The Truth About Dry Eye: What Happens When You Don't Treat It

well hi's and shine and welcome to today's education my name is Dr Joseph Allen and we today are going to be talking about dry eye syndrome now we're going to be answering some specific questions about dry eyes uh namely what causes dry eye like what contributes to the initial symptoms and the longevity of of why dry eye becomes such a problem we're going talk about the Vicious Cycle of dry eye and why it's so challenging to treat and just never seems to get better sometimes and then we'll also be covering what happens if you just try to ignore it and hope it gets better on its own like what can be the very endstage result of neglecting to treat dry eye syndrome if this is your first time here to the channel welcome we do these live educations every month with these live educations they are brought to you by our Channel supporting members so huge shout out and thank you to everybody body who is chiming in live as we are doing these live streams here live so you can engage and ask questions uh again huge shout out to all of not only our uh subscribers to the channel but also our channel members specifically because they make these educations possible if you want to learn more about how to support the channel and become a member yourself we'll put additional information either in the chat as well as in the show notes below so dry eyes when it comes to dry eyes almost everybody will experience dry eyes at least the early symptoms at some point in our lifetime even just to something is simple as going outside and it's a windy day out the surface of the eye will evaporate much quicker and you'll experience some dryness and irritation and maybe it'll only last for a few moments a few minutes or maybe even an hour but thankfully the human body is really good at detecting that there's a problem and so you do what you start to tear up and your body tries to correct for it itself now again this is just kind of episodic dry eye it happens now and again to everyone but the Challenge with dry eyye disease is that this becomes more than just an initial episode this becomes a chronic problem something that's lasting weeks months years and Beyond and so with that if you ever start to study dry eye one of the kind of the foundation Publications uh this is the tfos du's 2 2017 they included the Vicious Cycle of dry eye this diagram this uh will be kind of it seems really complicated looking at it if you're seeing our visuals don't worry too much we're going to break this down and it kind of explain in simple fashion really what's going on because it's not when it comes to dry eye you want to understand what is all happening in on the surface of the eye because it makes it much better to understand how you can change your life uh how certain treatments will be recommended uh as well as you know kind of helping make informed decisions about your own care if you do see a dry eye specialist to get this treated primarily we think about dry eyes in kind of two steps right there's the volume of tears and then there's evaporation of tears right you have the actual tears you produce and then you have how those tears evaporate and dry out into the air that's the simple kind of concept now when it comes to tier volume this is historically what eye doctors and Specialists have all sort of thought about as being the main issue with dry eye is that oh you just don't have enough tears Well turns out that it's actually not that common there are some causes uh things for people not to produce enough tears one of those are autoimmune conditions this includes a famous one called Shin's syndrome this is one that is not only having it's an autoimmune condition that not only causes dry eyes but also dry mouth and so I'm frequently asking my patients who come in for an evaluation I'm always asking them okay you don't have just dry eyes but does your mouth feel dry do you have challenge of swallowing do you have to drink food drink water while you're eating food to in order to swallow a lot of my patients who tell me yes those are exact things I'm struggling with too I immediately refer out so that they can get blood work and testing to see if they might have that autoimmune condition aging just getting older unfortunately our hormones do change throughout our lifetime and especially for women over the age of 50 who are entering into menopause those hormone changes are strongly associated with reduced reduced tiar volume and a higher risk for dry eye systemic medications this is another big one that can cause that reduced tear volume or production and think of it if somebody's taking an oral antihistamine for their allergies maybe they're on high blood pressure medications or cardiac medications or even anti-anxiety and anti-depression medications can all cause a side effect of dry eyee and reduced tear production so that's another big role two others one called reflex block uh which is your corneal nerves on the eye don't sense that there's dryness uh and because of the blockage and then you don't produce more tears otherwise your body naturally picks up hey I'm dry make more tears and then lacal block this is complete this is actual physical blockage of the lacrimal gland itself that's producing tears unfor fortunately enough the laal block is not that common now uh I'm going to be uh of course answering questions I see some people leaving comments in the live chat so thank you guys uh we will be doing some live Q&A at the end of this education so definitely stick around and then we'll see what kind of questions people have the next Big B I'm going to zoom in on our visual here is tear evaporation again it's tier volume how much tiers you produce versus how much they evaporate and the evaporation has a lot of components to it and so the one big one has to do with the environment is true evaporation based on the humidity based on wind and temperature so if it's really low low humidity like it is here uh inside my apartment because we have furnaces on being it's wintertime so humidity drops and dry eyes happen a lot more so uh sometimes people do really well some something like a humidifier in the office or or in their place of living because then that can kind of bring those humid levels back to a tolerable level tear film instability and we have a lot listed here and I'm going to work through some of these because these play such a huge role in the development of dry eyes so the first one I want to kind of talk about here is myomi and gland dysfunction if you're new here to the channel then this might be a new term but if you've been watching any of our dry eyye content we talk a lot about Mylan gland dysfunction or MGD it is a leading cause of teer fil instability and dry eye syndrome with over 86% of people with dry eyes having some form of MGD this is where the oil glands within the eyelid these are the Moman glands and they secrete a little oil sits on your teer fil prevents them from evaporating and a little oil is supposed to come out every time you blink the challenge for many reasons and we have other videos and we'll do even maybe a more in-depth video soon uh really going into the pathophysiology of MGD