Tips for Dry Eye Syndrome

Dry Eye Syndrome affects millions of Americans, and most are over about 40 years old. It's an insufficiency of tears -- the eyes are either not producing enough tears or are producing tears of inadequate quality. Tears have a variety of ingredients and some may be missing. There is no cure for Dry Eye Syndrome but it can be managed.

Tears are made in each eye's lacrimal gland, which is beneath the upper eyelid. There is a system of tiny ducts and canals for the tears to enter the eyes and drain out again, being replaced by fresh tears. They drain out through the puncta (singular = punctum), which are apertures at the inside corner of each eye connecting to the nasal sinuses and throat.

Many Causes of Dry Eyes

Allergies are more famous for causing streaming eyes, but some can cause dry eyes. So also can many medical conditions that don't appear to be related to the eyes:

• Diabetes
• Rosacea (there are both dermal and ocular rosacea, usually found together)
• Rheumatoid arthritis
• Lupus (Systemic Lupus erythematosus (SLE) -- an autoimmune disease
• Sjogren's syndrome -- another autoimmune disease where the body's immune cells attack the glands that make tears and saliva

Dry eyes can be a temporary side effect of LASIK. Our eyes naturally become drier with age, and there are also eyelid problems, some medications, and various environmental factors, all of which can make the eyes too dry. So even without any allergies or diseases, dry eyes can happen, and be very annoying. It gives a feeling that something is in the eye -- and there may indeed be things like dust or cat fur, since the tears are insufficient to wash them out.

Some Ways to Mitigate the Dryness

Start noticing how often you blink. Each blink distributes tears over the eye's surface. But when we use a computer, read, or watch TV, we tend to blink less often. That's a habit that can be modified.

Keep chlorinated water out of the eyes, as chlorine is a known irritant. Wear sunglasses at all times outdoors, and choose a pair with side pieces and a top piece to block sun from those directions as well as rays going directly into the eyes. That style also help to keep dust and wind out of your eyes.

Think about the humidity in your home. Both furnaces and air conditioning make the air dry. Fans can blow air directly into the eyes and be as drying as a strong wind. A humidifier is a great investment for improving air quality -- there are some which tell you what the current humidity is and keep you updated as they inject more moisture into the air.

Are you taking any medications which cause dry eyes as a side effect? Read the labels and ask your doctor if there might be any alternatives.

Be careful what eye drops you use for moisturizing. This is another thing to consult your eye doctor about, even if youre just using an over-the-counter brand. Some brands look good but actually worsen the problem over time. Some have preservatives which irritate the eyes.

If nothing works well enough, your eye doctor might suggest punctal plugs. This is a procedure where those little exit canals are partially blocked to slow down the rate at which the tears drain out.

"Staged Implants" Becoming More Popular

Presyopia is that middle-aged vision which requires reading glasses, even if your eyes are still 20/20. The lens becomes unable to change its curvature enough, become steep enough, to give clear close vision. As the Baby Boomers age and presbyopia occurs more often in the population, ophthalmologists have correspondingly increased their research and experimentation for how to treat it.

Intraocular Lenses (IOLs)

IOLs are replacements lenses for the eye's natural lens. In a short procedure, the eye surgeon gently disintegrates the natural lens, removes it by suction, and replaces it with an artificial lens which will give clear vision at most distances.

For several years now, we have had three FDA-approved IOLs for treating presbyopia:

• Crystalens -- an accommodating lens which mimics the behavior of the lost natural lens and its power of accommodation. It is attached to the same eye muscles which previously controlled the natural lens curvature; now they move the Crystalens forward or back to give sharp vision at varying distances.
• ReZoom -- a multifocal lens with concentric zones built into it, each reacting differently with incoming light. Between them they give clear vision at most distances.
• ReSTOR -- also a multifocal lens, with concentric steps in its structure. Again they give clear vision at most distances.

These IOLs have been re-issued at various times, with improvements made. In addition, many ophthalmologists have used a fourth IOL that is popular in Europe and still in testing for the U.S. FDA.

• TECNIS -- another multifocal lens with concentric rings, each of which breaks up the incoming light into two parts: one for near vision and one for far vision. It gives good vision in all lighting situations.

