March 5, 2025 • 39 mins
Unlock the secrets to managing dry eye syndrome more effectively with our latest podcast episode hosted by Dr. Holly Thacker. We promise you'll gain invaluable insights into cutting-edge treatments, including treatment for tackling Demodex mites that often go unnoticed and can be a main cause of dry eyes.
Explore the crucial role omega-3 fatty acids play in alleviating dry eyes and learn how to incorporate these essential nutrients into your diet for better eye health.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Becker,the Executive Director of
National Speaking of Women'sHealth, and I'm back in the
Sunflower House for somewhat ofa new episode.
Our faithful listeners mayrecall that in Season one I did
(00:25):
a very important podcast calledDry Eye Symptoms, causes and how
to Get Relief.
Dry eyes is such a commonproblem, especially amongst
midlife women and there's atleast 20 million people in the
United States women and there'sat least 20 million people in
(00:49):
the United States and it seemsto be frequently notoriously
underdiagnosed and undertreated.
And since that original episodeplayed and now that we're into
season three, there have beenseveral updates in the medical
and ophthalmic world on dry eyesand potential treatments.
So we're going to first talkabout mites, demodex mites.
(01:15):
Recently, the FDA approved atreatment called Exdemvi and if
you follow our news releases andhighlights on
speakinginwomenshealthcom orfollow us on social media, like
on Facebook or Instagram, youmay have seen this release and
(01:37):
it's the first and only FDAapproved treatment.
It directly targets demodexmites, which is the root cause
of demodex blepharitis, anddemodex blepharitis impacts one
in every 12 adults and it'scommon, but it's often
(02:00):
misdiagnosed or it'sunderdiagnosed as an eyelid
disease that's caused by aninfestation of demodex mites and
this is the most commonectoparasite that is found on
human skin.
And these demodex mites arenocturnal.
(02:23):
They come out at night to eatand mate and lay their eggs and
I know this sounds so gross, butit's true Expel their waste
products on your eyelids andalso in the glands of your
eyelids, which are called themebobian glands, which are
(02:47):
called the mebobian glands.
This, combined with the debrisof their bodies once they die,
causes significant inflammationand mechanical damage.
So it's not necessarily aproblem to have an occasional
demodex mite on your skin or inyour eyelash follicles, because
in small numbers they're commonand benign and they generally
don't cause harm.
(03:08):
I mean, we live with multiplebacteria and fungi in our skin,
our mouth, our gut, and so it'snot surprising that there are
some mites that are along forthe ride.
But if you have an overgrowthand a significant amount of
(03:28):
these mites, they can eithercause or make worse, exacerbate
dry eyes, styes, calasians,blepharitis, mebobian gland
dysfunction, ocular rosaceaa androsacea of the face.
That's thought to be one of thecauses of rosacea of the face
(03:54):
and we've done a podcast onrosacea now.
An infestation of these demodexmites unfortunately can cause
irreparable damage to youreyelashes, eyelids and mebobian
glands if not treated, andthat's why we want to reprise
(04:14):
this episode about dry eyes withthe exciting news of new
treatment for a relativelycommon cause of dry eyes, and
why you need to be empowered tobe strong, be healthy and be in
charge when you're seeing youreye physician, be that your
(04:34):
ophthalmologist, who's usually aMD, or a doctor of osteopathy
or an optometrist and if you'reseeing someone in urgent care or
primary care, they may or maynot feel comfortable evaluating
and treating this.
I also want to talk aboutomega-3s.
(04:56):
I've done columns on omega-3fats.
Basically, the guidelines areit's much better to get it in
food than just takingsupplements, but not everyone
can get enough omega-3 in theirdiet.
We have a great list onspeakingwomenshealthcom of
(05:18):
omega-3 rich foods like pound orounce for ounce.
Mackerel is one of the highestones.
Salmon is an excellent sourceof omega-3s, which isn't
particularly high in purines ifyou tend to run higher uric
acids or gout, many differenttypes of fatty fishes, sardines,
(05:42):
herring, anchovies, caviar, buteven non-fish eating people or
vegetarians.
There are plant-based sourcesof omega-3s, particularly
walnuts and flaxseed and chiaseeds.
There's some vegetables likespinach and Brussels sprouts.