because it's so common but this is where the oil glands they become clogged and they don't secrete anymore and so we see a lot of inflammation and in our pictures we have not only image of what those glands look like through infrared Imaging we have the blockage of a gland that wasn't expressing and then we have a picture of a tool that we'll use in the office in the eye exam to express those oils and you can see in that picture it's very waxy uh it's no longer a smooth liquid oil the another next one is bleer itis blefaritis is also a common condition this is the buildup of oils dead skin cells and then bacteria and other microorganisms which love to eat these oils and this kind of scurf that's left around the eyelids this will cause inflammation and redness irritation Burning Sensations and it's really like a buildup of bacteria another microflora which caus this irritation and so that's why a lot of eye doctors are frequently recommend in just like people say hey blush brush like dentists will say brush your teeth twice a day people are doctors are now recommending clean your eyelids every day and we have to be aware of how our eyes are reacting to harsh debris that's people are avoiding to clean the next one that influences tfilm stability is allergies contact lens wear and then vitamin A deficiency allergy pretty common if it's springtime we see a lot more dry eye come out uh content talk if you're a contact lens wearer like myself that is one of the reasons why you have such dryness irritation with contacts especially later in the day because this tier film is no longer stable and then thankfully vitamin A deficiency is very rare like true dry eye from vitamin A deficiency not common especially in developed countries people who do develop vitamin A deficiency are usually very malnourished as well as some people who have digestional issues or you've had maybe lap band surgery and you're not taking the appropriate vitamin are supposed to be uh but thankfully again bitamin a deficiency pretty rare but still a cause this last one uh is really important and that's preservatives in all of our content that we talk about eye drops we always recommend non-preserved or preservative free eye drops when you can uh this is because these preservatives namely a famous one called Bak or stands for benzoni chloride this is a very potent preservative great at preventing your ey drop bottles from from getting contaminated but have been found to be toxic to the surface of the eyeball causes instability of the tear film and has been found to be toxic to the coral nerves themselves so um unfortunately with uh a lot of medications for the eye infections and other diseases like glaucoma these preservatives uh almost always are in those medications not always but a lot of the time they are you'll see a lot of if you're somebody who has Glock and takes medications for glaucoma these eye drops uh a lot of doctors and glaucoma dry eye specialists have been turning patients over to preservative free versions downside is they're expensive but it's still something that a lot of doctors are kind of recommending now because we know long term these preservatives can cause a lot of problems one great tool that I want to share with you and we've if you've been a long time viewer we've mentioned this in several videos over the last few years this is a device called the Nano dropper uh I like i' like to share this because I think it's just a really cool great invention it reduces the drop size coming out of your eye drop bottle by 70% which does multiple things it means less waste because most of eye drops you use in the eye are in fact kind of Splash and or too much so it reduces waste because it's using 70% less it extends the life of the bottle and because of that means you don't have to refill it if you're using medications so with glaucoma you can extend the life of your by 70% that means less refills that means less cost uh it's a it's a really cool thing uh now Nano dropper is not sponsoring this content in any way this is a code says if you want to save 10% on your first order Nano dropper has been cool and given this to us for a few years just to share with our viewers if you put in Allen 10 my last name a L Len 10 you'll save 10% off your first order that is not an affiliate code for me the channel does not generate any income when you use use that code it is strictly because Nano droper is awesome as a company and they've been giving that discount to our viewers for a few years now so huge shout out to them for just making an awesome product and helping people we also use this in the clinic uh we we use it for a lot of the eye drops we use for Therapeutics in in in the office so back to this vicious cycle of dry eye all of this uh tough damage that's occurring again we've addressed the evaporation and The Tear fil instability and so those two things combined if you have an unstable tear film and then the tear film in the little shallow spots of the tear film that's really that's really just unstable that evaporates and that evaporates so quickly that it leaves behind all of the salt all of the proteins and other other electrolytes that are all in the your ti film that leav them behind and that increases what is called your tier film osmolarity so the tier film becomes hyp per osmolar meaning you have a lot more salt in your tears and when this happens it touches the surface of the eye and aggravates it and your body releases inflammatory signals these signals are in the form of cyto kindes tumor necrosis Factor proteases such as mmp9 which is a test that we use in the clinic to know how bad your dry is dry eye is we can measure mm9 map kinases and NF Kappa B signaling this all recruits inflammatory mediators basically your eyes saying hey help help sending these chemical signals out Bring inflammation in to help us heal and in short term that's great but in long term these inflammatory mediators they cause damage to the surface of the eye they reduce the mucus production on the surface of the eye and that's a mucus that helps not just it's not just like tears on the eye the mucus helps kind of glue and hold that liquid of your tears to the eyeball surface and so these inflammatory proteins damage and stop the release of these of these mucus this mucin and then it causes damage to the Goblet cell itself which makes the mucin and so long term you're having this chronic damage to the goblet cells you're not producing as much mucus and the tears just don't want to stay on the eye with that more exposure you have cell damage to the surface and this is when start to see clinical changes to the surface of the eye these are pictures from some of the patients that I've seen uh that are pretty extreme on the left side here we have an image of a cornea that we would grade as like a four plus diffuse spk or superficial punctate keratitis this is as if someone took like a piece of sandpaper and and rubbed it up against like a piece of glass you would see all these little divots that show up it's like scratched the eye on the other side on the right side you can see just this coales spot on the bottom onethird of the cornea there everything else looks good but it's all really