 20 minutes look 20 feet away for 20 seconds. Also practice various blinking exercises to take more frequent and complete blinks. Also try to hold your digital device further away from you, to reduce eye strain. Additionally, using an anti-glare filter on your screen/glasses can help. Another cause of eye discomfort is if you wear your contact lenses for a prolonged period of time. The simplest thing you can do is to reduce the amount of hours you wear your contact lenses, and switch into your glasses. Also, make sure to have a contact lens evaluation with your optometrist, because you may need another type of contact lens that allows for my oxygen permeability to reduce your symptoms of eye dryness/discomfort.

Are there some every day activities that can cause Dry Eye?

Yes, when we perform tasks that require high visual concentration, such as staring at a computer screen, reading, or writing for a prolonged period of time, this results in us blinking less, causing dry eyes. Additionally, some other everyday activities that can cause dry eyes are using a hair dryer, not drinking enough water, sitting in front of the office air-conditioner or fan, wearing eye makeup, working in extreme temperatures, wind blowing in your face, or being surrounded by cigarette smoke.

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

Yes, typically older females going through menopause are more prone to having dry eyes than others. Also people taking certain medications such as anxiety medications, antidepressants, antihistamines, antipsychotics, anti-muscle spasm medications, Accutane, beta blockers, contraceptives, as well as certain diuretic medications, are more prone to have dry eyes. Also people who are contact lens wearers who don’t properly take care of their contacts or are wearing contacts with low oxygen permeability may be more prone to dry eyes. Additionally, people who tend to work on a digital screen for a prolonged period of time can increase their risk of dry eyes.

Are there some every day activities that can cause Dry Eye?

Yes, when we perform tasks that require high visual concentration, such as staring at a computer screen, reading, or writing for a prolonged period of time, this results in us blinking less, causing dry eyes. Additionally, some other everyday activities that can cause dry eyes are using a hair dryer, not drinking enough water, sitting in front of the office air-conditioner or fan, wearing eye makeup, working in extreme temperatures, wind blowing in your face, or being surrounded by cigarette smoke.

My eyes are frequently overly watery, what is causing it?

Normally we have tear ducts located in the inner corners of our eyes that help to drain our tears out of the eye into the nose; but if your tear drainage system is blocked (lacrimal stenosis) and/or not functioning properly it may cause overly watery eyes (epiphora). Additionally, if you’re experiencing excessive tearing, this may sound counter-intuitive, but it may mean that your eyes are dry. When our eyes are dry, they feel irritated and uncomfortable, which stimulates the lacrimal gland to produce so many tears that this then overwhelms the eye’s natural drainage system, causing our tears to roll down our face instead of through our tear ducts. Allergies, and irritants can also cause excessive tearing. Infections can also cause overly watery eyes because part of your body’s response to an eye infection is to produce excess tears in order to keep the eye lubricated and wash away any germs or discharge.

What are some of the symptoms of Dry Eye?

Some symptoms of dry eyes are that your eyes may feel gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or you may experience light sensitivity. Other symptoms may include blurry vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up, after going in and out of focus, due to an unstable ocular surface.

Does weather cause my eyes to feel painful, gritty, and dry?

Yes, especially winter weather. In the winter due to cold weather outdoors and heated air indoors we have less moisture and low humidity, which may result in our eyes feeling dry. Also if it’s windy and cold this can cause excessive tearing as well. Snowfall can also cause your eyes to be sensitive to light/painful because snowfall creates many reflective surfaces that increase the amount of light. If there is a lot of pollution outside or if it’s during the spring time and there is a lot of pollen in the air this can also make your eyes feel itchy and gritty.

How do I know if I have Dry Eye?

You may have dry eyes if your eyes are feeling gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or if you’re experiencing light sensitivity. Dry eyes can also cause blurred vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up after going in and out of focus due to an unstable ocular surface caused by dry eyes.

Why do my eyes water if I have dry eye?

When you have dry eyes this sends out a signal to your lacrimal gland to produce more tears, but then this results in an overproduction of tears causing tearing/watery eyes. The overproduction of tears is called reflex tearing. Your body is trying to counteract your dry eyes, so it then starts to produce more tears, but then it ends up flooding your eyes with too much tears, resulting in a vicious cycle of dry and then teary eyes. That is why it’s important to deal with the root of the cause of the tearing, which is your dry eyes, to stop this sequence of events from happening. But it’s important to also note that watery eyes can be caused by other conditions as well, so be sure to get a thorough evaluation by your eye doctor to determine the proper diagnosis and treatment.

If my eyes water how can I have dry eyes?