(06:03):
Seaweed is another rich sourceand there are some studies it's
somewhat inconsistent thatomega-3 supplements may help dry
eyes and so high triglyceridesand dry eyes or other
inflammatory conditions that areworse in patients that have low
(06:26):
levels of omega-3, I think ispotentially reason enough to
consider supplementation if youcan't clean up your diet and you
want to get other heart healthyfats in your diet, like avocado
and olive oil diet, likeavocado and olive oil and meats
(06:50):
that are like grass fed orpasture raised chickens that lay
eggs that can have omega-3s.
You can read the labels whenyou're buying eggs.
I always try to look for theomega-3 eggs.
So because some studies andindividually some patients and
some ophthalmologists have foundthat in some people omega-3s,
by reducing inflammation andrestoring kind of a heart
(07:11):
healthy fat balance, can improvedry eyes.
Now, part of the problem withpeople not having enough omega-3
is having too much inflammatoryomega-6.
Some of these industriallyaltered so-called seed oils,
like corn oil and safflower oiland sunflower and palm and
(07:32):
rapeseed cottonseed these oilsare chemically altered and
increase inflammation and Ithink trying to get these things
out of your diet.
I have so many patients tell meoh, I don't ingest those.
And then you ask them?
Are you using regularmayonnaise, regular salad
dressings?
Do you go out to eat?
(07:52):
Because very few restaurantsare committed not to using seed
oils.
If you're eating a lot ofpre-processed foods, things that
have long shelf half-lives, ifyou read label you'll see that I
(08:12):
mean olive oil and coconut oiland avocado oil tend to be more
expensive and don't quite havethe same shelf half-life, and so
you don't see that as often mygranddaughter Artemis loves
popcorn and we don't always havetime to make it and so much of
the pre-made popcorn you knowhas extra sugar and artificial
(08:33):
colors and seed oils.
So I found a brand that doesn'thave any of that and they used
coconut oil.
I was so kind of curious totaste it and it tastes just
absolutely delicious.
I was so kind of curious totaste it and it tastes just
absolutely delicious.
It is more expensive andcertainly many times getting
better quality foods isunfortunately more expensive,
(08:54):
but with planning andorganization you can many times
do this for yourself and yourfamily.
So for my patients, if they havedry eyes and particularly if
there's other reasons toconsider omega-3 supplements, I
(09:14):
tell them that the researcherssay that the risks are limited,
but there can be an increasedrisk of bleeding linked to very
high doses of omega-3.
So usually we don't go morethan three grams a day and
anytime you swallow something todo something to make yourself
(09:36):
feel better, there is a strongbrain effect and placebo effect
and researchers have pointed outthat patients have to usually
take like several, like at leastthree large capsules a day to
get the recommended doses.
And this also includes havingcalories.
So if you're doing intermittentfasting, which I recommend for
(09:57):
so many of my patients, you takethese capsules when you are not
fasting and a lot of peopledon't like to burp fish oil.
That can be unpleasant.
Some of them have some lemon orlime added to kind of take that
fish down.
(10:18):
Some of the most practical waysto deal with dry eyes are
artificial tear lubricants.
So for a 30 day supply,depending on usage you're
talking about, you know, atleast $10.
Warm compresses, environmentalchanges, like having a good
humidifier, particularly in thewinter, um, if you're planning
(10:42):
on trying to take omega-3s fordry eyes and you've already been
evaluated and it isn't mightcausing your dry eyes, then I
think you should talk to yourclinician about doing this.
Other tear care if you havevery extremely dry eyes and
(11:08):
known Mabobian gland dysfunction, which is caused by dysfunction
of some of these really tinyglands that make up the oil
layer of tears, and this layeris one of three that keeps the
eye surface from drying out tooquick quickly, which is critical
, and if your mebobian glandsget clogged, you have less oil
(11:32):
naturally reaching the eyesurface and tears dry out too
quickly.
There is an FDA tear care,which is a procedure has to be
done in three months and itdoesn't negate the need for
(11:55):
drops or other medication, sothat is something that you might
want to look into.
There is some evidence that lackof androgens the more
masculinizing hormones thatmales and females have women
just have much less.
If you're low in that becauseof age, ovary removal, sometimes
(12:20):
higher doses of oral estrogencan drop down the androgen
levels, then you don't makequite as much natural oils, and
that can make dry eyes worse.