dense that dense yellow at the bottom that uh when I see that in the clinic that tells me that the bottom onethird of their cornea is always exposed to air and they're probably a not blinking completely throughout the day and B that they might be even sleeping with their eyes cracked open a little bit and so uh that's that's just what we see in the clinic as damage occurring to the surface so you have this inflammation you have all this damage going on that's what results in your symptoms of redness on the eye because this inflammation is causing the redness on the on the white part of the eye you have irritation doesn't feel good you can have pain it's truly painful because your body's trying to make new tears to fix the problem you have tearing you can get fatigue in the later evenings in fact my patient yesterday today just said like I'm having tough time at night time I just want to read but at night my eyes are just tearing all the time and my eyes feel tired well for her that was more due to dry eye because it only occurred in the evening when she's trying to read otherwise not throughout the day this this fluctuation and cell damage to the surface of the eye will cause blurred vision and fluctuating vision and then light sensitivity is another symptom with this again inflammation cell damage you also have your blinking process your body's like I'm in pain let's blink well this can cause a scratch if you let me know in the comments if you've ever struggled with dry eye and you just have felt that it is so bad that every time you blink it feels like you're scratching your eye because that's the way I think about it the surface is irregular and damaged it's like having uh a bad injury on your skin on your arm and you're scratching it with your fingernails that's your eyelid moving up and down and then finally you have the reflex tearing again these are the signals this damage is what's signaling your your eye and your brain to say hey make more tears let's fix this problem and so that's why you get those reflex tear this is uh an important but unfortunate part of this process is because this inflammation and cell damage it Loops back around and this itself contributes to tier problems with tiar evaporation and instability and so with that unstable tier film it just becomes a complete circle and that takes us back to the Vicious Cycle of dry eye because you have the unstable tier film with the evaporation becomes hyperosmolar or too much salt content that causes damage to the eye and signals inflammation that causes further damage of the mucus production on the eye and damage to the surface cells which causes more instability and we're back to the beginning so hopefully that makes a little bit more sense and gives some more guidance on really why dry eye happens and then why it's so difficult to treat it that's why if you ever see a new medication that comes out or new treatment for dry eye it's aiming at one of the things that we just covered so what happens when you don't treat dry eyes what ultimately happens what's the course so this is just um kind of an illustration I'm showing here to show that dry eye and the path of dry eye is not straightforward and it's not the same for everybody usually you'll have some good days and some bad days and again let us know in the comment section if you're catching us live if you've had fluctuations in your symptoms because some days will be great and maybe even a few days or a few weeks you're not really noticing symptoms but then you have a long night where you didn't sleep well or it's really Smoky outside because of forest fires or or something's going on you will have a flare up it'll trigger things and your symptoms will get really bad your eyes will get red for a few days and you'll see seem like it it takes even longer to get back to Ground Zero again so that's uh expected that things are going to go up things are going to go down but on a long enough timeline if you just ignore your dry eye let the symptoms get worse and worse it eventually will spiral and again cause more serious damage to the eye so this is just kind of a list of unfortunate activities that are inhibited in our lives if you really suffer with dry eye disease and this is important uh I like to point out because if you're watching this if you're catching this either live or you're catching the replay I hope that PE if if anybody's watching and they know someone that works in the health not just the healthcare Industries but works with insurance here in the US uh it seems like a lot of insurance companies don't really care too much about dry eye or they don't recognize how important treatment is and just to think of it when you go through this list not only do you have symptoms of not being able to wear contacts that's like the early symptom you can't apply makeup so because your eyes are so sensitive you have trouble reading because your vision's fluctuating same thing with computer and phone use that makes it challenging watching TV enjoying doing Simple tasks driving becomes difficult doing things outdoors because your eyes are so sensitive to light wind and pollen exercise even just holding a job and working and then social interactions can all be affected by dry eyes so again my hope is that somebody out there will see this and they'll know someone who works in insurance and getting Health Care uh benefits for people and share it with them so that they'll understand how serious dry eye really is because there's a lot of doctors and a lot of professionals out there who just still I feel like haven't really cons really understood how serious dry I can be give me a second to get some water thank you so the after you get those symptoms and it really starts progressing the challenge with this path of dry eye is again the surface of the eye can slowly be damaged and it get it can get so severe where Vision starts to become blurry this is a picture again from a patient I've had and this patient's Vision was 2060 in the state of Minnesota R practice they were not legal to drive at that point because their Vision was reduced by just their dry eye thankfully with treatment the dryness improved and they got them seeing 2020 finally when they were getting toward full recovery so it was great great success for that patient but it just shows to say how blurry the vision can get uh and the real concern is that again as this damage of the surface happens you get reduced visual Acuity and pain so you guys start to get painful and not just blurry but that increases the risk of ulcers developing on the eye and that increases the risk for infection and then ultimately it can cause scarring on the eye now we're going to show just two examples of how scarring can form on the eye thankfully this isn't super common but I do have patients who have it and it's called Salman's nodular degeneration so this is where the parts of the cornea that are made of collagen and extracell Matrix it starts to grow on the surface in these little spotch and then underneath it there's a for for people who want to take a test later there's a a structure called Bowman's membrane which ends up getting destroyed underneath but you get these they're almost like buildup