30 Oct 2019Update on Dry Eye Disease

El Paso- the Sun City - known for its sunny warm climate and over 300 days of sunshine per year. Many of us appreciate El Paso’s warm and inviting climate. However there is at least one drawback to not having much rain - and that is low humidity. Very low humidity in-fact. A consequence for our eyes from being bathed in dry air is having to put up with dry, scratchy uncomfortable eyes. Not surprisingly, the arid Southwest is the region of North America with the greatest amount of dry disease. At Sun Eye Care, PA, we see many patients every day with dry eye complaints. Treatment, which has until very recently been limited to just artificial tears, now has a wide array of options. Over the last 10 to 20 years there has been an explosion in therapeutic treatments. Dry eye disease can have many potential causes of immune disorders such as rheumatoid arthritis or Sjogren’s disease to chronic inflammation as a result of ocular allergy. Many years of contact lens wear can lead to chronic tear insufficiency. Also, inadequate oil release from small glands on the eyelids located near the eyelashes can result in more rapid tear film evaporation. Most people over the age of 40 will experience some degree of dry eye. Sometimes younger adults can experience dry eye too. Because of ambient low humidity in the Southwest anyone with an underlying condition causing dry eye can have even greater symptoms. Ordinarily people with healthy eyes don’t “feel” them – or in other words, they don’t really have any sensation from the eyes. Patients with dry eye often complain of burning, stinging, irritated feeling eyes or red eyes. Contrary to what seems logical, patients with dry eye often complain of tear-ing! (This happens when excessively dry surface of the eye stimulates the accessory tear gland to release tears – essentially you begin crying). Patients with dry eye will also complain that their vision becomes blurry especially at the end of the day or that they can only read for short periods of time before their eyes feel tired. Patients may notice red, irritated looking eyes or in more severe cases may have the sensation of a foreign body on the eye. In very advanced cases of dry eye, the cornea can scar causing permanent decreased vision. Fortunately, many treatments have been developed to help patients suffering from dry eyes. Several medications have been developed to combat dry eye disease. Restasis (cyclosporine a 0.005%) a topical medicated eye drop prevents inflammatory cells from slipping through small blood vessels into the eye’s surface. Restasis helps to combat inflammation that can promote dry eye disease. Newer formulations of cyclosporine are also now available as Restasis has come off patent and is going generic. Another eye drop called Xiidra (lifitigrast) works with a different mechanism to achieve the same result of decreased ocular surface inflammation. Lower potency steroids such as Lotemax, Flarex or Alrex can also help reduce inflammation and simultaneously reduce allergy helping to control dry eye symptoms. To help retain more of your natural tear on the surface of the eye, small plugs made of silicone or collagen can be placed in the tear drainage canal of the eyelid. This canal – called the nasal lacrimal duct – is why when we cry we get the sniffles! It takes extra tears into the nose. Collagen plugs are designed to dissolve over either weeks or several months. Silicone plugs are designed to be semi-permanent. They can be removed at any time, but while in place help to make the eyes less dry. For people with more advanced dry eye who may not be responding well to a combination of prescription eye drops, artificial tears or plugs, a new therapy using neural stimulation is now available. True Tear, manufactured by Allergan, is an electrical device that stimulates the nervous system to help augment your natural tear production. It’s safe and effective and can really help patients with more advanced forms of dry eye or those who may feel overwhelmed with more traditional treatments. Finally, there are therapies geared to improving eyelid health which can be a major contributor to dry eye disease. Please see the sidebar about breakthrough treatments to help with this problem. Your eye care provider will walk you through these varied treatment options and help you to personalize the treatment best geared toward your particular situation!   -Michael W. Foote, MD