That's why, certainly, hormonaltherapy in general helps skin
dryness, vaginal dryness andskin elasticity.
(12:43):
But some women notice when theygo on oral hormone therapy that
they may have more dry eyes,and so sometimes I readjust
things or I check the adrenalhormones and testosterone.
None of this, you know.
Supplementation with androgensis FDA approved, though for dry
eyes, but I do mention it Now.
(13:04):
If you lose tears too quickly,it can make this chronic cycle
of inflammation, friction in theeyes and actual damage to the
ocular surface of the eye, andit can disrupt that very
intricate balance among the manyimportant layers of eye
function.
(13:24):
For some people it causesdryness, itching, stinging or
like there's some foreign bodyin the eye, or infection.
Studies have shown that Mebo,which is a prescription eye drop
, directly targets the excessivetear evaporation instead of
(13:47):
just tear formation, and forsome people this can be highly
effective.
The solution in it isperfluorohexaloctane and it's a
substance that's designed tomimic a key natural function
where the mebobian glandsproduce a lipid-rich secretion
(14:08):
that forms the tear layer andhelps maintain a healthy ocular
surface.
Now another solution calledTyravivie is varanacillin
solution, and this offersanother option for patients
(14:32):
whose eyes don't make enoughtears, and it's a nasal spray
that starts your own body toproduce its own natural tears,
and this solution works byactivating the glands and cells
connected to the nerves insideyour nose, and it's part of a
(14:53):
pathway for controlling tearfilm production and in some
cases it can help relieve thesymptoms for people who have not
had success with othertherapies.
There's also sometimesdifferent types of light
stimulation therapies that havebeen used, and there are other
(15:18):
things in investigation.
Because this is such a chronicproblem, it's very important to
take care of your special senses, and once you're over 50, you
really should be seeing an eyedoctor and having an exam at
least every one to two years,and certainly once you're over
60 to 65, yearly and so up.
(15:43):
Next is the dry eye podcast fromseason one, with all these
additions we've talked abouttoday, and I hope that you enjoy
listening to this episode,whether it's for the first time
or the second time, and thankyou so much for joining me in
the sunflower house and I'll seeyou next time.
(16:03):
Be strong, be healthy and be incharge.
Welcome to the Speaking ofWomen's Health podcast.
I'm your host, dr Holly Thacker, and I'm glad to be back in the
Sunflower House, and today'spodcast is on dry eyes.
(16:25):
In fact, I needed to put eyedrops in my eyes.
Just reading over the materialwas making my eyes dry.
It's such a common problem,especially amongst midlife
women's health, and a lot ofwhat I'm going to be discussing
is really nicely encapsulated bya terrific column on our
website, the nonprofitspeakingofwomenshealthcom, and
(16:49):
it was authored by one of ourgraduated specialty women's
health fellows who I hope to beable to recruit back to the
Cleveland Clinic, dr TiffanyCochran.
She's just a fabulous woman.
She's an internist and awomen's health specialist and
she is practicing internalmedicine and specialty women's
(17:11):
health and seeing patients rightnow at Port Royal Medical
Center in Port Royal, southCarolina.
She's originally from Alabamaand she is such a well-mannered
Southern lady and her patientsjust adored her.
She got her Bachelor of Sciencefrom Valdosa State University
(17:32):
and her Doctorate in Medicinefrom Morehouse School of
Medicine and she also has aMaster's of Arts in Healthcare
Administration and I really hopeto interview her live later in
the month on women's health,hormones, blood clots, dvts.
(17:55):
She authored an excellentchapter on this.
She's also authored chapters inosteoporosis and menopause.
So a couple of her columns Ithink we really need to
highlight, and one includes dryeyes.
Now, dry eye disease is a reallycommon reason for needing to
see an eye doctor, like anophthalmologist or even an
(18:15):
optometrist or even your generalphysician, because it can lead
to eye discomfort, lowereyesight and a reduced quality
of life, particularly for peopleover age 50.
And dry eyes affect over 350million people worldwide and
over 50% of all, perimenopausaland menopausal women experience
(18:36):
dry eyes, dry eyes, dry skin,dry mouth, dry vagina, and this
disease can impact the qualityof the tears, leading to overall
poor eye health.