collagen warts on the eye that's what I'm just going to call them right now just to describe it but we see these little white scars on the eye and this we don't know exactly what causes them you know women are more likely to get it in an older age but it has a strong association with myroman gland dysfunction and other chronic surface diseases including dry eye unfortunately when these kind of scars develop on the surface it becomes kind of bumpy this changes the surface of the eye and causes increased levels of a stigmatism and again more blurred vision another type of scarring that can occur is called calcific band keratopathy again another one thankfully not super common but I do get patients who get sever cases of this this is an imbalance of calcium and phosphate that occurs on the surface of the eye just on the front few surfaces of the cornea there are many causes to this uh including renal disease we have to be aware of juvenile idopathic arthritis is for an example uvi or inflammatory conditions within the eye and then again dry eye can contribute to this this can be a full band of calcium that completely eclipses over the eye and prevents you from seeing so there thankfully are surgical procedures to remove these but still something you don't want the other big change longterm that occurs on the eye from dryness this is when things don't don't get treated aggressively they go too long there's a lot of different factors but this is because of coral nerve damage the nerves within the cornea there's over 7,000 nerve endings in the front surface of your cornea that's that feel pain and that's why small pebble piece of sand in your eye dirt or or just wind hitting your eye can be so painful it feels like there a huge Boulder in there if you have a piece of sand but that's because there's so many nerve endings well both dry eye dry eye can contribute to nerve damage as you can see in the visual here there's a publication and I have sources underneath if you really want to dig it up and read it but it shows that damage from dry eye leads to this cornal the nerves stop growing correctly and they don't grow grow as robust then you also have preservatives in the medications uh as well as eye drops those preservatives again are known to be toxic to these same nerves so long term what these nerves can start to change and they can cause some problems first they can cause nerve reflex block which if you remember back to the beginning of the Vicious Cycle One of the causes of reduced tier production is nerve reflex block because if you don't have nerve sensation on the eye you're not telling the brain to make more tears and so your tears you don't you don't produce any tears at that point or very little neurotrophic keratitis and then neuropathic corneal pain so uh first let's talk about the neurotropic K neurotrophic keratitis this is again a tough one and I hate seeing this in the clinic we work really hard now to identify this in the early stages neurotrophic Ker IUS this is where the nerves on the eye stop signaling to the brain to say hey uh or the brain to be able to Signal back to the eye hey let's heal the eye let's repair the eye and so if you're having this damage from dry eye long enough these nerve nerves change and the surface of the eye starts to not heal and slowly start to form ulcers and so this impaired healing leads to ulcers corneal melting and then in worst case scenarios perforation which is one of the worst things that can happen in the eye clinic that's when the eyes has an open globe and the content of the inner eye can leak out this is a major source of infection which can cause the worst eye condition basically in the world of eye care which is called an endopthalmitis so we're always trying to avoid that in any case so unfortunately yes this is uh can be devastating for some people so we work really hard at catching it early the challenge is that the early stages of neurotrophic hertis look very similar to severe stages of dry eye it's very difficult to tell the two sometimes and so that's why myself our Clinic where ey practice and many other dry eye specialists they're always testing for corneal sensitivity when they do their initial or potential future dry eye evaluations uh this can also be um somewhat triggered by other refractive surgeries and many other things like infections from herpes zoster or herpes simplex um there's a lot of lists but dry eye again can lead to this the next one is kind of the opposite uh we had the neurotrophic keratitis where the eye stops losing sensation of the eyeball but then there's the opposite where it can have neuropath I Coral pain and this is where the eye is hyper sensitized either peripheral nerves of the eyeball are sensing so much sensitivity in pain your threshold your pain threshold if you if you're somebody who who thinks you're pretty tough and you have a 10 out of 10 pain threshold imagine your body to said no more we're going to move it down to one this is this is one of the worst things I have a few patients uh who have this and I feel so bad for them all the time because it's just it's I can't imagine living every day with their symptoms uh two classic ones hyperalgesia this is a hyper sensitivity to things that normally will bother somebody's eyes but their threshold is so low that even just moving through the air like simple wind I have one patient who has to wear protective goggles while she just walks down the hallway because even her walking speed moves air across her eye fast enough that she feels that as like an eight out of 10 pain the other component to this is it can also be uh the other symptom is cornal Alodia or Alodia this is a burning sensation from normal non- nauseous stimuli so using rewedding drops on the eye usually feels good not to these individuals just using rewedding drops or even just the presence of their own tears can cause a burning pain sensation the other component to this is that this may not just be peripheral nerves on the surface of the eye that aren't functioning correctly it could be central nervous system components so this means that your brain isn't perceiving the pain correctly and you're you're constantly getting these pain signals firing off interpal nervous system and then that's where a lot of not just medications for the eyeball itself but also systemic medications pain medications have to be involved so again really a tragic thing when I when we try really hard to see what we can do to help people with this condition this uh unfortunately can lead to not only troubles with reading driving and computer work but can result in not only needing dark glasses and doors impaired physical and social function decreased enjoyment and quality of life challenges to dignity increased threat to physical suffering sleep deprivation anxiety and depression and existential suffering I know this got kind of dark really fast there but it's true that people who struggle with pain all the time of any kind can really struggle with mental health with just the challenges of life and being in that pain all the time and so um as an example PE you may have heard in the news there have been people the last several years who have had like lasic