People make an effort to hide their tears, while some offer to wipe others’ tears away. But for our eyes, a constant supply of tears is needed to see clearly and comfortably.
“Dry eyes are really common, especially as people get older. It’s one of the most common things we see in our office, and it’s often underdiagnosed or even misdiagnosed,” says Dr. Michael Donahoe, an ophthalmologist with Ophthalmology Consultants Ltd. The condition is caused by insufficient tear production or a problem with the quality of the tears, he says. Patients may complain of their eyes burning, stinging, or feeling generally tired or sore. Vision also may be blurry and require excessive blinking to clear.
“Many people suffer from blepharitis—or eyelid disease—which is also more prevalent as we age,” explains Dr. Karen Rosen of Rosen Optometry. “When blepharitis is present, the tear glands in the lids get clogged and don't produce the oily component of tears that prevent evaporation of the tears. This may be partially an effect from our modern diets that are rich in omega-6 fats and lacking in omega-3 fats. In addition, the excess bacteria from blepharitis tends to irritate the eyes.”
Donahoe agrees that omega-3 fatty acids, found in oily fish, flaxseed and walnuts, among other things, can help prevent dry eye when inflammation of the eyelid’s oil glands (blepharitis) is causing tears to lack the oily coating that helps prevent rapid evaporation. He recommends 1,000 milligrams of omega-3 fatty acids per day for patients who experience this problem.
Artificial tear supplementation is the first line of treatment if there is no significant eyelid disease. However, if that doesn’t relieve symptoms, a short course of topical steroids may be helpful to quickly reduce chronic inflammation. “Treating the eyelid disease is imperative,” Donahoe says. “Sometimes it’s as simple as applying warm compresses to the eyes to soften and liquify the oil. Sometimes we use a topical antibiotic ointment or an antibiotic/steroid combination.” Restasis is a prescription eye drop (topical cyclosporin) that fights surface inflammation, improves tear quality and increases tear production, although it takes at least a month to improve symptoms.
For patients who do not achieve relief with these treatments, a new approach recently became available. “LipiFlow was recently approved for use by the FDA as a medical device that treats evaporative dry eye by liquefying and evacuating obstructions in meibomian (oil) glands located in the eyelids,” says Dr. James Rieger, an optometrist with Pepose Vision Institute.
“LipiFlow works by applying heat and pressure directly to the inner eyelid area targeting the affected meibomian glands,” Rieger explains. “This clinically proven, painless treatment can be performed in-office and only takes 12 minutes per eye. After the treatment, the glands regain their lost function and maintain this relief for approximately one year.”
Donahoe, who also offers LipiFlow in his office, compares it to receiving a warm massage on each eyelid. He says the procedure is promising, but is not yet covered by insurance and may cost several hundred dollars per eye.