When you have dry eyes this sends out a signal to your lacrimal gland to produce more tears, but then this results in an overproduction of tears causing tearing/watery eyes. The overproduction of tears is called reflex tearing. Your body is trying to counteract your dry eyes, so it then starts to produce more tears, but then it ends up flooding your eyes with too much tears, resulting in a vicious cycle of dry and then teary eyes. That is why it’s important to deal with the root of the cause of the tearing, which is your dry eyes, to stop this sequence of events from happening. But it’s important to also note that watery eyes can be caused by other conditions as well, so be sure to get a thorough evaluation by your eye doctor to determine the proper diagnosis and treatment.

What can I do to prevent dry eyes?

There are ways to alter your environment in order to prevent dry eyes. For instance, avoid air blowing in your eyes such as a fan, air conditioner, hair dryers, or car heaters. Also consider adding a humidifier to add moisture to dry indoor air, which is especially useful when the heaters are on in the winter. Also, when you go outside the wind and dry air can cause your eyes to tear and be dry, so to prevent this and to protect your eyes it’s important to wear sunglasses or other protective eyewear when you go outside. Furthermore, if you are working with your digital device it’s important to take breaks and follow the 20/20/20 rule, which is every 20 minutes look 20 feet away for 20 seconds. Additionally, sometimes your eye doctor may notice early signs of dry eyes before you experience symptoms, so you can prophylactically treat dry eyes by applying warm compresses over your eyes and doing lid massage, as well as using artificial tears to keep the front surface of your eyes lubricated.

What eye drops do you recommend for dry eye syndrome?

Depending on the severity of your dry eyes there are different eye drops we would recommend. If you have the milder version of dry eyes then over the counter artificial tears such as Systane Balance or Refresh Optive Artificial Tears may be sufficient enough to help relieve your symptoms of dry eyes. However, if you have more moderate/severe dry eyes a more viscous drop such as a gel drop or ointment may be more beneficial. In the event that over the counter eye drops are not providing much relief, there are other various prescription eye drops that your eye doctor can prescribe, such as Restasis or Cequa or Xiidra. Dry eye is a multifactorial disease of the ocular surface, and one component that causes dry eyes is ocular surface inflammation and damage; so Xiidra and Restasis/Cequa work by regulating the inflammatory processes in the eye that can affect tear production.

How do I know if I have dry eyes, or my eyes are just tired?

There are various symptoms of dry eyes such as your eyes feeling gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, blurry vision, or you may experience light sensitivity. Dry eyes can also cause your eyes to feel tired. However, there can also be other causes of eye fatigue. Some activities that can result in your eyes feeling tired is prolonged use of digital devices, reading without breaks, activities that involve extended focus, being exposed to bright light/glare or straining your eyes because of dim lighting, uncorrected vision, or being stressed/fatigued.

When should a person come in to see their optometrist for Dry Eye symptoms and when is it enough to take care of this problem yourself?

If you’re experiencing any symptoms of dry eyes you should see your optometrist to get a thorough dry eye evaluation to determine the severity of your dry eyes and then have the proper course of treatment. Some symptoms of dry eyes are if your eyes feel gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or you may experience light sensitivity. Other symptoms may include blurry vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up, after going in and out of focus, due to an unstable ocular surface. Since symptoms of dry eyes can also be similar to symptoms caused by other eye conditions, it’s best to not just take care of the problem by yourself, and it’s important to visit your eye doctor so that you can get the proper diagnosis and treatment. Additionally, there are instances when sometimes signs of dry eyes can be detected by your eye doctor before you even experience any symptoms. So, in that case your eye doctor may also provide some sort of treatment to prevent you from starting to feel symptoms of dry eyes in the future. Thus, if you don’t experience any symptoms of dry eyes it is still important to get your eyes examined at least once per year.

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

Typically first your eye doctor would take a thorough case history reviewing your symptoms and the severity of the symptoms. (Some symptoms of dry eyes include burning, itching, excessive tearing, gritty/foreign body sensation, eye discomfort, inflammation, or blurry vision.) Your eye doctor will also review your medical history, any medications you’re taking, your day to day activities, as these can all contribute to dry eyes as well. Then a thorough dry eye evaluation will be conducted. Your eye doctor will look at your eyes under a microscope where they will assess your meibomian glands on your upper and lower lid margin. To get a better image of the inside of your meibomian/oil glands your doctor may also take an image of them using a Lipiscan/Meibography. If any of your oil glands are capped, truncated or atrophied this may indicate you have dry eyes. Also your tear layer will be assessed, typically a sodium fluorescein dye would be used. Here we can examine your tear break up time (TBUT), tear meniscus height, and blink rate. Various other tests can be used to detect dry eyes such as Lissamine green and Rose Bengal dye, Schirmer test 1 and 2, and Phenol red thread test. For the Schirmer Test your eye doctor will place a strip of medical paper inside of your lower eyelids, and the paper will then absorb your tears, which will show us the amount of tears you have. For the phenol red test it’s the same concept as the Schirmer test but instead a thin red thread string is placed inside your lower eyelids to determine the volume of your tears. If any of these values are below normal this can also help us detect dry eyes.

