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Dr. Gott: There is relief for dry eyes

Peter H. Gott, M.D. The Spokesman-Review

Dear Dr. Gott: Please enlighten me about “dry eye.” I have worn glasses for more than 60 years without any problems. I am 87 years old, and about two months ago, I had cataract surgery on both eyes. The left eye has developed “dry eye.” My doctor told me to use eye drops and warm compresses. The pharmacies have umpteen brands and prices to choose from. What kind of drops should I use? How many times a day should they be used? Can this condition lead to anything more serious, such as detached retina? In addition to the eye being dry, it burns and itches, testing my patience not to rub it!

Dear Reader: Dry eye can have several causes. Most cases are caused by a lack of tear production. Others are caused when the tears do not contain the appropriate mix of substances (primarily water, oils and mucus) that make normal tears. Eyelid disorders, medications and environmental factors can also lead to dry eyes.

Regardless of cause, the outcome is that the tear film that covers the eye and allows for good vision no longer functions properly. It develops dry spots that cause a variety of symptoms, such as burning, itching, sensitivity to light, stringy mucus in or around the eye and more. Some people may also experience constant tearing. This may seem a contradiction, but, in fact, these extra tears, known as reflex tears, are of poor quality. They are mostly water and lead to increased irritation and dry-eye symptoms.

Treatment depends on the cause of the dry eye. Lack of tear production can often be treated by using over-the-counter artificial tears. In some cases, prescription eye drops must be used. Some individuals choose to have their tear ducts, which drain away tears, closed. This can be done with silicone plugs or by cauterizing the area. Others still may benefit from customized contact lenses that cover the white area (sclera) of the eye and create fluid-filled layers over the corneas, which keeps them well lubricated. In severe cases, doctors may prescribe steroid drops.

If treatment fails to improve the condition significantly, doctors must start looking for other causes, such as certain medications. These include diuretics, antihistamines, sleeping and birth-control pills, tricyclic antidepressants, certain acne drugs, and pain relievers such as morphine. Rarely, an autoimmune disorder may be the cause of dry eye. Only your physician can tell you whether this is a possibility.

There are several self-care tips for individuals with dry eyes.

“Avoid air blowing into your eyes; this will only make your tears evaporate faster. Wear glasses on windy days to reduce air flow to the eye.

“Avoid rubbing your eyes; this will further irritate them and can introduce foreign material.

“Use eye drops before doing any visually demanding activity, such as reading or working on a computer. Eye drops can be used several times a day or hour. Preservative-free drops generally work best and reduce the chance of allergic reaction.

“And finally, remember to blink. This spreads tears evenly over the eye. Consciously increase your blink rate, especially when doing visually demanding activities.

“Chronic dry eye, while generally harmless, can lead to infection, inflammation and, rarely, scarring of the cornea. With proper care and treatment, this can often be prevented.

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