And if you don't treat dry eyes, you can get a higher risk of
eye infections, abrasions,inflammation of the eye
(18:57):
structures, which can lead todamage to the cornea, the front
surface of the eye, and this canresult in eye pain, ulcers,
even permanent vision problems.
In fact, one of my girlfriendswho has this cute Boston Terrier
Napoleon Bonaparte is his nameand he's got a big personality
(19:18):
and he's a little dog heapparently was attacked by a pit
bulldog and got a corneal ulcerand was in danger of losing his
vision, and so they had to setan alarm clock around the clock
every four hours to put eyedrops and ointment to save the
dog's vision, and luckily he'smuch better.
So we all have to protectvision.
(19:41):
Your eyes are very important.
Any kind of trauma, infection,pain, drainage, foreign objects
need to be taken care of rightaway.
In fact, I remember my husbandtelling me oh, just go ahead and
treat your two-year-old sonEmerson, he's got another ear
(20:02):
infection.
No, let's not take him to thedoctor, you already know what is
and I'm like no, I'm not apediatrician, I think we really
should take him in and we allthought that he had an ear
infection.
He actually had a foreign bodyin his cornea that the
pediatrician astutely picked up.
So in children who aren't thatverbal or you know, can't
necessarily describe what'swrong with them also, including
(20:24):
pets or elderly people oranybody with any communication
skills you have to be alert tosymptoms that actually might be
from the eyes.
So, getting back to dry eyes,what are some of the causes?
Well, there's a lot ofdifferent factors that have been
elucidated.
Certainly, autoimmune diseasesare right up there and women
(20:46):
suffer from more autoimmuneconditions than men, and some
common autoimmune conditionsthat can cause dry eyes are
Sjogren's syndrome, rheumatoidarthritis, systemic lupus
erythematosus, which isinflammation of the blood
vessels from an overactiveimmune response.
Systemic sclerosis, also knownas scleroderma, and also people
(21:10):
that have primary biliarycirrhosis, which is autoimmune,
can also cause dry eyes.
Lots of medicines can cause dryeyes Antihistamine, beta
blockers, diuretics,antispasmodics like baclofen and
flexerol, used for musclecramps or muscle disorders,
bentil, used for irritable bowelsyndrome.
(21:32):
All of these can lead to driereyes.
Certainly, differentantidepressants, especially some
of the older ones, the NSRIs,like amitriptyline and
nortriptyline are notorious fordry eyes.
Vitamin deficiencies can alsotrigger dry eyes, as well as
contact lenses, seasonalallergies, lower humidity, high
(21:54):
windy areas, certain types ofoutdoor job exposures and, of
course, aging.
We kind of get drier as we getolder and have less fluids.
Now there's other reasons thatone can have dry eyes.
If there's something wrong withthe mebobian glands, and
(22:17):
anytime that the blink rate islowered, there can be drier eyes
, because when you blink youactually stimulate some movement
of tears, and it's thought thatperimenopausal and menopausal
women produce less androgens,which we know that they do just
with age, and women have muchless androgens than men, and
(22:40):
that can cause fewer secretionsfrom mebobian oil glands as well
as lacrimal tear glands in theeyes.
The mebobian glands produceessential oils for tears, and if
you have less oil in your eyes,you just have less tears.
Now estrogen plays a criticalrole and women can experience
(23:01):
dry eye symptoms at certaintimes of their monthly cycle.
Dry eyes can be a side effectof certain hormonal
contraceptives, especially ifthey lower the androgen levels.
Now rosacea is a commoncondition and we'll do another
podcast on rosacea and otherskin disorders that are so
common in women, but rosacea isa skin inflammatory disease that
(23:24):
can affect not just the face,the nose, but also the eye
anatomy, and serious eyeproblems can develop, even if
the rosacea on the skin ispretty mild.
So ocular rosacea is arelapsing inflammatory condition
of the eyes and its structuresand it often requires continued
(23:44):
treatment.
Now, remember this is notmedical advice.
We are just empowering you tobe strong, be healthy and be in
charge and understand commonconditions that might affect you
or your family members or yourfriends.
