Show 1309: Coping With Dry Eyes and Tear Problems

This week on our nationally syndicated radio show, learn how to cope with tear problems. This is an extremely common eye disease, but that doesn’t mean it is trivial. An estimated 16 million adults in the US suffer with dry eyes, and suffer is the right verb for many of them.

What Is Dry Eye Syndrome?

The usual symptoms of dry eyes include irritation or a gritty feeling, redness and fluctuations in vision. Generally speaking, this is associated with an imbalance in the tear system. Tears have three components, water, mucus and oil. If these get out of balance, tear problems and dry eyes result. This problem appears to become more common as we age, and women are more susceptible to it than men. Perhaps a link with autoimmune conditions explains the gender imbalance, as women are also more prone to Hashimoto’s, rheumatoid arthritis and other autoimmune problems. Rosacea can also manifest as dry eye disease. Doctors have a fancy term for dry eyes: keratoconjunctivitis sicca.

Intensive use of computer screens may contribute to dry eyes, as frequently people immersed in their work or social media forget to blink as often as they would otherwise. Other contributors can include medications. Hydrochlorothiazide (HCTZ), a common diuretic prescribed to control blood pressure, is often a culprit. Anxiety medications and some drugs used to treat depression may also upset the balance of tears. Anticholinergic medicines of any type could contribute, especially if a person were taking two or three different ones. People taking antihistamines or decongestants for allergies may be dismayed to learn these medications can aggravate tear problems. To find a list of anticholinergic drugs, click here.

Surgery May Lead to Tear Problems:

Before you volunteer for LASIK refractive surgery or cataract removal, be sure to discuss your risk for dry eye with the surgeon. For some individuals, this complication becomes so unpleasant that they wish they had not undergone the procedures. But most people do not suffer such extreme tear problems.

How Can You Treat Dry Eye Syndrome?

The first step most people take is to use artificial tears. While this can be helpful, it is important to avoid the preservatives found in many such products. Our guest expert, Dr. Preeya Gupta, recommends Systane Complete or Refresh Relieva PF as preservative-free eye drops. These over-the-counter products can be quite soothing.

When the problem is primarily due to a failure of the meibomian glands in the eyelid that produce the oil film, warm compresses can sometimes help. These are most appropriate when the condition is mild.

Supplements That Might Help:

We asked about other nonprescription approaches, and specifically about omega-3 supplements. Although there is a paucity of studies showing that fish oil or krill oil can alleviate irritation or improve tear problems, Dr. Gupta says some patients find these supplements useful.

Prescription Interventions:

As we mentioned, warm compresses or heated eye packs containing seeds or plastic beads are likely to work best for mild symptoms. When meibomian gland dysfunction is more advanced, the eye doctor may recommend a few sessions with complex machines that provide more sustained and controlled warmth and pressure. These include LipiFlow, TearCare and iLux systems. Unfortunately, such sessions are pricey and insurance does not always cover them. When the underlying condition is ocular rosacea, intense pulsed light therapy is useful.

Prescription medications can be effective against dry eyes. The most common would be eye drops to fight inflammation, such as Restasis (cyclosporine) or Xiidra (lifitegrast). A new nasal spray, Tyrvaya (varenicline), works through its action on the trigeminal nerve.

This Week's Guest:

Preeya K. Gupta, MD, is the Managing Director of Triangle Eye Consultants (www.TriangleEyeNC.com) in Raleigh, NC. Dr. Gupta specializes in cataract, cornea and refractive surgery, and is an international expert in dry eye disease.

She is an Adjunct Associate Professor of Ophthalmology at Tulane University School of Medicine, and previously served on the faculty at Duke University Eye Center in Durham, North Carolina as an Associate Professor of Ophthalmology from 2011-2021. Dr. Gupta has authored many articles in the peer-reviewed literature and serves as an invited reviewer to journals such as Ophthalmology, American Journal of Ophthalmology and Journal of Refractive Surgery.

Dr. Gupta serves as an elected member of the American Society of Cataract and Refractive Surgery (ASCRS) Refractive Surgery clinical committee. She has been awarded the National Millennial Eye Outstanding Female in Ophthalmology Award, American Academy of Ophthalmology (AAO) Achievement Award, and selected to the Ophthalmologist Power List.