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Q&A on Dry Eye with Dr. Scott Lewis

Dr. Scott Lewis was asked a few important questions about Dry Eyes.

Dr. Lewis is an acknowledged expert on Dry Eyes and treats patients from all over Camas and Vancouver WA.

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

Although dry eye symptoms are often present year round, they can be more severe for many patients during the winter. Likely this is due to lower humidity in the air as well as exposure to heating systems both at home and in the car.

Q: 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?

Dry eye is a multifactorial disease in which the signs and symptoms don’t always correlate. Among the symptoms that patients can report include: irritated, gritty, scratchy, or burning eyes, a feeling of something in the eyes, chronic redness, excess watering, and blurred or fluctuating vision. Any of these symptoms would be a good reason to initiate an exam for dry eye evaluation.

Q: What is the examination like to determine whether someone is suffering from Dry Eyes?

A dry eye evaluation would include a thorough case history, as well as a detailed examination of the ocular surface. Vital dye tests are used to assess the quality of the tear film, the speed at which the tear film evaporates, and the health of the surface cells of the cornea. The lid margin is examined to look for signs of chronic inflammation and decreased flow from oil glands within the eyelid that are important to slow tear film evaporation. The eyes are also examined for signs of ocular allergy, which can also be present in many dry eye patients.

Q: I have a friend in whose eyes are frequently overly watery. That isn't Dry Eye, is it?

Excess watering of the eyes is a common symptom of dry eyes. The tear film in dry eye patients often evaporates too quickly, causing a physical irritation to the ocular surface. The eye then waters as a response to this irritation. The problem is that these response-based tears do not have enough oil to slow the evaporative process, so the irritation and watering often continue in a vicious cycle.

Watering eyes can also be caused by other issues, such as a blocked nasolacrimal drain system. In my experience, though, dry eyes and allergies are much more common causes of excess watering than a blocked nasolacrimal drain.

Q: What are the typical treatments used to help people suffering from Dry Eyes?

The exact treatment plan for a dry eye patient can vary depending on the case. Our recommendations continue to change as increased information becomes available from sources such as the Tear film and Ocular Surface Society (TFOS) and the Dry Eye Workshop committee (DEWS).

Early stage management of dry eye would include patient education, modification of local environment, recommendations for dietary modifications, modification/elimination of contributory systemic and topical medications, ocular lubricants, lid hygiene, and warm compresses.

More aggressive intervention might include: non-preserved ocular lubricants, punctal occlusion, moisture chamber spectacles/goggles, meibomian gland expression, topical antibiotics, topical corticosteroids (limited duration), and newer prescription medications such as topical LFA-1 antagonist drugs (Lifitegrast).

Your optometrist will advise you on the appropriate treatment regiment based on your diagnosis.

Q: Are some people more prone to having Dry Eyes than others?

Yes. Women in the United States are as much as 70% more likely to be diagnosed with dry eye disease than men, and also experience a greater impact on visual quality indicators.

Patients are more prone to dry eye with age. Certain systemic diseases (such as autoimmune disease like Rheumatoid Arthritis and Lupus) and certain medications such as beta blockers, antidepressants, heart medications, and Parkinson’s medications can also exacerbate dry eye disease.

More recently, studies have shown that people who spend more time on digital devices are more prone to increased dry eye symptoms.