Fluctuating vision, red tired eyes, burning, irritation, light sensitivity, excessive tearing, red swollen lids can all be indicative of dry eye syndrome.
There are numerous options for treating dry eyes including drops and oral medications.
For patients with evaporative dry eye or meibomian gland dysfunction, there is a new FDA approved procedure done in the office to help with dry eye disease.
Alan Leahey, MC is here to discuss dry eye and how you can help those precious eyes of yours.
Selected Podcast
Do You Suffer from Dry Eye? There is Help!
Featured Speaker:
Learn more about Dr. Leahey
Alan Leahey, MD
Dr. Leahey, the chief of ophthalmology at Greenville Health System, has been performing refractive surgery since 1996. He practiced ophthalmology in Allentown, Pennsylvania from 1992 to June 2014 before joining the Greenville Health System and becoming a Clinical Associate Professor at the University Of South Carolina School of Medicine at Greenville in July 2014. He is former Associate Chief of Ophthalmology at Lehigh Valley Hospital and a former clinical associate in ophthalmology at the University of Pennsylvania School of Medicine. He has published numerous articles in various ophthalmology journals and performed the first PRK and the first conventional LASIK and the first Custom Vue LASIK (wave front technology) that were done in the Allentown, Bethlehem area of Pennsylvania. Dr. Leahey is certified on the Visx excimer laser platform.Learn more about Dr. Leahey
Transcription:
Melanie Cole (Host): Millions of Americans suffer from dry eye. Are you one of them? My guest today is Dr. Alan Leahy. He is the Chief of Ophthalmology at Greenville Health System. Welcome to the show, Dr. Leahy. Tell us a little bit about dry eye. What is it and how do you know if you have it?
Dr. Alan Leahy (Guest): Dry eye is one of the most common problems in the world right now as the Baby Boomers get older. The biggest symptoms that people experience are burning, irritation, redness, tearing, fatigue of the eyes, and one of the biggest is fluctuating vision. A lot of people are often surprised when they hear, “Well, if I have dry eyes, how can I be tearing?” It’s your cornea sending a signal to the brain that the cornea is irritated and we need to turn on the faucets. One of the glands—the lacrimal glands-- that normally just turns on for emotional tearing or when you are cutting an onion, kind of turns things on so that the excess tears will get made to make up for the deficiency or the evaporation. It’s a very common problem. The two major components of dry eye are people not producing enough tears. That’s only about 10-15% of folks, whereas about 85% have a problem with increased evaporation of the tears. So, they make enough tears but they evaporate too quickly and that’s something that is called Meibomian Gland Dysfunction.
Melanie: So, tell us about tears. What is their purpose, really? Besides when we’re sad about something, they sort of show up. But, what is their main purpose for eye health?
Dr. Leahy: The tear film is your first defense for your ocular system and for the eye. It’s basically your immunoglobulins are there to prevent against infection. It’s a way to keep the surface of the eye clean and it takes away irritants and it takes away debris that can fly into your eye. It is also responsible for about 10-15% of the focusing ability of the eye. Everyone thinks about their normal natural lens or their cornea for all of their focusing ability but the tear film is very important. That’s why folks that have a problem with dry eye have a lot of issues with fluctuating vision where at 10:00 in the morning their vision may be pretty good and at 10:30 it fogs in and out and then they put a tear drop in and, “Hey! It’s better again.”
Melanie: Dr. Leahy, if people are experiencing these symptoms, when do they know it’s time to see an ophthalmologist?
