Interview: Top Ways To Diagnose & Treat Dry Eye with Dr. James Williams
Q: Can you describe the symptoms of dry eye and what a person is experiencing that would bring them to make an appointment with their optometrist? When should they come into the office to see you?
A: There are several things that can alert people to whether they have dry eyes or not; if a person walks outside into the wind and their eyes tend to water a lot, if they dislike when something blows in their face, if air conditioner is directed towards their eyes and they turn it away, or if they dislike ceiling fans then those are pretty good signs of dry eyes. Basically, a persistent bothersome awareness of how their eyes feel the majority of the time. Dryness can present in a myriad of ways, whether it is described as grittiness, a burning for some people, or an inability to tolerate contact lenses, it can be a major problem.
Q: Why should a person come in to see their optometrist for these issues? Why not just go and purchase some over the counter, artificial drops? Why is it important to come to the optometrist?
A: Over the counter drops are not permanent solutions. They’re just a quick fix and possibly make your eye feel better for 5-10 minutes. They don’t really correct any problems just offer temporary relief. It takes a fair amount of time to sit down and talk to somebody about their concerns. There may be 2 or 3 office visits, back and forth, and there’s some trial and error involved. It’s a long conversation and there’s some homework that patients need to do before results are seen. It is not an instantaneous fix in most instances as multiple reasons are the cause.
Q: When you diagnose someone with dry eye syndrome, what are the available treatments that you can offer in order to help them?
A: There are specific objective tests that can be performed to define a patients level of dryness, from the measurement of tear break up time, observation of blink patterns, tear assays measurement, lissamine green staining, evaluation of their lids and meibomian glands etc. To compound the problem patients subjective responses often do not correlate with the objective findings. In other words, patient’s responses do not match the level of dryness they experience. Their eyes have been dry so long; they no longer know what is “normal.” As far as treatments, there are non-preserved artificial tears and nutritional supplementation. I talk about environmental issues, drinking more water and decreasing excessive caffeine intake as well as smoking cessation. There is prescriptive medication, from steroid drops that can be temporarily used to quell more severe cases to Restasis which are drops used for the long term and promote increased tear production. We can also insert punctual plugs into the tear ducts to minimize the loss of valuable tears and mimic the natural state of a healthy eye. There are more solutions that can be tailored to individual situations. I also recommend visiting the website, www.dryeyezone.com.
Q: What does the fish oil do for them?
A: Fish oil has been found to help a percentage of people with dryness. In most cases it can take 4-6 weeks to see any benefit. It also requires a right concentration of fish oil. Not all fish oils are the same. I like the brand sold by Nordic Naturals. There are certain, specific cocktails of fish oil that have been devised that are based on peer reviewed medical studies. Fish oil is good for not only your eyes but in a multitude of systems.
Q: Are there certain risk factors that make someone more prone to having a dry eye problem?
A: Yes. As example, there are gender issues and a person’s age. The older females, post-menopausal women, they tend to have more complaints. Certain parts of the country with dry climates, Arizona and Texas, tend to aggravate. The lack of sleep, people who have fans blowing on their face as they sleep, medication side effects, smoking, computer users that blink improperly, and certain systemic diseases all are causes for dry eyes. Patients with Sjogren’s syndrome, have arthritic issues, dry eyes and dry mouth that can lead to major dental problems.
Q: What category is dry eye? Is it a disease? A condition?
A: Dry eye falls into a medical problem, so the visits can be filed under major medical insurance. So that’s another plus. It’s going to take listening and the proper time to tailor treatment. I prescribe steroid drops for 3-4 weeks to calm their subjective symptoms. I will prescribe Restasis at the same time. As stated earlier, I may recommend punctal plugs, nutritional supplementation, blinking exercises, lifestyle changes etc. I am honest, yet blunt, by telling them, if they’re not going to follow my directions, and really work hard then it is a waste of time. If a person’s has daily complaints, especially contact lens wearers, those are the most motivated. You know most people, when I diagnose dry eyes, are surprised that no one’s ever talked to them in such detail.
Q: That was all great. Any further comments or a take-home message that you’d like to give to patients?
A: Dry eyes can be controlled. You don’t have to accept the problem. A lot of times, they’ve been putting up with it for so long, they don’t even realize the degree of the problem, and sometimes they don’t even realize they have a problem. Sometimes you don’t know you’re happy till you’re sad. Patients are amazed when you work with them, and give them answers/treatment; they’re amazed at how much better their eyes feel. They’re less tired, their eyes aren’t red, they can work on the computer and they can wear their contacts longer. There are good websites I recommend, nordicnaturals.com and dryeyezone.com. Occasionally, I’ll give recommend sleep masks (tranquil eyes) they can wear at night, to seal their eyes so their eyes don’t dry out while they sleep for patients whose eyes don’t completely close.
Q: Fascinating that your eyes can dry out when your eyelids are closed.
A: Well, a lot of people’s eyes don’t close [all the way] at night. You ask people, when you wake up, are your eyes are always gritty and feel sandy? Do you have to put drops or blink excessively to get relief? I talk about how eating salty foods increases dry eye, nose and mouth in some people.
The bottom line is you can find answers and you can find relief because the problem is manageable, treatable and life can get better! If you're looking for treatment for dry eye syndrome or simply in need of an eye exam, contact Williams Eye Care. Thank You!