LITTLE glands play a BIG role in dry eye

A lot of people who are living in this high tech world experience eye discomfort at some point.  The reason…inadequate blinking.

"I thought it was normal for my eyes to feel tired after a long day of work."

“I thought it was normal for my eyes to feel tired after a long day of work.”

We  spend countless hours on the computer for both work and leisure.  At home we play video games and use smart phones, read and watch television.  All of these activities are proven to decrease our blink rate in half.  If we don’t blink as many times per minute the surface of our eyes experience dry spots.  When we are exposed to this repeatedly our eyes give us warnings signs:

  • Burning
  • Grittiness
  • Redness
  • Fatigue
  • Blurred vision
  • Even Watering

Why? to warn us and to get us to either blink, rub the eyes or use an eye drop for relief.  Have you been there?

So here’s what’s going on inside your eyelids with your blinking that makes the “water” layer of the tears stay on the eye’s surface long enough to prevent evaporation.

Meibomian Glands:  There are about 50-60 oil glands lining the upper and lower eyelid margin that with each blink secrete and thin oil onto the eyes surface.  This oil provides a barrier to the outside world that prevents quick evaporation.

meibomain glands

Normal meibomian gland secretions are thin and clear.  It resembles olive oil.

normal meibomian

 

For many reasons age, hormonal changes, medications, certain medical conditions, environment and our activities the secretions from these glands change over time.  It becomes thick and cloudy.  As this occurs it is much harder for the oil to be pushed out with our blink.  Also, it has a lot of inflammatory particles that becomes more irritating to the eye’s surface.  This increases evaporation of the moisture and our eyes dry out faster during the day.

 

What evaporation looks like during your eye exam:

TBUT

 

Unhealthy secretions

thickened secretions

 

If left untreated the secretions can become very thickened and the consistency of toothpaste.  This is very irritating to our eyes.severe mgd

The most surprising thing to me as your eye care provider is that this process is usually very advanced before you come into the office with complaints.  My advice to you is if you have any discomfort after your work day, seek out a dry eye specialist in your area for an evaluation before you go to the drug store for one of the 50+ moisture drops on the market.

http://www.dryeyecenterofpa.com

 

 

 

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Dry eye- the basics

For anyone suffering from dry eye disease, the frustration of living with uncomfortable eyes can have a negative impact on daily living.  Some sufferers have to decrease their time on the computer, alter their work environment or even avoid driving in bright sunlight.  The good news is that we as doctors are gaining a wealth on knowledge about this multi-factoral disease- yes it’s a disease of the eye!  And like any other disease it is chronic and if not treated properly progressive.

STEP 1: Have a formal dry eye evaluation.  At May Eye Care we have a specialist available to provide this type of exam, myself Dr. Leslie E. O’Dell.  There are a lot of factors that need to be addressed during this exam to help diagnosed the type of dry eye you have which is crucial to our treatments.

STEP 2: What type of dry eye?  You either are classified as Aqueous Deficient dry eye ( too little water or aqueous), Evaporative Dry eye (too little oil) or BOTH.

STEP 3: Treatment tailored to your disease This is really where the art of medicine is cruicial. You want to have a doctor with a lot of experience treating dry eye disease to assure you will have symptom relief.  These treatments include:

Over the counter products

Nutraceutical (ie Omega 3 fish oil)

Medications

Warm compresses

Moisture goggles

Punctal occlusion

Lipiflow treatment

STEP 4: Setting realistic expectations  This is a big a part of your success.  It’s important o understand that this is a chronic disease  day to day activities can contribute to your overall comfort or discomfort.  Also it’s important to understand that dry eye is a progressive disease, if you are starting treatment with mild disease you are much more likely to have symptom relief quickly.  On the other hand, a severe dry eye patient is going to have to do a lot in the way of treatment and work at those treatments each day to maintain a level of comfort and symptom relief.

 

Finding a good specialized eye care center is sometimes worth a trip.  We are always happy to see new patients.  Contact May Eye Care today for your evaluation, relief is in sight!  (717)637-1919

 

 

 

 

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Top 50 worse places for dry eye sufferers to live

Texas tops the charts for the driest environment to live if you suffer from dry eyes.  A recent survey ranked cities across the country looking for the “perfect” environment to cause dry eyes and here are the results:  data from www.eyecaresource.com

According to The National Women’s Health Resource Center:

1. Las Vegas, NV

2. Lubbock, TX
3. El Paso, TX
4. Midland/Odessa, TX
5. Dallas/Fort Worth, TX
6. Atlanta, GA.
7. Salt Lake City, UT
8. Phoenix, AZ
9. Amarillo, TX
10. Honolulu, HI
11. Oklahoma City, OK
12. Albuquerque, NM
13. Tucson, AZ
14. Norfolk, VA
15. Newark, NJ
16. Boston, MA
17. Denver, CO
18. Pittsburgh, PA
19. Bakersfield, CA
20. Wichita, KS
21. Dayton, OH
22. Kansas City, MO
23. New York, NY
  24. Philadelphia, PA
  25. Baltimore, MD