Dr. Leahy: Most people find that they’ve gotten tired of having the fluctuating vision. They’re having fatigue often where their eyes feel tired and they find that they can’t do their normal job or hobbies by looking at a computer or reading. They’re having a lot of difficulty with irritation, redness, fluctuating vision. When those things start to happen, most folks will seek out professional help, whether it’s with their ophthalmologist or a cornea specialist for dry eye, or their optometrist. Usually most of these folks can be helped with early treatment just with some artificial teardrops. Often many folks will try this on their own. But nowadays, we can do a lot more things for treatment if tears alone don’t seem to help their symptoms. We often can use topical steroid drops, topical cyclosporine drops which many people know as Restasis. They may have seen advertisements on TV for it. Other drops--antibiotic drops--often help lower the bacteria that live on our normal skin and on the lids so that we decrease the inflammation. Oral agents such as fish oils, Omega-3’s and -6’s also help. Sometimes oral antibiotics also help open up those meibomian glands that we discussed before. Years ago many people used plugs to sort of plug up the bathroom drain, if you may, and to overflow those tears. That is still done now days, but not as early as it was years ago because we now know that we need to decrease the inflammation before doing that because if we just well up the tears for somebody and they have excess tears there on top of their corneas and we don’t decrease the inflammation, that actually may do more harm than good.
Melanie: If you do decrease the inflammation, and people get a prescription for a certain type of medication to take to help them with this, is this something that goes on for their life? Or is it something that goes away or comes and goes?
Dr. Leahy: Dry eye, unfortunately, is a chronic condition. We do not have a cure for dry eye. We can definitely treat it and the whole goal of the treatment is to get their activities of daily living back to where they would like them to be. They may always have to use some type of tear drop or prescription drop or use it for six months or a year, get off it and they may do fine for several years and then they may have to get back on it again. It is something they have to maintain all the time. It may be as simple as using an artificial tear a couple of times a day and a warm compress on the lids once a day to open up some of those glands that secrete the oils to prevent evaporation of the tear film.
Melanie: Does it hurt or affect us if people are rubbing their eyes a lot and can dry eye affect your vision in the long term?
Dr. Leahy: Dry eye can affect your vision in the long term, if it goes untreated. However, most people have enough symptoms and irritation and redness that they know they need some help with what’s going on with their eyes because they hurt. If they don’t seek treatment over time, yes, you can get corneal scarring that could cause a permanent decrease in vision. It would be silly to have to undergo some type of surgery such as a corneal transplant for untreated dry eye. Now, that would be rare, but it could happen. Nowadays there are a lot of options besides what we talked about already. Some of the things that are nice is testing can be done to take out the subjective part from the patient. “Well, I think I feel this.” There are ways we can actually measure the concentration of the tear film and to see how dry it is. There are also ways that we can look at the individual glands, the meibomian glands--the 40 of them in the lower lid and 30 in the upper--and actually put that on a large screen so that the patient can actually view his own glands and see where the problems are. Then, if there are problems with the glands, there are treatments now such as Lipiflow which is the newest FDA approved treatment for dry eye, approved in 2012, where we can actually, in the office over 12 minutes, open up all of those glands and folks can get significant relief from anywhere from nine months to two years.
Melanie: Wow! What’s involved in that procedure?
Dr. Leahy: The Lipiflow is a way to do a warm massage on the lids. It’s basically a small applicator that goes over both eyes and it wraps around the upper lids and the lower lids while somebody is lying back in a chair. It is basically warm heat on the eye. The lids are heated up to 108.5 degrees Fahrenheit. That sounds hot but remember, your normal body temperature is 98.6. So, it is only elevating the temperature by about 10 degrees over your baseline. While it’s doing, that at the same time, it’s putting pressure, squeezing the upper lids and the lower lids to milk those glands. That allows a lot of the thick secretions that are in those glands causing blockages to be released. Then, your normal lipid that you make in those glands can be released to help prevent evaporation of your tear film. So, it is a great option for people where other methods have failed.
Melanie: Is there anything else that you would like to add in just the last few minutes, Dr. Leahy, about dry eye? Tell the listeners, please, your best advice--what you really want them to know and why they should come to Greenville Health System for their eye care.