eye surgery and then later committed suicide because of the dry eye symptoms now I haven't managed any any of those patients myself so I can't speak to it but I think it's a good chance that if they had bad dry eye they probably were dealing with neuro this kind of neuropathic pain so I think if you are somebody or you know somebody that really struggles with dry eye and there you're thinking okay maybe there actually this pain issue it's that severe then I do encourage seek therapy encourage somebody if you yourself have it seek therapy encourage people to try to support them the best you can uh mental health is a big thing we all have tough times but people who are going through this suffering have a really really challenging time so again always seek help uh seek seek help from your local eye doctors seek help from your family doctors again find professional help to help you with those struggles so from this sort of end thing I don't want to start on like leave on a bad note the good thing is there is hope dry eye is something that's constantly being studied and improved on uh there are many treatments and ways to manage it including Lifestyle Changes which I encourage for everyone conservative therapies if you're somebody who doesn't want to go too deep into medications or other surgeries and then there are Advanced treatments both medications different in-office procedures uh and so there there are ways to treat it and think and and if you haven't done so already I do always encourage find a specialist somebody who um studies maybe dry eye more intensely and has Tools in their Clinic to do proper testing almost every eye care professional will have experience and fundamental knowledge on treating dry eye but they just may not have the tools and it may may not be something that they love doing so it's still uh I think it's worthwhile to seek a dry eyye specialist I did do a video last year on giving some tips on how to find a dry specialist in your area if you're not sure uh where someone might be with that we also have plenty of previous videos and will have future videos on dry eye on treatments um updated um eye drops that are coming to the market both medications and overthe counter uh lots of different content so you can check those out on our homepage uh we also if you're somebody who again wants to pursue just vitamin Lifestyle Changes we have content on that we do have a video on a dry eyye exam so I break down all the tests we do in the clinic what I'm doing that test like why I'm doing that test what we learn from that test and how that influences our decisions about treatment we also have a longer video going over severe dry eyye treatments if you're someone who's well beyond just doing lifestyle changes and you need medications uh that video will explain uh all the different current treatments that are going on uh just so that you are aware what options your doctor may be able to offer you so with that I want to say thank you so much for joining in on this education we are going to switch over to some live Q&A I do like to give a medical advice disclaimer that this is not a place for me to provide diagnosis I do not provide treatment this is just a way for me to provide education to answer questions and help out people the best I can so if you have a question that is about a specific thing that you're going through uh I will try to phrase the answer in kind of an educational way that everybody tuning in can uh learn from please if you have questions start putting some question marks uh with in front of and then put your questions some question marks after so it'll show us a little bit easier uh who are uh everybody who is part of our supporting channel members do get priority when we do Q&A so huge shout out to our channel members thank you guys all for supporting the channel helping us out on our mission to help people learn about the eyes keep them healthy see their best not just today but in the future so with that thank you guys uh I know uh I'm G to ask I'm going to answer just one or two questions that I took down before the chat some people who came in early first was my thought thoughts on aanova aanova is a brand of hypochlorous acid hypochlorous acid I don't have any to show me here right right now but hypor acid is a cleanser that was originally invented to treat diabetic foot ulcers what's is quite fascinating about hypoc chloris acid is it's safer than bleach but it kills more than bleach in fact it's even been found to kill covid-19 uh so u avanova in general is a brand uh there's several other ones out there in the world of uh iare Optometry Opthalmology there is sort of a battle between a few companies that claim to have like a patent or a better way of of making hypochlorous acid that makes it more stable and pure and more effective versus a lot of other older methods that have been around for hundreds of years to make hypochlorous acid so there are some um battles about branding um but I've used aanova I have a lot of patients who use it I find it's great I honestly carry some with me when I travel uh just because it's an easy way for me to clean my face and my eyelids uh so definitely something I I personally have liked um but yeah there's there are several Brands out there and I don't have any Publications for me to to quote to say anything is is actually better not uh the last question I had quickly was on Zenna glasses uh this was somebody asked me what type of glasses are for dry eye there is a type of um there's a brand of glasses called Zenna uh they uh make more they they're probably the most realistic glasses look looking glasses like they don't look like you're wearing motorcycle goggles they just look like regular glasses but they have an extra silicone insert that's magnetic that kind of create a gasket like effect around your eyes so that the moisture of your tears don't evaporate into the air as quickly so that's a that's a brand called Zenna z i e n n a I believe I might I might might have misspelled that but the you can certainly check it out online they have a website and so I know some eye clinics even carry them so uh thank you for those questions earlier right away I see uh I want to see Emerald strange uh why do arm compresses and massage make my eyes worse even though my myomi and glands are blocked so this is this is a great question so uh there are different things on the eyes my warm compresses are largely uh believed to be helpful for the symptoms of dry eye and myomi and gland dysfunction because it melts the thickened mbom and allows that to get out of the oil glands the challenge is that some people do have like it seems like it almost gets worse it's tough to say if if it's making the myom gland dysfunction worse it's probably helping melt those oils but symptoms of irritation can occur and it's thought two ways well I should say it's thought that it could be that all of this thickened inflamed mayom these oils are getting on the on the eyelids and the eyes and causing irritation so that's one thought but in my experience uh some people and I can't say this is is your case but some people who do are known to have more of a trigger for the heat are people with rosacea or forms