How do your eyes feel at the end of the day? If you are like the majority who are literally staring at a computer or cell phone for much of the day, or part of the growing aging population, you’d probably answer, “My eyes are often tired and dry.”
Chronic dry eyes affect as high as 87.5% (Fenga et al) of computer users and 73.5% (Uchini et al) of the elderly population. It is the number one vision problem that optometrists and ophthalmologists treat. Dry Eye Syndrome (DES) is becoming an epidemic because our work, play and socialization has shifted from working with our bodies, to working with our eyes.
Symptoms of DES include fluctuating vision, tired eyes, redness, burning, foreign body sensation, excessive tearing, itching and recurring eye infections. Causes include heavy digital use, stress, age, sleep deprivation, menopause, allergies, medication (i.e. antihistamines, diuretics, antidepressants, birth control pills, beta-blockers and hormone replacement therapy), low humidity environments, lid disease and contact lens wear.
Staring at a computer or digital device decreases your blink rate by 60% so oily tears are not spread over the eyes to lubricate and nourish them. Combine this with stress or inadequate sleep which compromises the immune system. These tears end up coagulating in the meibomian glands with the unchecked bacteria flora.
Traditional treatment for dry eyes has been: artificial tears, punctal plugs, prescription eye drops: Restasis and Xiidra, steroid drops, antibiotic drops, autologous serum drops (preparing eye drops from your own plasma) and managing prescription drugs that cause dry eyes.
The problem is that many of these treatments do not adequately address the underlying causes of dry eyes: inadequate production or poor quality tears, stress and clogged oily tear glands (meibomian glands). Also, many of these eye drops contain preservatives that further irritate the eyes.
Addressing the underlying cause of dry eyes improves the likelihood of making your patients more comfortable, while also treating the problem. Here is an integrative approach that you can use to help your patients with DES.
- Use homeopathic tear stimulation drops instead of artificial tears or prescription eye drops, which may feel good when you apply the drops, but do not have a long-lasting benefit. Homeopathic tear stimulation drops trigger release of all three layers of your own tears: mucous, oily and aqueous. I have had wonderful success with both the Tear Stimulation Forte Drops and Women’s Tear Stimulation Drops by Natural Ophthalmics. It has helped patients with everything from Dry Eye Syndrome to Sjogren’s Syndrome. The women’s formula has two added ingredients which address dry eyes due to hormonal changes from aging.1 Homeopathic medications are all FDA approved, and are cited in at least two Materia Medicas with provings of their efficacy.
- Unclog plugged meibomian glands that become clogged over time with the oily tears and bacteria. I use both an in-office and home heated eye massage to open the meibomian glands to get the tears flowing, and bacteria out. In the office I use the Mibo Thermaflow which is a therapeutic medical device that effectively liquifies the clogged oily tear ducts and evacuates bacteria by heating the lid safely and comfortably to 110 degrees Fahrenheit. For home treatment, I give patients an infrared heated mask which not only heats, but also promotes healing with the infrared heat. To treat the bacteria that is expressed with the heated massage, I prescribe Zocular foam, which is an okra-based product to decrease the bacteria and moisturize the eye lids.
- Improve tear quality and quantity from the inside out with omega 3’s. Only 2 formulas have been clinically proven to do this: HydroEye by Science Based Health, and Ultra Dry TG by OcuSci, Inc.2,3
- Treat co-existing allergies with Allergy Desensitization Drops by Natural Ophthalmics which decreases the over-reaction to pollens the same as taking allergy shots. The two main ingredients in Natural Ophthalmics’ Allergy Desensitization Drops, Apis mellifica and Sabadilla, have been clinically shown to increase stability of basophils by decreasing their degranulation.4,5 Allergic conjunctivitis aggravates dry eyes by irritating tear production glands to diminish tear production. In turn, insufficient production and release of tears decreases the eye’s ability to flush away airborne allergens such as pollen and dander, which exacerbate the allergic conjunctivitis.
Summary: DES is the number one eye problem that patients present with in an eye care practitioner’s office. The first step in treating dry eyes is to ask patients how their eyes feel at the end of the day, then connecting the symptoms to DES. After that, the problem can be diagnosed using several tests including meibography (infrared imaging of meibomian oily tear glands using the Meibox), tear break up test, meibomian gland manual expression, and Phenol Red Thread Test or Schirmer’s Test. Once the diagnosis is made, the key is to treat the underlying cause rather than simply using artificial tears which don’t get to the root of the problem.