26. Providence, RI
27. St. Louis, MO
28. Greater Cincinnati, OH
29. Cleveland, OH
30. Fresno, CA
31. Tulsa, OK
32. Miami, FL
33. San Antonio, TX
34. Charlotte, NC
35. Sacramento, CA
36. Colorado Springs, CO
37. Boise, ID
38. Detroit, MI
39. Orlando, FL,
40. Louisville, KY
41. Memphis, TN
42. Allentown, PA
43. Hartford, CN
44. Austin, TX
45. Raleigh, NC
46. Tampa, FL
47. Pueblo, CO
48. Springfield, MO
49. Akron, OH
50. Knoxville, TN

Why these cities:

Your environment plays a big role in how comfortable your eyes feel.  Sometimes this can even mean moving to a new house.  I’ve recently seen a patient who really started suffering more since moving because of the quality of air and also the change in the heat source between his old and new home.

  • Temperatures– Extreme temps, both hot  and cold can cause significant irritation to your eye.  Perfect example: my eyes water on a cold winter day!
  • Humidity– Areas with little to no humidity causes a lot of discomfort if you’ve been diagnosed with dry eye. A humidifier will help the situation.  I encourage my patients to use one in the bedroom while sleeping and they notice improvement in comfort in the am.
  • Wind– Wind will dry the surface of the eye very quickly usually resulting in tearing/watery eyes.
  • Altitude– Higher altitudes have lower amount of oxygen resulting in dry eye.
  • Pollutants– Pollutants like smoke, smog, and exhaust fumes are irritating to the eyes.

Other contributing factors for dry eyes:

  • Ocular allergens– a dry eye is more suseptable to allergens because they stick to the surface more and sometimes are not flushed from the eye as well.  Itching is also mistakened as allergy but is a very common symptom for dry eye.
  • Indoor air quality– This can be relieved with the help of an air purifier.
  • Contact lenses– Most people with dry eyes refuse to wear contacts because of the irritation of having something in their eye is too much to handle.  Proteins more easily build up on the lenses.  A great cleaning system- Clear Care– a good first step in getting rid of these proteins.
  • Medications–  High blood pressure medications, antidepressants, heart medications, antihistamines, decongestants, muscle relaxants, sleeping pills, pain relievers and drugs for Parkinson’s disease and gastric ulcers, and hormone therapy, particularly estrogen therapy can often make your dry eye symptoms worse.
  • Computer use– Sitting in front of the computer for extended periods of time, whether it’s for work or leisure, can dry your eyes out. People using the computer too much forget to blink, and the less you blink the dryer your eyes become.  Good rule of thumb is to take a short (2-3 sec) break for every 20-30 min spent on the computer during your work day.

 

 

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Adherence to glaucoma treatments

Dr. O’Dell spends most of her time diagnosing and treating dry eye disease.  But she is also a Fellow of the American Academy of Optometry in ocular disease and has extensive training in the field of glaucoma.

Recently, she teamed up  with Dr. Alan Robin, a well known glacoma specialist  to publish a research paper about adherence to glaucoma treatments.

Their work is very interesting, demonstrating that patients are not as loyal to treatments as we think, even with sight threatening diseases.  If this is the case image how non-compliant you might be to non-sight threatening treatments such as your dry eye treatment.  How many are guilty of waiting days between the dosing of your artificial tear or only using them when symptommatic?

Click the link for the full article.

http://www.dovepress.com/articles.php?article_id=9090

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“I know I don’t have dry eyes, they water all of the time”

I can’t tell you how many times I hear this from my patients.  It’s a hard thing to explain but in reality a dry eye will water excessively and here’s why!

1. Our eyes need to be moist

  • Vision: In order to have your best vision the tear film must be uniform and evenly distributed across the front of the eye, the cornea.  If the any part of the tear film is inadequate, the result is dryness.  Think of this like having a film or haze on your windshield of your car, until you clean it off it really makes your view difficult.
  • Good Health: If our eyes are chronically dry it increases our risk for eye infections. Within our tears are cellular componets that help to fight off infection.  In severe dry eye the white of the eye, the conjunctiva ,as well as the cornea can become scared resulting in a permanent loss of vision.
  • Because keeping our eye moist is a big part of our vision, if the eye starts to become dry our bodies reflex mechanism is to ramp up the production of tears- this results in watering, sometimes the watering is so extreme that it runs out of the eye and down the cheeks like you are crying.

