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Dry Eye QA

Your Eye Doctors Answer Your Questions About Dry Eyes

1) 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?

Since symptoms in dry eye disease don’t always equal the potential signs that the optometrist can see with their microscope it is always a good idea to see an optometrist to make sure that you are aware of all of your best treatment options when dealing with this chronic disease. There is much more to treatment than just artificial tears.

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

Yes. Particularly in Winnipeg where we have very dry winters. Like so many people who suffer with dry hands, dry skins, dry nose, etc… our eyes are definitely not spared these symptoms. We often recommend a humidifier running in the bedroom at nighttime to increase the humidity levels while sleeping.

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

At Armstrong & Small Eyecare Centre we establish a baseline via an exam we call a ‘Dry Eye Assessment’. The Dry Eye Assessment will include as assessment on the severity of the patient’s symptoms, a determination on the amount of tears produced by the patient and a close examination of the lids and ocular surface before a complete review and written instructions on a treatment plan and follow up exams. There are two types of dry eye one being what we call ‘lipid deficient dry eye’ where there is a lack of oil in the tear film and the other being ‘aqueous deficient dry eye’ where there isn’t enough aqueous (water like) produced. It’s also possible that a patient might have both of these issues called ‘mixed mechanism’ dry eye. Our goal, no matter what type of dry eye, is always help the patient return to an ocular comfort zone where they can get through their day thinking less about their symptoms.

4) What are the typical treatments you recommend to help people suffering from Dry Eyes?

Treatment plans depend on the severity and type of Dry Eye Disease that the patient presents with. Mild dry eye can often be managed with a good artificial tear (using on a consistent basis), hot compresses and Omega 3 supplementation. Lid wipes or foams may also be prescribed if blepharitis (eye lid inflammation) is an issue and antibiotic ointments may be applied to the lids and lashes if an infection is present. Moderate dry eye disease will include the previously mentioned treatment plans and often include a course of steroid drops to control the inflammation and then the potential for a medication that can control the inflammation long term (Restasis / Xiidra). Often a patient at this level of Dry Eye will also be switched to a preservative-free artificial tear to avoid the amount of preservatives on the ocular surface causing more issues. Severe dry eye will include all of the previously mentioned treatment plans and may include punctual occlusion, meibomian gland expression, biofilm removal from lids and lashes and potentially oral antiobiotics. A referral to a corneal specialist is also available if treatment protocols fail to improve the patients symptoms.

5) Omega3 fish oil is a hot topic in the news today. What is it, and what are its benefits in regard to Dry Eyes.

Omega 3 fish oil has been shown to control inflammation of the eye lids long term. Within the eye lids are specialized glands (meibomian glands) that produce oil that helps keep the tear film covering the eye from evaporating quickly. Patients with ‘meibomian gland dysfunction’ or ‘lipid deficient dry eye’ can benefit from Omega 3’s as it thins the oils that can get clogged in these glands and decrease overall inflammation of the eye lid margin. Specifically we will prescribe a triglyceride based Omega 3 with an EPA and DHA value equalling a 1000 mg (sometimes more) per day.

6) My eyes are frequently overly watery. That isn’t Dry Eyes, is it?

Yes, typically this is one of the symptoms of ‘lipid deficient’ dry eye disease. Since the poor quality tear film will evaporate quickly from the ocular surface there is a trigger mechanism to release more of the aqueous or watery type tear that overwhelms the surface and can even run down ones cheeks. In Winnipeg, cold wind will often trigger this effect and it is typically a reflex to the type of dry eye that a patient has.

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

Yes. Women over 50 are 3x as likely to suffer from Dry Eye Disease than men therefore both age and sex play a role in the potential for the disease. Those with certain systemic diseases such as diabetes and rheumatoid arthritis are also at higher risk. Contact lens wearers can also have a higher chance of symptoms since the lens itself can disrupt the tear film. Many systemic medications can also have drying side effects that put that patient at higher risk of Dry Eye Disease (particularly allergy medications and anti-depressants/anti-anxiety medications).

8) Do you have any recommendations for people to help them avoid Dry Eye issues?

First and foremost, it is important for patients to realize that Dry Eye is a chronic disease with a variety of variables that can worsen the severity of the disease. Be sure to see your optometrist to establish a baseline on the type and severity of the dry eye disease that you have. Once a treatment plan has been established it is key to be as compliant as possible with the recommendations outlined by your eye doctor. Often the optometrist will start with a higher amount of treatment options to get the disease under control and then tailer these treatment options so that compliance is maximized going forward.