How you know if you have dry eye?
Here are some of the most common symptoms of Dry Eye reported by patients at our Seattle clinic:
~A gritty feeling in the eyes upon awakening, after lots of computer time, or at other times
~A sensation of having something in your eye, often with dryness, irritation, or discomfort
~Often, itch is an important component of the symptoms of dry eye disease
~Excessive tearing. Oddly enough, a tendency to over-produce tears is a common symptom of dryness
~Inability to wear contacts
~Vision that is intermittently blurry, or vision that changes significantly after blinks
Dry eye is a common condition. It’s also a chronic condition. This combination means that lots of people have it, and loads of patients have not yet been diagnosed or treated. In most cases it’s getting worse over time due to the chronic nature of the disease. Our goal at Cannon EyeCare is to do something about it. Let’s improve your eye health together.
The eye doctors at Cannon EyeCare are experienced optometrists and have lots of tools in their toolbox for managing dry eye disease. You can learn more about our dry eye treatment protocol later in this article. It’s worth noting that related terms like ocular surface disease, superficial keratitis, and meibomian gland disease are also sometimes used as if they are synonymous with ‘Dry Eye Disease’, but these terms are all describing different slices of the same monster. Dry Eye Disease is a good overall term that is worth discussing.
Our basic goal in managing dry eye disease at Cannon EyeCare is to get patients off of the slow, insidious decline into chronic dry eye disease as soon as possible. We want to give your body a fighting chance to heal itself. Our goal is to curb the inflammation and/or irritation that might be exacerbating your dry eye symptoms so that we can restore homeostasis. We strive to restore function to your ocular tissues so that they may heal themselves. Long-term, expensive medical (drug) therapy is our last resort. Typically expensive drug therapy is only utilized in our practice when our attempts to restore function to the eye have not done enough to control the symptoms and frustrations that come along with dry eye.
Some people may wonder, are there really dry eyes in Seattle, Washington? We are known for our rainy climate after all. Clearly that must mean we have less dry eye than arid places like New Mexico and Arizona, right? It turns out there are many important causative factors that determine dry eye risk, and they don’t all revolve around the weather. Things like climate, temperature, and relative humidity do play a role. Yet tens of thousands of patients in Washington have dry eye. Most of them are undiagnosed.
Dry Eye treatment in Seattle:
Yes, there are medicines that can be prescribed to help with Dry Eye Treatment. The downside is that these drugs are expensive and need to be used long-term. When the optometrists at Cannon EyeCare create a dry eye treatment plan at our Seattle clinic, our goal is to restore health to the eye, ideally without long-term drug therapy.
There are a number of different causative factors for dry eye disease. Our goal in managing dry eye is to restore function to the tissues that are effected. We want to get to the root of the problem, restoring function as we treat. We do not just throw artificial tears on a hot, irritated eye like some dry eye treatment centers in Seattle. Our approach is multi-faceted because ocular surface diseases such as dry eye syndrome are complex, with many variables at play.
Some of the major causes of dry eye are dehydration, incomplete blinks/ sleeping with lids slightly open, and clogged oil glands in the lids (aka Meibomian Glands). Other factors play a role for sure, but the major causes we see in clinic are
1. not having enough tears (often from dehydration)
2. having poor quality tears (typically from clogged meibomian glands), and
3. Exposure, wherein the ocular surfaces are desiccating as a result of incomplete blinks, infrequent blinks (very common in computer users), and sleeping with the eyes open or scarred lids that can’t close properly.
There has been billions of dollars spent on research and development of dry eye devices in recent years. One of the big players in this technology is LipiFlow. This company has devised a tool that scans the health of your tears and the meibomian glands in your lids called LipiScan. This imaging info can then inform doctors about which patients are a good candidate for treatment with LipiFlow, which is a rather expensive in office treatment of the lids. The treatment device costs tens of thousands of dollars, and each patient treated uses up hundreds of dollars of single-use equipment. So, as a result the treatment cost for Lipiflow is typically $1100 or more. Lots of local clinics are charging $1500 to have both eyes done one time.