What Are "Staged Implants"?

This is a cooperative way of treating presbyopia with IOLs, where only one eye is first treated. The eye surgeon makes a judgment call as to which particular IOL to use, and after he or she has implanted it, waits for patient feedback.

If the patient is happy with the vision improvement in the treated eye, the surgeon implants the same type of lens in the other eye. If the patient is not happy, and would like, for example, better near vision, the surgeon will choose a different type of IOL for the second eye.

Although all the IOLs vastly improve vision at most distances, some perform better for near vision, some for intermediate vision, and others for far vision. Presbyopia is a problem with near vision first, and only as the person ages further becomes more of a problem with intermediate vision and then distance vision. Therefore the TECNIS IOL has been useful, as it delivers clearer near vision than the other IOLs.

Popular combinations for near and intermediate distances are:

• ReSTOR and ReZoom
• TECNIS and ReZoom
• ReSTOR 4.0 and ReSTOR 3.0
• ReSTOR and Crystalens

If presbyopa seems to be catching up with you lately, and you are finding store-bought glasses to be inadequate, the next step in keeping clear vision would be scheduling a consultation with an experienced and fully-qualified eye surgeon.

What's All the Flap About?

The mass media is heating up over the small percentage of LASIK patients who experience complications afterwards, such as dry eyes, glare or halos around light sources, and difficulty with driving at night.

After more than a decade of increasing numbers of people having LASIK and being delighted with their new clear vision, suddenly the LASIK downside is being emphasized. All surgeries have risks and complications. A small percentage of people always has some trouble after a surgery, which is why no surgery is ever guaranteed to give a perfect outcome 100% percent of the time.

LASIK Candidacy

In the early LASIK days, it's true that some eye surgeons rushed to offer it to as many people as possible, and failed to screen their patients adequately. It has been said a million times that LASIK is not for everybody. To qualify as a good LASIK candidate, you must:

• Have a stable prescription
• Be over 18 years old
• Have no autoimmune disease such as Lupus, or any condition that might interfere with healing
• Have appropriate corneal thickness and pupil size
• Be within a certain range in the severity of your myopia or hyperopia
• Preferably not be a diabetic
• Have realistic expectations

There are more requirements, and each individual must be carefully tested, examined, and questioned. No two human eyes are exactly the same, and each individual responds to surgery in their own way, healing quickly or not so quickly, following the doctor's directions or perhaps not, etc. There are many variables that go into a successful LASIK outcome.

Choosing a Good LASIK Surgeon

If you would like to have a LASIK surgery, you need to do some homework first. Read up about LASIK, and look around for a highly qualified and highly experienced eye surgeon. Do not choose the one who charges the least. A low fee will usually indicate that some corners are being cut at that doctor's office. Perhaps staff is not fully trained, or instruments are not sterilized often enough, or patients are not well screened. LASIK equipment is expensive and the medical skill required to do it well does not come cheap either.

So do yourself a great favor and take time over choosing your LASIK surgeon. Ask to speak to some previous patients. Check the doctor's standing with the American Board of Ophthalmology. Ask each doctor you consult with how many LASIK procedures he or she has performed, and expect the answer to be in the thousands.

The mass media thrives on negative news, and usually magnifies it to dramatic proportions, as this sells newspapers and increases TV audiences. However, despite the current flap, LASIK has overwhelming success when it is performed on good candidates by a qualified ophthalmologist.

What are Floaters?

Have you ever been gazing up at the sky and noticed strange little shapes floating around in your vision? When you try to examine one of them, it darts away and continues to drift lazily around, maybe shimmering or vibrating a little. They may gradually change their shape and may disappear, or not. This drifting behavior occurs because they exist in fluid.

Floaters Related to Aging and Usually Not a Danger

Our eyes are filled with fluid -- aqueous fluid in the anterior chamber (in front of the lens) and vitreous fluid in the much larger posterior chamber, behind the lens. As we age the vitreous fluid (often referred to as just "the vitreous"), starts to shrink, with cells clumping together here and there and casting little shadows on the retina, the light-sensitive cells at the back of the eye. These shadows are floaters.