2. There could be excessive “skin” causing a chronic irritation to the eye surface.

  • There is a condition of the eye called “conjunctivochalasis” that can result in watering or tearing on a chronic basis.  This excess skin is a loosening of the conjunctival tissue and is a natural part of aging.  For my patients, I examine the eye closely for this especially when convential treatments are not giving any relief.  It can be treated by surgically removing the excess tissue.

 3. There could be a problem with how your body drains the tears.

  • In the nasal corner of both the upper and lower lid is a drainage tube called the punctum.  It gathers the tears and drains them through the nose.  If the punctum is narrowed or blocked the tears will not drain properly and will result is excessive watering. 

As you can tell, the eye is a very complex part of our body.  If you are having symptoms of watering you should contact your eye care provider for an evaluation.  Sometimes simple treatments will give you great relief!

For more about dry eye visit our website: www.mayeyecare.com

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Sjogren’s (SHOW-grins) Syndrome and Dry Eye Disease

Sjogren’s syndrome is a disorder of your immune system often defined by its two most common symptoms — dry eyes and a dry mouth.  It often accompanies other autoimmune disorders, such as rheumatoid arthritis and lupus. In Sjogren’s syndrome, the mucous membranes and moisture-secreting glands of your eyes and mouth are usually affected first — resulting in decreased production of tears and saliva.

Because it the symptoms can often just be dry eyes, it is important for you to be aware of this condition and ask your eye doctor if and when testing is appropriate for Sjogren’s Syndrome.

Although you can develop Sjogren’s syndrome at any age, most people are older than 40 at the time of diagnosis. The condition is much more common in women. Treatment focuses on relieving symptoms, which often subside with time.

Symptoms vary from person to person but may include:

  • a dry, gritty or burning sensation in the eyes
  • dry mouth
  • difficulty talking, chewing or swallowing
  • a sore or cracked tongue
  • dry or burning throat
  • dry or peeling lips
  • a change in taste or smell
  • increased dental decay
  • joint pain
  • vaginal and skin dryness
  • digestive problems
  • dry nose
  • fatigue

When to ask your eye doctor if testing is needed…As a rule of thumb for eye care providers, blood-work for looking for Sjogren’s Syndrome should be ordered if a patient has 1)experienced dry eye symptoms for >3 months, 2) has foreign body sensation in the eyes or 3) has low tear production (schirmer score of <5mm- this is  test done in the office that easily measures your tear production) and 4) used artificial tears >3 x a day.

For more information visit this website www.sjogrens.org

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Is it time for your next eye exam?

Statement from Paul A. Sieving, M.D., Ph.D., Director of the National Eye Institute, National Institutes of Health, during Healthy Vision Month, May 2010

During the eighth annual Healthy Vision Month observance this May, the National Eye Institute (NEI), part of the National Institutes of Health, encourages community organizations and the American people to make vision health a priority. This year’s theme, “Your Eyes are the Windows to Your Health,” highlights the importance of scheduling an eye exam to maintain good quality eye health and preserve the sense of sight.

In a 2005 national survey conducted by NEI and the Lions Clubs International Foundation, 70 percent of adults reported that the loss of eyesight would have a great impact on their daily lives—a 10 on a scale of 1 to 10. However, 26 percent reported they had not had an eye exam within the previous two years, and 9 percent reported never having had their eyes examined.

Unfortunately, an estimated 14 million Americans are visually impaired. In fact, the prevalence of myopia, or nearsightedness, was shown to have increased 66 percent in the past 30 years, according to a 2009 NEI study. About 11 million Americans have refractive errors—common vision problems such as nearsightedness, farsightedness, astigmatism, and presbyopia—that can be detected during an eye examination and simply remedied with glasses or contact lenses.

Americans can also become visually impaired or blind from eye diseases. Of adults age 40 or older in the United States, more than 2 million have glaucoma, more than 4 million have diabetic retinopathy, and more than 1.75 million have age-related macular degeneration. These numbers will continue to increase as the population ages. These and other eye diseases have few warning signs or symptoms but can be detected in their early stages through a comprehensive dilated eye examination. Early diagnosis is critical, as vision loss and blindness may be prevented through timely treatment.

During a comprehensive dilated eye exam, the pupils are dilated with eye drops so an eye care professional can examine the back of the eye to detect signs of eye conditions such as diabetic retinopathy, glaucoma, or retinal detachment. Refractive errors can also be detected during a comprehensive eye exam.

NEI is committed to educating the public about vision and eye health. NEI’s National Eye Health Education Program has developed a wide variety of resources and materials that can be used during Healthy Vision Month and throughout the year. Visit the NEI Healthy Eyes Toolkit at www.nei.nih.gov/healthyeyestoolkit to find free resources that can be used to educate the public about the importance of eye exams. The toolkit includes e-cards, text messages, fact sheets, drop-in news articles, web links, posters, stickers, bookmarks, public service announcements, and more.

For more information about Healthy Vision Month, visithttp://healthyvision2010.nei.nih.gov/hvm.

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