And rosacea is a frustratingskin condition and particularly
(24:04):
when it affects the mebobianglands and if there's scarring
of the opening of these glandorifices sometimes there's also
telangiectasias or dilation ofthe blood vessels the eyes can
become very irritated and dry.
And unfortunately, sometimesocular rosacea is overlooked
(24:25):
because people think the eyesymptoms are simply allergies or
problems from contact lenses orcontact lens solution.
So 50% of all people withrosacea will develop symptoms in
their eyes and when I seesomeone with rosacea who doesn't
have eye symptoms, I justremind them of that.
And really anyone over the ageof 50 should see an eye doctor
(24:47):
every year.
So what are dry eye risk factors?
Well, we told you, femalegender is certainly one, being
over the age of 50, having anykind of connective tissue
disease like Sjogren's orrheumatoid arthritis.
Use of contact lenses, whichare very popular.
Medications, including thediuretics, the antihistamines,
(25:10):
the antidepressants, as well asAccutane isotretinoin, which is
used to many times, give acnecures dramatically reduces oil
gland secretion.
People who've undergone bonemarrow transplant, any person
with lower testosterone levels,as well as, of course,
perimenopause and menopause.
(25:30):
Lower testosterone levels, aswell as, of course,
perimenopause and menopause.
I get a lot of calls frompatients saying oh, their eye
doctor said that you know theirhormone regimen is causing their
dry eyes and I think sometimesit's a little bit misinterpreted
.
Certainly, being low inhormones or having a hormone
imbalance may make thatpredisposition or condition
worse.
So what are some of the signsand the symptoms?
(25:50):
Well, swollen red eyes arecommon.
There can be bloodshot eyes andI think using things like
Visine, which just causevasoconstriction, aren't really
a good idea.
If there's pink eye, it can bea sign of a viral or bacterial
infection and you need to seekmedical attention.
There can be crusty eyelids oreyelashes.
(26:12):
In fact, my cat, my cuteelderly, almost 19 year old
ragdoll kitty cat, she, everymorning I would clean out her
crusty eyes and once I got myair filtration and duct system
cleaned in my house, my airfiltration and duct system
cleaned in my house.
She has no more crusty eyes, soreally good quality air that's
(26:35):
also humidified, and she likesto come into my bedroom and put
her little face and whiskersright in front of the humidifier
.
But, come to think of it, shereally doesn't do that behavior
now that we've cleaned out theair ducts.
Getting back to symptoms, therecan be burning, itching,
sensitivity to light, blurryeyes or feeling like there's a
(26:56):
gritty sensation or foreign bodyin the eye.
Anytime there's any recurrenteyelid infections, you need to
worry about these mebobianglands and the tear ducts.
So certainly, if you have thesesymptoms, talk to your primary
care physician.
You might need to see adermatologist or an
ophthalmologist.
(27:16):
So what are some of thetreatments?
Well, the main goal oftreatment for dry eyes focuses
on restoring the tear production, and so you might need to
approach it from multipledifferent ways.
Eye hygiene is very important.
Using a very soft like babywashcloth with maybe some baby
(27:37):
shampoo and warm water gentlywashing around the eyes, warm
compresses can help improve oiland tear production.
Keeping your eyelids clean andapplying a warm cloth or pad
several times a day may berecommended to keep the debris
away and the gland ducts open.
(27:59):
Be careful not to overexfoliate, though, because that
can really irritate the skin,and if you're in front of a
screen like many of us are infront of phones and computers
and electronic devices take somebreaks.
Blink frequently, because we doknow when people are on the
screen they don't blink as much,and blinking does improve tear
(28:21):
production.
Protect your eyes.
Wear sunglasses with UVAblocking to block harmful
sunlight.
Also, really dry, windyconditions can be hard on the
eyes and avoid triggers likepollen.
Listen to one of our priorpodcasts on allergies and
pollens and physical things youcan do to your home.
(28:43):
Try to avoid smoke.
Bad air quality In fact, I amrecording this at the end of
June of 2023, where many areasof the country have had
dangerous air conditions becauseof all the Canadian fires.
In fact, you know, on abeautiful day like today, the
(29:05):
kids in the summer camps wereinside because of the air
quality in the summer camps wereinside because of the air
quality.
