Wednesday, July 19, 2017

Dry Eye - Practical Prevention Pointers (1 of 2)

Today's post is for you if:

  • You have no dry eye symptoms (so far as you know), OR
  • You have mild dry eye symptoms 
Today's (and tomorrow's, for that matter) will be bit of a hodgepodge of the kinds of tips I wish everyone without dry eye knew, for prevention purposes. Enjoy!

Recognizing early symptoms (hint: dry does not mean dry!)

  • Watery eyes. Sounds counterintuitive for "dry" eyes to be excessively wet, which is why so many people don't realize that they have dry eye! The answer lies in the type of tears. The ordinary top coating of the eye is what's called basal tears, which are a combination of water, oil to prevent evaporation, and mucous to help them adhere to the surface of the eye, plus lots of other goodies. Basal tears are there to sharpen vision, keep you comfortable and protect and nourish the eye surfaces. But if your basal tear layer is lacking in some way, the eye surface gets drier and irritated and signals the brain to tell the lacrimal glands to pump out some emergency tears (called reflex tears) — to re-wet the eye and if necessary to wash out whatever dirt got in — though that might just be because the dryness sensation makes it think there is actual grit. These reflex tears are what you experience on a windy day. They do NOT have all the extra goodies; they're mostly water. The more of them you produce, the less comfortable your eyes will be - similar to when you have a long cry and your eyes are sore and feel 'stripped' afterwards. All that to say, if your eyes are watery more frequently than normal and in more circumstances, dry eye could be the reason. (It's not the only reason; you could have blocked tear ducts. But either way, get thee to a good eye doctor.)

  • Feels like something's in my eye: Formally known as foreign body sensation.... Of course, there might actually be something there. But a frequent or chronic sensation of this kind is quite common with dry eye. If it's this kind of 'phantom' foreign body feeling and there's no debris visible, keep some preservative-free lubricant eye drops handy and avoid using water or saline to wash out your eyes, because those will actually make it worse, by washing the better part of your tears away. Water and saline should be reserved for true debris-in-the-eye emergencies.

  • Eye allergies  (classic signs: redness and itching). An immediate clarification needed here... I am not saying that eye allergies are a symptom of dry eye. They're two different things. But they overlap a lot and sometimes pose chicken-or-the-egg dilemmas; so if you have, or have been told you have, ocular allergies, make sure you have a conversation with an eye doctor about dry eye as well. An eye with allergies going on is going to tend to be drier (did I mention that antihistamines, by the way, are very, very drying?). On the other hand, a dry eye, that is, an eye that does not have a good solid healthy basal tear layer, is more vulnerable to allergens and environmental stresses in general. Incidentally, most allergy eye drops, both over-the-counter and prescription versions, are preserved with a toxic preservative called benzalkonium chloride, which is also drying. Can't escape! 

  • Inflamed, red, or scaly eyelid margins: I'm talking about where the base of your eyelashes are. If you see these as being irritated first thing in the morning, any chronic redness or soreness or if they're looking a bit scaly or you have 'eyelash dandruff', you should visit an eye doctor and have a conversation about blepharitis or (longer name, broader category) meibomian gland dysfunction. Meibomian glands secrete oil through little orifices all along the base of the lashes. The most common type of dry eye is NOT when your tear production is decreased — it's when your oil production is decreased because of chronically clogged oil glands. If you don't get enough oil into your tear film, your tears evaporate too fast, which has the same effect as if you didn't produce enough in the first place.

  • Light sensitivity, especially in conjunction with other symptoms like the ones above or with tired, achy eyes or gritty, dry feeling eyes, is another common sign of dry eye.

  • Contact lens intolerance. This should probably head the list, but it's the one everyone dreads — no one wants to anticipate the day when they can't wear contacts any more. (Though truthfully, these days, there really are some good dry eye-friendly options with some of the newer scleral lenses coming on the market.) Contact lens discomfort is often because of increasing dryness and should not be ignored. Just quitting wearing contacts doesn't mean the problem's fixed, either. 

Simple, easy prevention suggestions

  • Don't abuse contact lenses. Be compliant with all contact lens care steps; never wear contacts overnight; don't continue wearing them when they're getting too uncomfortable; and report any symptoms to your eye doctor.

  • Pay attention to symptoms. It's easy to ignore mild things that don't seem like any big deal. With dry eye, though, sometimes those 'mild' symptoms can be masking a brewing condition like meibomian gland dysfunction that may, down the road, turn into a much more uncomfortable form. Get ahead of things, discuss them with your eye doctor early on. Speaking of which:

  • See an eye doctor for regular exams, not just for glasses and contacts or emergencies, and ask questions if you have any symptoms. Don't expect them to flag mild dry eye issues without prompting. Talk to them about mild symptoms, ask if they can do a bit of a workup of your tear system, and if they have any prevention recommendations. 

  • Take extra precautions when using the computer for long stretches. With dryness, it's all about the blink. Eyelids pump tears out; eyelids spread tears around; and eyelids keep part or all of the surface covered, reducing evaporative tear loss. The less you blink, the drier you are, by definition. My computer suggestions?
    • Blink more.
    • Keep hydrated.
    • Keep your monitor as low as ergonomically acceptable.
    • Adjust your screen lighting if necessary. Try handy tools like 

  • Protect your peepers from low humidity and wind by wearing wraparound sports-style eyewear. There are many that have a slim lining of foam that helps with additional wind-proofing. The closer the fit, the higher the humidity immediately in front of your eyes will be. 

  • Keep your lids squeaky clean. Inadequate eyelid hygiene plays a role in blepharitis. 

  • Do a gentle warm compress nightly before bed, like a gel pack or rice baggy. 

  • Protect your peepers during sleep — another low tear production time — by using a sleep mask, especially if you have air conditioning, heating, or ceiling fans going. 

  • Supplement with Omega 3s. They're good for you in so many ways, and eyelid / oil gland health is one of those many.

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