of ocular r OA uh which is something that if somebody does put a warm compress on and it just makes it worse and their face is all red and they kind of break out afterward or have a flare up on their skin then it could be associated with rosacea so good question to ask both uh your your eye doctor as well as any family doctors if you have a history of rosacea if there's any treatments that maybe would be helpful for that uh but I always defer tell your eye doctor if the warm compresses make it worse maybe they'll be able to offer um better guidance but hopefully that helps thank you uh cat asks how long should you wait to put eye drops in before reading an eye chart honestly if you're at the eye doctor um it shouldn't take too long you know put an eye drops in a minute or two later as long as they're not thick gel drops you should be able to Blink a few times and be able to to read pretty well so there's times in the clinic where I've I'm doing a r fraction the you know I have the the big device the fer opter over your eyes I'm asking you better one better two trying to see where your vision's at and I'll ask a patient who's having trouble reading if they'll blink a few times and does that clear it up and oftentimes if they say yeah everything cleared up that tells me that they have in fact some dry eye so uh I've occasionally put an eye drop in a patient's eyes just to see if that helped and stabilize things and usually does it doesn't take very long uh another question from Emerald do you recommend Scaro lenses for dry eye Scaro lenses if you've never heard those before Scaro lenses large contact lenses that Vault over the cornea they are custom fit for your eye not just for the power so your vision but they are custom made fit for the roundness shape of your eye because everybody's ey is very different uh those Scaro lenses are filled with a fluid a saline solution and that kind of gets trapped on the eye so people with chronic surface disease and damage to the coronal surface benefit a lot from these because it's constant being bathed in the saline solution and protecting it it's like this shell covering the surface of the eye downside for some people um scleral lenses if you have bad myomi and gland dysfunction your oil glands are clogged up even when you wear the lens you're still going to have oil problems on your tier film and that means the surface of the Scaro lens will dry out and your vision will still be bad so uh a lot of times patients who have sclero lenses or will benefit from a Scaro lens for dry eye we will aggressively treat the mayian gland dysfunction first or in conjunction with the use of the scleral lenses uh but they can be a great option for some people so thank you for that question um let's see uh I'll just answer this one quick Quaid uh can you do a future video on lce degeneration I may be able to do one I might maybe maybe I'll do I'll write that down and do a short on for people who' have never heard of lattice degeneration uh it's basically a thinning spot in the peripheral retina inside the eye so when you eye doctors look inside uh if I see a patient with it I'll usually tell them that they have like a stretch mark in the back of the eye where the tissue is sort of pulled and started to separate a little bit there's a if you could see the if you were in in in school for Optometry you'd learn about the liquefaction that occurs Above This lattice formation and that it can increase risks of having a retinal hole a tear or Detachment form only by about 1% uh at least that's what I learned back in school maybe things have changed in the last 10 years but uh as far as again big things to be know be aware of floaters and if you have new floaters flashes of light any loss of vision see a doctor as soon as possible um but thanks for that question qu hopefully that helps you out let's see I love this Pamela thank you for the question about are steroids bad for the eyes like how are steroids bad for the eyes so there topical steroids are usually used as a as a form of treatment because it shuts down inflammation on the eye but it's used as a treatment for dry eye these steroids uh the bad part of them is that longterm they can contribute to the development of cataracts inside the eye as well as some people have a steroid response which causes their eye pressure to go up and that increases the risk for glaucoma in addition to this because steroids they shut down your immune system a little bit if you have an active infection the infection is going to have um a better time attacking you because your immune system is not fighting it and so people who are on steroids for a long periods of time they may be at higher risk of certain infections uh so that's the reason why usually steroid eye drops and treatment for dry eye is a shortterm term solution because we don't want to be on it for too long so short-term solution but longterm we want to be on safer eye drops uh medications uh and try to avoid those nasty side effects so again great question thank you uh this is another good question Emerald thank you you got you just throwing out the questions I love it uh can atrophied my Boman glands be treated uh and can IPL reverse that atrophy so atrophy myomi and glands still debated um right now there's not much evidence in the research that myomi glands can be rejuvenated or brought back like if they're completely gone I haven't seen anything I have heard anecdotal reports from some professionals um and I've seen some pictures that they've shared on on kind of doctor groups that I'm on online where they've showed that using typically I've seen it as using IPL to contribute along with other treatments to help get at least some gland gland that's in that's about to atrophy it's like almost gone they're able to get that back and then a healthier more vitalus is that the right word their Vitality has been restored so uh right now unfortunately I I don't tell people that it's possible because I just don't have the evidence to support it but hopefully with more research we we'll have a solution so thank you for that question uh quickly again Emerald do pinguecula cause dry eye can they be removed pinguecula is a growth on the eye usually do the environment uh both inflammation as well as sunlight damage and dryness it can cause a disruption to the tear film and so that may contribute to it uh if pulas get bad enough cosmetically they can be removed but it's not something that's usually covered by any healthcare insurance uh DD I me to say ask thanks for the question about the best eye drops uh I'm gonna say stay tuned because I did a whole video on that and it's coming out uh next week so uh I think it'll be go a lot more in detail different types of dry eye drops which ones I personally use which ones I sometimes recommend for patients as well as some extra tips in that so I'd say stay tuned for that so thank you uh oh thank you Savon uh we have why do I cry when I when I walking in winter so I love that you brought this up because if you've ever noticed if you do go outside and it's a little colder out your eyes may tear up and that's because the coral nerves on the are more sensitive to cold it's kind of cool in fact that's one