Cannon EyeCare in Seattle does not have Lipiflow, nor do we intend to purchase one. We address the same issues (lid health and meibomian gland function) using a warm compress and lid massage protocol, as outlined below. We also have brought new technology called NuLids into our practice.
Doctor Cannon’s 2-step method to unclog the oil glands in your lids
Background info: A lot of people don’t realize that there are oil glands in their eyelids, but it turns out there are a bunch of them. We have about 50 per eye, and they come to the edge of the lids in a radial pattern, much like spokes in a wheel. They should be flowing really easily with an olive-oil like substance.
FYI, in medical lingo they are called ‘meibomian glands’ and the problem we are treating is called ‘meibomian gland dysfunction’ but that’s not really important.
If your doctor has prescribed this treatment, then in your case some or all of these glands are clogged with a stagnant, solid oil, kind of like butter or Crisco. As a result, there is not enough healthy oil in your tears. This lack of oil in the tears contributes to symptoms like dry eye, irritation, itch, and/or vision that blurs up a few seconds after you blink. Sometimes clogged glands in the lid can even get infected which causes a “stye,” also known as a hordeolum.
At this point many patients ask why their glands are clogged, which is a good question. It turns out that the eyelids are not quite 98.6 degrees F like the core of your body, which allows the oil to cool and solidify.
Now let’s discuss the treatment. Mark J. Cannon, O.D. of Cannon EyeCare in Seattle created this simple treatment to help his patients feel and see better by optimizing their ocular health.
Step 1: Hot Compress This will heat the lids up, to melt the oil in the glands. Grab a clean, dry washcloth and fold it once so that you have a rectangle in your hands. Then soak it with hot tap water, like hot shower water – in fact a lot of patients do the treatment in the shower. Do not use a kettle or microwave to heat the cloth due to the risk of thermal burns.
Hold the compress on both eyes for a minute or two (until it starts to cool off) then heat it up again and repeat. Heat it up again and repeat the compress several times until you get at least five minutes of heat on the eyes. If you have time to do 10 minutes, that is even better.
As a side note some patients prefer to use a therapeutic eye mask like the Bruder MediBeads. They stay hot enough to relax on the couch with the mask in place for up to 10 minutes. Due to the fact that a damp wash cloth with hot water will transfer heat more quickly, we generally ask patients to re-heat the Bruder Mask briefly after 5 minutes to get a full 10 minutes of heat treatment.
Step 2: Lid Massage You won’t get much benefit from the warm compress alone, as the oil would end up cooling off and staying put. Step two is crucially important, as it gets the (now liquefied) oil to flow. In this step you are going to be expressing the old, stagnant oil out of the glands. The meibomian glands open up right on the edge of the lid, near where the lashes pop out.
To get the oil flowing you will use the tip of your index finger kind of like a rolling pin. So it is a rotational movement of the wrist, with your index finger extended. Start out on the right upper lid (temporal side) with the pad of your right index finger resting about ½” (1cm) or more above the edge of the lid, then roll down towards the pupil all the way to the edge of the lid. Again, Dr. Cannon likes the rolling pin analogy to help you conceptualize the movement. It’s also useful to think of flattening a toothpaste tube to get the contents out.
It is important to use a substantial amount of force, but not enough to hurt. If you feel pain or your vision distorts, then you are pressing too hard. Do about three lid-rolls on each lid (on the temporal, central, and nasal sides). Always roll towards the pupil. That means when you are working on the lower lids you should roll up to the edge of the lid.
Most patients need the treatment twice a day for about two weeks, and some are asked to continue it once a day to maintain healthy gland function. Most patients report a significant improvement in ocular comfort and sometimes even improved vision, but this only happens if they do their homework. If the treatment is only done for a day or two and then it is discontinued, the patient is rather unlikely to notice any benefit.
Other key factors for treating dry eye include maintaining adequate hydration (2+ quarts of water /day) and using appropriate artificial tears as directed by your doctor. Some patients even need prescription drops, but your optometrist or ophthalmologist will be able to determine what is best for your eyes. Getting the lids to function optimally is a key first step.
©2017 Dr. Mark J. Cannon, OD, of Cannon EyeCare in Seattle, Washington