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

There are various treatments used to help people who suffer from dry eyes. The type of treatment depends on the severity and type of dry eyes (aqueous or evaporative). One treatment option is to apply warm compresses 2x a day for 10 minutes over your eyes with lid massage and lid scrubs. Also using over the counter artificial tears 2-4x a day can reduce your dryness. If your dry eyes are more severe, you can also add a gel drop or ointment at night, and/or add prescription eye drops for dry eyes, such as Restasis or Xiidra. Dry eye is a multifactorial disease of the ocular surface, and one component that causes dry eyes is ocular surface inflammation and damage; so Xiidra and Restasis work by regulating the inflammatory processes in the eye that can affect tear production. Another treatment for dry eyes is to have your eye doctor insert punctal plugs in the inner corners of your eyes, which partially closes one of your tear ducts to allow your tears to stay longer on the front surface of your eyes and keep your eyes lubricated. There are also other in-office devices such as LipiFlow, iLUX, TearCare, Intense Pulsed Light, or Blephex that your eye doctor can use to treat your symptoms of dryness. Furthermore, changing your environment can also help reduce your dry eyes, such as adding a humidifier to your room or taking frequent breaks from your digital devices.

How is dry eye best detected?

Dry eyes can be detected by your eye doctor first reviewing your symptoms and the severity. Some symptoms of dry eyes include burning, itching, excessive tearing, gritty/foreign body sensation, eye discomfort, inflammation, or blurry vision. Then a thorough dry eye evaluation will be conducted. Your doctor will look at your eyes under a microscope where they will assess your meibomian glands on your upper and lower lid margin. To get a better image of the inside of your meibomian/oil glands your doctor may also take an image of them using a Lipiscan/Meibography. If any of your oil glands are capped, truncated or atrophied this may indicate you have dry eyes. Also your tear layer will be assessed, typically a sodium fluorescein dye would be used. Here we can examine your tear break up time (TBUT), tear meniscus height, and blink rate. Various other tests can be used to detect dry eyes such as Lissamine green and Rose Bengal dye, Schirmer test 1 and 2, and Phenol red test. For the Schirmer Test your eye doctor will place a strip of medical paper inside of your lower eyelids, and the paper will then absorb your tears, which will show us the amount of tears you have. For the phenol red test it’s the same concept as the Schirmer test but instead a thin red thread string is placed inside your lower eyelids to determine the volume of your tears. If any of these values are below normal this can also help us detect dry eyes.

Why do my eyes water all the time? What can I do to make it stop?

You may have watery eyes because your eyes are actually dry. When you have dry eyes this sends out a signal to your lacrimal gland to produce more tears, but then this results in an overproduction of tears causing tearing/watery eyes. The overproduction of tears is called reflex tearing. Your body is trying to counteract your dry eyes, so it then starts to produce more tears, but then it ends up flooding your eyes with too much tears, resulting in a vicious cycle of dry and then teary eyes. To stop your eyes from watering all the time, it’s important to deal with the root of the cause of the tearing, which is your dry eyes, to stop this sequence of events from happening. But it’s important to also note that watery eyes can be caused by other eye conditions as well, such as allergies, eyelid inflammation, blocked tear ducts, outwardly turned eyelids etc, so be sure to get a thorough evaluation by your eye doctor to determine the proper diagnosis and treatment.

 

Are there some every day activities that can cause Dry Eye?

Yes, when we perform tasks that require high visual concentration, such as staring at a computer screen, reading, or writing for a prolonged period of time, this results in us blinking less, causing dry eyes. Additionally, some other everyday activities that can cause dry eyes are using a hair dryer, not drinking enough water, sitting in front of the office air-conditioner or fan, wearing eye makeup, working in extreme temperatures, wind blowing in your face, or being surrounded by cigarette smoke.

Are there some every day activities that can cause Dry Eye?

Yes, when we perform tasks that require high visual concentration, such as staring at a computer screen, reading, or writing for a prolonged period of time, this results in us blinking less, causing dry eyes. Additionally, some other everyday activities that can cause dry eyes are using a hair dryer, not drinking enough water, sitting in front of the office air-conditioner or fan, wearing eye makeup, working in extreme temperatures, wind blowing in your face, or being surrounded by cigarette smoke.

 

Dr. McBryar cartoon

Dry Eye - Q&A Page

Dry eye is a common eye problem suffered by many people, and is typically characterized by redness, pain, or an itching/ burning sensation in the eyes. We have answered some of the most popular questions here.

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