of the reasons I I can't I don't know this for certain but I believe uh so one brand of ey drops at the store is called Roto uh and there's a few others that are kind of testing this out but they include Menthol as an ingredient in the eye drops and Menthol has a cooling effect so I believe that perhaps they made that so that that cooling effect will trigger the nerves to make more tears um that given said uh the Roto is not my favorite brand um they there's some versions of Roto that do contain Bak which I'm not a huge fan of uh so but thank you for that question hopefully that this is kind of cool info um let's see Kathleen uh why do you think uh or what do you think of darista recommend for glaucoma to reduce preservative so darista is new to kind of to the iare scene this if I'm not incorrect this is the new uh implant inside of the eye for um I believe it's bimatoprost or not bpro it's a timolol version It's a beta blocker I believe uh so yeah dur Dura yeah it's by matpro uh so it's an intercal implant that gets implanted in the eye uh from what I've heard it's lasts for reding reducing the eye pressure for about three months but um that's what I believe the FDA has cleared it for but it can in the early studies now or the later studies they're starting to show that it lasts longer and so it may be something that um will become more popular with time uh do I recommend it for glaucoma to reducing uh to reduce preservative certainly because you're not using eye drops as often it's all going on aside the eye uh then you don't have to um use preservatives as much so that might be a great option so thank you for that question um and thanks for giving me just a moment to make sure I'm giving the right information this is another good question Emerald you just again you've got such good ones on dry eye related content here um do you recommend santra or Ivermectin cream on the islands to treat deodex mites so the Ivermectin cream has been shown in studies to be beneficial at treating Demodex mites however it has not been FDA approved here in the US for that specific condition and so uh there are some ior mecan creams that I could prescribe for this but I personally have not reached that as a lot of other treatments we now have xdy on the market which is specifically FDA approved for the treatment of Demodex mites and i' I've had good success with that the other one um IPL again not FDA proved for it but IPL has benefit of killing Demodex mites without having to go on a medication uh but iveron cream is an option and I know some doctors who do treat it treat with it and they have good success so hopefully that just gives you a little bit more insight on that one um Michael uh mentioning that he's using heating pads on the eye like a warm compress he washes his eye eyelids every other day uh still has en crusted eyelids in the morning is it more than dry eyes uh so good question if you if anybody's having these sort of symptoms and it just seem they're trying all these different things to manage it and it just seems to stick around of course you want to see a doctor to make sure it is just dry eye because there could be a lot of things going on a lot more than just dryness um dry eye often goes hand inand with other conditions like blepharitis uh there's other um could be that your eyelids aren't closing all the way or have exposure issues maybe sleeping with the eyes open a lot of times that crusting sleep on the eye that you wake up with and I should do a video going into all of that um but the crusting is basically the buildup of mucus the mucus mucus drying out and all the debris trying to flush down toward your nose and it gets crusted there uh and usually the more inflammation more irritation going on in the eye the worse it's going to be think of when you if you've ever had pink eye you wake up the morning and they're fully crusted shut and that's because your eye is trying to push all of this Gunk and get it out of the eye so hopefully that gives a little bit insight for anyone who's struggling like that but thank you Michael uh real estate Prof uh maybe you can give some some some advice to us on real estate but uh what are your thoughts on Zyra so I I've had success with Zyra it's uh an anti-inflammatory drop that's safe longterm on the eye it's used twice a day um myself Zyra found great success with some patients I've had patients even come back within a month and say wow things are so much better at that same hand not everybody's a perfect candidate for Zyra and some people do get side effects like a bad taste in the the back of their mouth their Vision can go blurry for 30 minutes or they have installation sight installation irritation or redness um this is common symptoms with kind of side effects from a lot of dry eye medications but it's something that sometimes does come with Zyra um uh I've had some patients again that I've prescribed on it and did fantastic and it's still something that I depending on the case I will prescribe it mainly just again to reduce inflammation let's see here I do want to cut ahead here uh one of our um one of our members Barb thank you so much Barbara gold gold FR gold fuss uh uh to cataract surgery doesn't really matter with cataract surgery um so I don't fully understand the question but I do want to um at least kind of address that you know with cataract surgery dry eye does sometimes dry eye gets worse after cataract surgery because of all the inflammation and all the eye drops and preservatives that can cause irritation so we oftenly often see uh a spike of dry eye after cataract surgery so it's great for people who are considering cataract surgery to use eye drops for a few weeks before cataract surgery and then continue using lubrication drops uh with other prescribed medication drops after the procedure as well um but still uh thank you for being a member barbs thank you so much um [Music] Robin I wish I um could could give more specific uh guidance to you but it's something uh so Robin here mentions that she's had pink eye recently uh and then the dry eyes gotten worse in fact when we wake up the eye doesn't want to open on its own have to pull it open that's that's tough um because I know how painful that can be uh I of course can't say specifically what you should be doing on this but for for people in general if you have pink eye or an eye infection that can trigger a flare up for dry eye symptoms and so dry eyes can get worse uh depending on the type of pink eye because there's a lot of different types of pink eye out there I know some people think it's just one thing the true term is called a conjunctivitis and it can caused by bacteria can caused by viruses in fact viruses are even more common than bacterial conjunctivitis you can you can get pink eye from autoimmune issues lots of things so um I always do encourage if you have a pink eye or eye infection do see a eye doctor I know if you're in an area that doesn't have access to that so you'd rather go to the ER they know how to doctors at the ER know the basics but they don't know all the specific ways to diagnose and figure out what it is and and if it's a serious infection we know how to navigate and test for that um so I was