Dr. Leahy: The biggest thing with dry eye that I often find as a cornea specialist is, it is a frustrating condition both for the patient and the physician. By the time I’m seeing these individuals, they have often seen 6-8 different ophthalmologists and often they are just given tears and told, “Well, use the tears there is not much that we can do for you.” Well, that’s really not correct nowadays because there are so many different modalities that we can use now to aggressively treat dry eye to manage it so it doesn’t become a chronic problem as they get older. So, no matter what they have been told in the past, they really need to believe that there are many alternatives that may not have been explained to them in the past. There has been a lot of research in dry eye over the last 10 years and a lot especially in the last 5 years. The National Institutes of Health has actually convened a couple of dry eye workshops to look at this problem. People should realize there is a lot more available for them for dry eye treatment than there was even five or six years ago.
Melanie: Thank you so much, Dr. Leahy, for such great information. You're listening to Inside Health with Greenville Health System. For more information, you can go to GHS.org. That's GHS.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Millions of Americans suffer from dry eye. Are you one of them? My guest today is Dr. Alan Leahy. He is the Chief of Ophthalmology at Greenville Health System. Welcome to the show, Dr. Leahy. Tell us a little bit about dry eye. What is it and how do you know if you have it?
Dr. Alan Leahy (Guest): Dry eye is one of the most common problems in the world right now as the Baby Boomers get older. The biggest symptoms that people experience are burning, irritation, redness, tearing, fatigue of the eyes, and one of the biggest is fluctuating vision. A lot of people are often surprised when they hear, “Well, if I have dry eyes, how can I be tearing?” It’s your cornea sending a signal to the brain that the cornea is irritated and we need to turn on the faucets. One of the glands—the lacrimal glands-- that normally just turns on for emotional tearing or when you are cutting an onion, kind of turns things on so that the excess tears will get made to make up for the deficiency or the evaporation. It’s a very common problem. The two major components of dry eye are people not producing enough tears. That’s only about 10-15% of folks, whereas about 85% have a problem with increased evaporation of the tears. So, they make enough tears but they evaporate too quickly and that’s something that is called Meibomian Gland Dysfunction.
Melanie: So, tell us about tears. What is their purpose, really? Besides when we’re sad about something, they sort of show up. But, what is their main purpose for eye health?
Dr. Leahy: The tear film is your first defense for your ocular system and for the eye. It’s basically your immunoglobulins are there to prevent against infection. It’s a way to keep the surface of the eye clean and it takes away irritants and it takes away debris that can fly into your eye. It is also responsible for about 10-15% of the focusing ability of the eye. Everyone thinks about their normal natural lens or their cornea for all of their focusing ability but the tear film is very important. That’s why folks that have a problem with dry eye have a lot of issues with fluctuating vision where at 10:00 in the morning their vision may be pretty good and at 10:30 it fogs in and out and then they put a tear drop in and, “Hey! It’s better again.”
Melanie: Dr. Leahy, if people are experiencing these symptoms, when do they know it’s time to see an ophthalmologist?
Dr. Leahy: Most people find that they’ve gotten tired of having the fluctuating vision. They’re having fatigue often where their eyes feel tired and they find that they can’t do their normal job or hobbies by looking at a computer or reading. They’re having a lot of difficulty with irritation, redness, fluctuating vision. When those things start to happen, most folks will seek out professional help, whether it’s with their ophthalmologist or a cornea specialist for dry eye, or their optometrist. Usually most of these folks can be helped with early treatment just with some artificial teardrops. Often many folks will try this on their own. But nowadays, we can do a lot more things for treatment if tears alone don’t seem to help their symptoms. We often can use topical steroid drops, topical cyclosporine drops which many people know as Restasis. They may have seen advertisements on TV for it. Other drops--antibiotic drops--often help lower the bacteria that live on our normal skin and on the lids so that we decrease the inflammation. Oral agents such as fish oils, Omega-3’s and -6’s also help. Sometimes oral antibiotics also help open up those meibomian glands that we discussed before. Years ago many people used plugs to sort of plug up the bathroom drain, if you may, and to overflow those tears. That is still done now days, but not as early as it was years ago because we now know that we need to decrease the inflammation before doing that because if we just well up the tears for somebody and they have excess tears there on top of their corneas and we don’t decrease the inflammation, that actually may do more harm than good.