You are more likely to develop floaters if you:

• Have diabetes
• Have had a cataract surgery
• Are very myopic (nearsighted)

Floaters can arise because of an infection, eye injury, inflammation, bleeding in the eye, or tears in the retina. These causes will have consequences more damaging than just floaters.

Vitreous Detachment May Require Immediate Care

In some older people (over about 50), the vitreous can abruptly pull away from the retina. You may notice this by a sudden increase in the numbers of floaters, or by light flashes at the side of your vision. It usually does not need any treatment, as it does not threaten vision. If it happens in one eye, it will likely happen in the other eye too, although perhaps not for a few years.

However, in some cases, vitreous detachment pulls hard enough on the retina that it can pull the retina itself out of position -- known as retinal detachment, and definitely sight-threatening. Or it can cause damage to the macula, which is the central area of the retina where the fovea centralis is. The fovea is the small area that gives us our clearest visual focus.

If you experience any sudden increase in light flashes at the sides of your vision, or in floaters, do contact your eye doctor immediately. Your vision could be in danger. Retinal detachment can cause blindness, and any tears or breaks in the retina can lead to retinal detachment. So it's better not to delay in seeking advice and care.

New Angle on Glaucoma Causes

There are several types of glaucoma and the most common one is open-angle glaucoma. Glaucoma is detectable damage to the optic nerve caused by high intraocular pressure and its causes are not well understood. The fluid inside the eye always exerts a certain amount of pressure outwards, and in a normal eye, the cornea (front clear part) holds its curvature steady, the lens, iris, and sclera are not damaged by the pressure, and the optic nerve and retina remain healthy.

However, in a glaucomatous eye, the pressure is too high and causes eye tissue damage. When the optic nerve is damaged, our sight is compromised. Glaucoma is a progressive disease, and if not treated will cause blindness.

The retina is made up largely of light-sensitive cells which receive the image information in light rays entering the eyes. They convert it to electrical energy. The optic nerve is connected to the retina and carries this electrical (neural) energy to the brain, which interprets it. When the optic nerve is damaged, it is less able to carry that vision information to the brain, which gradually reduces our visual field until it becomes zero.

Diagnostic Tests

Traditionally, glaucoma is diagnosed through several tests. Two are tests of intraocular pressure:

• The 'puff test' -- where a puff of air is sent to the eye and gives a measurement of how much intraoculat pressure that eye has
• The visual field test -- where tiny lights flashing for a moment are the stimulus for you to press a button at each light. The testing system converts this into a map of each eye, with black areas where lights flashed but you didn't press the button because you didn't see them.

A third is an examination of the optic nerve:

• Stereoscopic photographs are taken of the optic nerve

Newer tests attempt to measure the thickness of nerve fibers in the retina. Glaucoma reduces their thickness until they are lost. By measuring any changes in the thickness of these fibers, these tests detect the glaucoma progression.

A Recent Mayo Clinic Study

Using Mayo Clinic records, a team of ophthalmologists (all members of the American Academy of Ophthalmology) and others recently compared intraocular fluid pressures to cerebrospinal fluid (CSF) pressures. CSF surrounds the spinal cord and brain, extending to the area of the optic nerve.

They chose 28 glaucoma patients and 49 control group patients without glaucoma. Both groups had received eye examinations, and had had CSF samples taken through a lumbar puncture between 1996 and 2007.

The researchers found that CSF pressures were significantly lower in all glaucoma patients than they were in any of the control group patients. This was independent of any patient's age, or the reason he or she had had the lumbar puncture done.

In other words, they found that in the glaucoma patients, lower CSF pressures were combined with higher intraocular pressures. Further studies are now planned, to learn more about the role of CSF pressure in the development of glaucoma.

If you are approaching age 40 or so, and have not had any glaucoma testing, it is strongly urged that you do so. Glaucoma can creep up silently on a person, and you may not notice anything is amiss until you have permanently lost a significant amount of vision. If you are in the Bloomington or Peoria areas in Illinois, please visit the Gailey Eye clinic, where any of six highly-trained ophthalmologists can help you keep your eyesight intact.