encourag that for pink eye or red eyes but if you do get a flare up after dry eye best is talk to your doctor see if there is a certain lubrication uh like an eye drop over the counter a gel or even an ointment sometimes at night time will help people um get more lubrication that'll last throughout the night so that when they wake up in the morning the eye isn't having to peel open um some people do that with using a sleep mask at night time over that too so they put the gel on sleep mask um the uh other forms of treatment for that will depend on what's going on because if the dry eye activated something else that's happening you want to make sure everything's okay so I do again encourage talk to a local eye care professional on that um but thank you for the question I hope things get better um Rita what treatment do you recommend for a chelian so chelian for again people who have never heard of this uh we have a video going more in depth on chian p uh not not just P but sorry chian or other forms of sty the infection called a holum uh that's a painful red hot infection of the eyelid but a chilean's more of like a cyst that's just the easy way to say it it's a buildup of inflammatory U proteins in the mayian glands and it becomes this hard lumpy nodule on the eyelids it can be top or bottom uh un some people do get these recurrently the treatments usually one time a lot of times Chileans will get better on their own over time using warm compresses and heat to the eyelid multiple times a day uh following and then following a gentle massage May encourage for that to heal faster and so those are kind of the old school um methods recommendations to to try to get things to heal better with chazians using uh eyelid cleansers uh HP hypoc chlorus acid cleaning the eyelids regularly to uh prevent future irritation infection um try to get oils that are building up on the surface and causing inflammation away from the eye otherwise uh chazians some medications or antibiotics that have some inflammatory re um benefits for reducing inflammation in the skin uh such as doxycyclin aiyin those can sometimes be used uh however doesn't always end up getting rid of it then there are some procedures that help uh historically there's a surgical correction where they excise and they kind of we have a tool that looks like a miniature ice cream scoop uh where we first flip the eyelid inside out with a little clamp to hold it in place and then we use this little ice cream scoop to to scoop out all the inflamed globules uh that are stuck in the eyelid that unfortunately can leave kind of a scar tissue can damage the myomi and gland so can potentially make dry eyes worse the um other treatment is an injection of a steroid into that same location on the eyelid to reduce inflammation however some newer uh Publications have shown even use of IPL using at least one up to even four treatments can help reduce the size of those chazians so that's something that we um can offer patients as well uh but those are primarily the the most common ones that and things that I mentioned when people ask about that so thank you I know this is an interesting one from khil uh khil Omar asks do gym sessions and intense workouts woren I dryness I haven't read a specific study on this largely exercise is very good for the whole body and can help move the lymph system and I believe can help with dry eye treatment for lifestyle changes as far as far as really intense workouts I can imagine yeah the eyes are going to get dry for a couple of reasons namely because if you're not staying hydrated during those intense workouts your body is going to be prioritizing water to different parts of the body and then perhaps sweat and other oils dripping from your face could be getting into the eyes that way and disrupting the tear film so good question um and hopefully you know if anyone does spend some time and find a research article on that send it my way I'll definitely read it um and then we'll probably take this one last and call it a good for the evening oops wrong one there is Sherry uh does putting castor oil on the eyelids help dry eye so castor oil there's a lot on the internet about castor oil and there's I would say more probably BS than truth with a lot of the social media trends that you see uh when it comes to castor oil there are benefits for for removing makeup and it can be good on the skin certain types of castor oil uh but as far as eyes there's a lot there in fact I'm doing a video and it'll be coming out in a few weeks on casor oil and breaking down all of the research publications of how when it can be beneficial for dry eye and what it can and cannot do in terms of Eye Health like based off of published literature uh about castor oil so um tuned for that one but in short answer castor oil can be helpful for dry eye specifically putting on the eyelids tough to say but again stay tuned for that video because we'll go much more in depth but thank you guys so much for everyone being on here um I know there's so many questions coming in and uh some people did have good ones uh I do want to oh I do want to call out Barbara she's one of our our um uh one of our channel members I got a question a little bit better thank you is it dangerous to go into cataract surgery with severe dry eye tough for me to say it's dangerous but severe dry eye the the best practice right now is to treat dry eye aggressively before cataract surgery because the dryness on the Sur surface can make the accuracy of testing of the eye for cataract surgery make the accuracy wor it makes the accuracy worse because the surface is irregular but we know that the cataract surgery is likely going to cause a flare up in dry eye and so we want the eye to heal the best it can and so to improve the accuracy and the success of the procedure also the help with the healing uh best practice is now to treat dry eye aggressively before cataract surgery same thing with lasic or any form of refractive surgery so again thank you guys to everybody who joined in this evening uh please continue to ask questions in the comment section I will jump in and try to be as active in those as I can um and just everybody appreciate everything thank you so much for watching shout out to the uh gold play button from YouTube for hitting a million subscribers thank you to everybody and con congratulations to our um we had a giveaway for that one million so that is done with now and we've reached out to all the winners so thank you all who contributed and joined in that again thank you have a great rest of your evening and we'll see you in the next video

Channel: Doctor Eye Health

Views: 193,741

Keywords: dry eye, dry eyes, dry eyes treatment, dry eye syndrome, dry eye treatment, dry eye disease, what causes dry eyes, doctor eye health dry eyes, dry eyes symptoms, how to treat dry eyes, dry eye treatments, dry eyes cure, meibomian gland dysfunction, doctor eye health, eye health, ophthalmology, dr eye health, eye doctor, severe dry eyes, interventional dry eye, how to get rid of dry eyes, evaporative dry eye, severe dry eye symptoms, what happens when you dont treat dry eye

Id: BJ-KDNdNykY

Length: 61min 28sec (3688 seconds)

Published: Thu Feb 22 2024