Dry Eyes As a Challenge For Professionals
Author: Mohammad Ghandehari-Motlagh,Optometrist
Member of Contact Lens Society of America(CLSA)
Shiraz-Iran
Every eye care professional knows dry eye is an important challenge in contact lens practice.In this article I’ll try to review some basic principles,etiologies, treatment plans and its prognosis step by step. I’ve used different references especially Contact Lens Society of America’s publications. Details have been ignored because some of my readers will be professionals. My article consists of the following 9 important questions:
Q1:Do dry eyed patients really need our concerns as an optometrist?
The population of people over 50 years old will increase per year over the next five years and 20-40% of the patients will have some form of dry eye. Dry eye affects as estimated 20.7 million people in the United States and is the one of the most common reasons that people visit their eye doctor.
Q2: Some dry eye patients go untreated. Why?
Many our patients don’t think dry eye is a medical diagnosis and don’t think any thing can be done about it. You should know untreated dry eye is one of the most important causes of a disconnected contact lens wear.
Q3: What are dry eye etiologies?
Age and gender are risk factors. In one study found that women who complain of sever dryness outnumber men 46/1 !
Patients with rheumatoid arthritis,diabetes,thyroid disease,graves disease,asthma,glaucoma (and its ocular medications to treat it) and lupus are also more likely to experience dry eye.
Systemic medications such as anti-depressants,decongestants,antihistamines,blood pressure medication,beta blockers and diuretics will also all increase dryness in a patient.
The patient environment(cold climates and computer users) is an important factor.
Lasik is also a cause of dryness.Most of the nerves serving the cornea come in from the nasal and temporal sides.When the flap is cut to leave the hinge on the top, both the nasal and temporal sides of the sensory nerves are cut.
Q4:Is monitoring dryness important for you?
If you think you’ll miss your patients only for untreated or ignored dry eye, what will you do? Yes. You’ll be very angry.
Q5: What’s the best procedure for Schirmer test?
Roll a cotton swab along the inside of the lower lid that removes excess tear found there and provide a more accurate assessment of the tear volume.
Q6:Are dry eyes so complex?
There are number of causes of dry eyes.Increased tear osmolarity is due to the tear film evaporation or decreased production .
Decreased production can occur from lacrimal gland disease and in neurotrophic corneas,corneal surgery,diabet and contact lens wear.
Q7:What’s your opinions about artificial tears?
We should have the patients put in drops several times/day, even if they don’t feel they need it. if the patient will continue a routine of drops at least 4 times/day for a minimum of 4 weeks,they should notice a big improvement.
A.TheraTears(Advanced Vision Research):It increases goblet cell density,which increases mucin and the eye will be wetter.
B.Restasis(Allergan):It has been used by vets to treat dry eyes in dogs and approval for use in human has now been granted. I should tell you Restasis treats inflammation,an underlying cause of dryness.
Q8:Do you recommend punctal plugs for your patients?
There are 3 kinds of plugs: 3 days plug(is a diagnostic tool for poor candidate of permanent plug), extended duration plug(for 2-3 months plug and work well for post lasik dry eye patients) and non-dissolving plugs(for permanent plug). Extended duration plug can elongated to 6 months.Because it usually takes 3-6 months to nerve regeneration after lasik surgery.
Q9:What’s your patient’s instruction for bacteria removal in blepharitis?
Eliminating bacteria around the lids and lid margins will help patients with dry eyes. Scrubs with baby shampoo have been the industry standard.However it has been understand that it also removes some of the skin oils that are naturally antibacterial.
Sterilids(Advanced Vision Research,inc.) is a new product out now that can be used instead.What Sterilids does is kill 100% pseudomonas in 30 seconds. By letting sterilids sit on the lid margins for 30-60 seconds before rinsing it off bacteria has been eliminated without getting rid of the natural oils.
Please feel free to contact me: oculist233@live.com
References available Upon request
Help answer the question about lasik dry eyes
Does LASIK make your eyes dry?
I heard that LASIK dries your eyes for a while so an optional treatment after LASIK is to get plugs for your tear ducts to keep your eyes moist. How long does this condition last? I heard someone say your eyes are dry permanently. I thought it was only temporary.
Also, if one chooses not to pay for the tear duct plugs, are normal eyedrops enough to keep your eyes moist?
After the initial several months of dry eyes, is it possible to spend the rest of your life COMPLETELY FREE from dependence on eye drops or any other treatment for moisture? In other words, live like someone who never needed the surgery?
I don’t want to keep spending money and time buying and using eye drops or any other treatment. After LASIK, I want to be DONE worrying about my eyes (except of course for the natural deterioration that comes with aging). Is this possible?
About Author
Optometrist, Primary Eye Care,Shiraz-Iran