Top 5 things to know about Dry Eye.
- If you spend a dollar on treatment, you should be a dollar better.
- Dry Eye is not an allergy. The allergy is not dry eyes.
- There are dry eyes that bother the patient, and there are dry eyes that bother the doctor getting measurements for cataract surgery or LASIK.
- Unfrozen Serum Eye Drops work better, faster, and cheaper than most prescription treatments. It is usually only taken for two months every year or two.
- Chronic Meibomian Gland disease and Conjunctivo-chalasis are two conditions often misdiagnosed as dry eye.
Dry Eye is a very common and frustrating problem. It’s underdiagnosed, misdiagnosed, and sometimes even caused by doctors.
The eye’s natural tears are very complex. Normally made up of water, mucus, and oil layer in a very special balance, they lubricate the eye so the lids glide over them.
They also keep small things from irritating the eye, and they help us see better. When something is wrong with tear film, we can have dry eyes. Dry Eye Syndrome is actually a number of conditions under one umbrella term.
Understanding the disease as a chronic one and being proactive rather than reactive in treatment are the keys to solving this frustrating problem.
Using the correct lubricant to keep your eyes from getting dry, as opposed to treating only when they feel dry, is crucial for success.
There two main categories of dry eye. For some, the tear production is low. For others, the tear composition is abnormal, and the tears evaporate too quickly. It is possible to have a little of both kinds.
Usually, the treatment for the low tear production type of dry eye is regularly dosed lubricant. I prefer Thera-tears Extra 3 times a day. It’s slicker, not thicker, and works 90% of the time.
There was a time that preservative-free artificial tears were often recommended. But nowadays, the preservative in Thera-tears and the Refresh Family of drops disappears before it touches the eye (ie, when it “sees” light or air when out of the bottle). I don’t see the benefit for the preservative-free little vials, but also don’t recommend other brands with lots of preservatives that don’t disappear and can make the eye drier.
In times past, patients that failed conservative dry eye treatment measures were offered punctual plugs, which can keep the tears in the eye longer. I no longer recommend this as it makes things worse more often than better. Additionally, plugs are a terrible idea if you have blepharitis or meibomian gland disease. The plugs can keep abnormal tears in contact with the eye longer, creating more irritation. They don’t work as well as other things, so I don’t recommend them often.
Mild steroid drops (for a short time) can help but require follow-up because glaucoma and cataract can result from long-term unsupervised use. They also can be quite expensive and make contact lenses unclear.
Cyclosporin (Restasis) drops and Xiidra is heavily promoted. I rarely see patients wowed by the results. Most complain of the expense and never-ending use. I notice that most patients who use them tell me they spend $1 on the drop and feel only a nickel better. We can do better.
IPL or intense pulsed light is another technology. It’s often touted for dry eye but works mainly for the meibomian gland disease version that responds to much cheaper treatment about 95% of the time.
Many doctors will proceed stepwise through the above choices, but we tend to skip most of them because serum works better and is cheaper. Why not use the best treatment first? Serum drops have been the best thing for dry eye. It works quickly and doesn’t need to be continued forever. Most patients never go back to any other treatment after using a short course of serum.
Serum for Dry Eyes at The Eye Clinic of Florida
Serum drops are made from the patient’s own blood. Two tubes of blood are drawn. The blood cells are separated from the serum with a centrifuge. The human serum has many growth factors and hormones that can help dry eyes. It’s been studied with published results in major respected journals for decades. It’s safe to use because it’s made from your own blood.
Typically, a patient will use the drop twice a day for two months. Unlike other treatments, the effect of serum drops last long after the two months you use them. The typical patient has 9-12 months of relief after using the serum. In our experience, patients who try Serum rarely choose to retry Restasis.
We make the unfrozen version of serum drops. It works much better probably because the proteins we isolate are not damaged by freezing. Many places cannot do this because they are not doctor’s offices.
There are other causes of dry eye besides having low tear water layer production.
Meibomian gland disease or dysfunction is the most common mimicker of dry eye syndrome. It often can co-exist with regular dry eye. It sometimes goes by the name of ocular rosacea.
Many people with chronic dry eyes actually have blepharitis. Many doctors prescribe treatment for external blepharitis when internal blepharitis is the real problem. Shampoo scrubs of the lashes are a waste of time if the problem is the meibomian glands.
When internal blepharitis (meibomian gland dysfunction) is causing the tear film to evaporate too quickly, it is important to consider treatments that last. Think of oil on a puddle of water, like the image above. The oil prevents the water from evaporating. This is what the layers on our cornea mimic. When the oil layer isn’t there, the water evaporates quickly.
Many eye doctors are trained to use combination antibiotic-steroid eye drops every time the disease flares up. This will disappoint the patient and the doctor as the disease keeps coming back. The thick abnormal oil produced by the sick oil glands in the lid burns the eye and blurs the vision.
My favorite treatment for this condition is once weekly azithromycin by mouth. The problem isn’t an infection, but azithromycin has a side effect of thinning the thick oil and has an anti-inflammatory effect. Oral doxycycline has the same effect. At the doses we use, antibiotic resistance is not a concern as shown by several published studies. The cost is often less than $1-2 a week to treat.
Finally, a condition called conjunctivochalasis is often mistaken for dry eye. This problem is a mechanical one where the smooth skin over the white of the eye slides around when the patient blinks. The patient isn’t helped by lubricants and often feels something “sticking” when they blink. A simple surgical technique often fixes the problem. Unfortunately, some doctors charge up to $15,000 an eye for this surgery. With us, it is less than 1/5 of that and insurance often pays most of it.
Another kind of dry eye is the kind that interferes with measurements for surgery but is otherwise unnoticed by the patient. I often see Tampa area patients often pay so much for the treatment that they don’t get to choose a better lens implant because of the poverty caused by the business model of the eye surgeon. We can do better so please give us a call if you are spending more than $200 on pre-surgical dry eye treatment.
Some eyelid disorders can mimic dry eyes. We have more than 25 years of experience with cosmetic and functional eyelid surgery, so we don’t overlook this.
Finally, some people get dry eyes after using multiple eye drops after cataract surgery. This is largely avoidable by using our DropLess cataract surgery technique. Not only do patients get less dry eye, but they also have less chance of infection (100 times less!) and save over $300 over traditional drops. We have been DropLess for over 8 years and speak around the country on this topic.
Many dry eye patients come to us for expert opinions and results. We also see many patients who have been treated elsewhere who want a second opinion or a simpler, less expensive, or less time-consuming dry eye treatment. Dr. Mahootchi and The Eye Clinic of Florida have the right kind of experience to help you with and help you avoid dry eye.
Contact The Eye Clinic of Florida at (813) 538-1503 to treat your dry eyes.
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