Melanie: If you do decrease the inflammation, and people get a prescription for a certain type of medication to take to help them with this, is this something that goes on for their life? Or is it something that goes away or comes and goes?
Dr. Leahy: Dry eye, unfortunately, is a chronic condition. We do not have a cure for dry eye. We can definitely treat it and the whole goal of the treatment is to get their activities of daily living back to where they would like them to be. They may always have to use some type of tear drop or prescription drop or use it for six months or a year, get off it and they may do fine for several years and then they may have to get back on it again. It is something they have to maintain all the time. It may be as simple as using an artificial tear a couple of times a day and a warm compress on the lids once a day to open up some of those glands that secrete the oils to prevent evaporation of the tear film.
Melanie: Does it hurt or affect us if people are rubbing their eyes a lot and can dry eye affect your vision in the long term?
Dr. Leahy: Dry eye can affect your vision in the long term, if it goes untreated. However, most people have enough symptoms and irritation and redness that they know they need some help with what’s going on with their eyes because they hurt. If they don’t seek treatment over time, yes, you can get corneal scarring that could cause a permanent decrease in vision. It would be silly to have to undergo some type of surgery such as a corneal transplant for untreated dry eye. Now, that would be rare, but it could happen. Nowadays there are a lot of options besides what we talked about already. Some of the things that are nice is testing can be done to take out the subjective part from the patient. “Well, I think I feel this.” There are ways we can actually measure the concentration of the tear film and to see how dry it is. There are also ways that we can look at the individual glands, the meibomian glands--the 40 of them in the lower lid and 30 in the upper--and actually put that on a large screen so that the patient can actually view his own glands and see where the problems are. Then, if there are problems with the glands, there are treatments now such as Lipiflow which is the newest FDA approved treatment for dry eye, approved in 2012, where we can actually, in the office over 12 minutes, open up all of those glands and folks can get significant relief from anywhere from nine months to two years.
Melanie: Wow! What’s involved in that procedure?
Dr. Leahy: The Lipiflow is a way to do a warm massage on the lids. It’s basically a small applicator that goes over both eyes and it wraps around the upper lids and the lower lids while somebody is lying back in a chair. It is basically warm heat on the eye. The lids are heated up to 108.5 degrees Fahrenheit. That sounds hot but remember, your normal body temperature is 98.6. So, it is only elevating the temperature by about 10 degrees over your baseline. While it’s doing, that at the same time, it’s putting pressure, squeezing the upper lids and the lower lids to milk those glands. That allows a lot of the thick secretions that are in those glands causing blockages to be released. Then, your normal lipid that you make in those glands can be released to help prevent evaporation of your tear film. So, it is a great option for people where other methods have failed.
Melanie: Is there anything else that you would like to add in just the last few minutes, Dr. Leahy, about dry eye? Tell the listeners, please, your best advice--what you really want them to know and why they should come to Greenville Health System for their eye care.
Dr. Leahy: The biggest thing with dry eye that I often find as a cornea specialist is, it is a frustrating condition both for the patient and the physician. By the time I’m seeing these individuals, they have often seen 6-8 different ophthalmologists and often they are just given tears and told, “Well, use the tears there is not much that we can do for you.” Well, that’s really not correct nowadays because there are so many different modalities that we can use now to aggressively treat dry eye to manage it so it doesn’t become a chronic problem as they get older. So, no matter what they have been told in the past, they really need to believe that there are many alternatives that may not have been explained to them in the past. There has been a lot of research in dry eye over the last 10 years and a lot especially in the last 5 years. The National Institutes of Health has actually convened a couple of dry eye workshops to look at this problem. People should realize there is a lot more available for them for dry eye treatment than there was even five or six years ago.
Melanie: Thank you so much, Dr. Leahy, for such great information. You're listening to Inside Health with Greenville Health System. For more information, you can go to GHS.org. That's GHS.org. This is Melanie Cole. Thanks so much for listening.
powered by: 