Alcohol causes dehydration andmakes a lot of things worse Heat
, dry air, certain cosmetics youknow the eye doctors usually
recommend changing your eyecosmetics anytime there's any
eye irritation or infection andjust regularly getting new eye
(29:31):
makeup Again.
Considering that humidifier tomoisten the air around you I use
one year round Exercise, lightaerobic exercise might actually
improve tear production.
Many of my patients say theydon't have any dry eyes during
the day, when they're movingaround, but they get it at night
(29:52):
.
Certainly you should eathealthy foods, mediterranean
type diet rich in omega-3s, andavoid processed foods, sugary
foods and getting enough vitaminA, which is a real vitamin, as
opposed to vitamin D, which is apro-sterile hormone.
You can become toxic on vitaminA, so you need to avoid
(30:12):
anything more than twice theupper recommended daily
allowance, especially pregnantwomen.
But vitamin A is good for theeyes, so it's in foods like
carrots and pumpkins and squash,yellow and orange foods and
omega-3 foods, which we'll havean upcoming podcast on omega-3,.
(30:33):
They also help with tearproduction and some women find
that higher doses of omega-3really do help their dry eyes.
Now it's extra calories.
It can sometimes cause breastcysts and breast tenderness, so
I think you really should get aphysician's advice before doing
that.
(30:53):
Now there are manyover-the-counter lubricating eye
drops and ointments.
Artificial tears in the form ofdrops or even thicker ointments
can provide some relief for dryeyes.
They can maintain the moisturein the eyes, but in general they
can make ocular rosacea worse.
So again, you need to see yourphysician.
(31:14):
Generally, drops should not beused more than four to six times
per day because if you'reexposed to a lot of the
preservatives it can damage theeye surface and lead to
conjunctivitis.
Preservative-free artificialtears are less irritating to the
eye surface and can be usedmore frequently, and because
(31:34):
they don't have preservatives,they're usually like in single
application.
Autologous serum tears orplatelet-rich plasma can be a
treatment option because itcontains both anti-inflammatory
factors and growth factors thatcan help in treating dry eye
disease and support healing ofthe eye surface.
(31:57):
Now tetrahydrolizine, which Ihad mentioned earlier, the
vasoconstrictor that narrows theblood vessels, can lead to
rebound redness with chronic use, so in general I don't
recommend it.
Now there are some emulsionformulated eye drops that
replace oil to tear production,which can help reduce the
(32:20):
evaporation of just the liquidH2O water, and so these emulsion
formulated eye drops might be agreat choice for people who
have the blurry vision, andsometimes it actually improves
people blinking.
There are lubricating eye gelsand ointments.
(32:40):
Generally they're used at nightbecause they can cause blurry
vision.
Steroid eye drops.
Corticosteroid eyedropssometimes are prescribed but
they're only prescribedgenerally by ophthalmologists
because they can causedrug-induced glaucoma, which is
an increased pressure of the eye.
They can increase cataractformation, especially if they're
(33:04):
used for more than four weeks,so it should be restricted and
generally not routinely used.
Hormonal related dry eyetreatments it's a little bit
debatable about using systemichormone therapy because we don't
really have consistent results.
I think it's kind of individual.
Certainly there is some studiesin using androgen formulations
(33:32):
in patients showing someimprovement, so I think that's
something for us to watch in theliterature.
Some medications can reduceeyelid inflammation, including
antibiotics.
So sometimes antibiotics areused not to treat bacterial
infection but to actually reduceinflammation, and a common one
(33:55):
is doxycycline, which is atetracycline-based antibiotics
and it can be used daily for upto six weeks.
If someone is tetracyclineallergic, occasionally
erythromycin or azithromycin areused.
Certainly these antibiotics,especially doxycycline or any
tetracycline, cannot be used ina pregnant woman because it can
(34:16):
affect the developing baby'steeth.
There are otheranti-inflammatory prescription
treatments.
One of the first ones wasRestasis, which is topical
cyclosporine and that acts toincrease tear production due to
eye inflammation because itinhibits the activity of certain
inflammatory immune cells inthe lacrimal tear ducts and
(34:41):
glands.
Topical ivermectin, which is ananti-parasitic medicine and
cream, can be applied to rosacea, face and eyelids and
dramatically reducesinflammation.
Zydra is the brand name for thegeneric Lifidagrast, which is
an ophthalmic lymphocytefunction associated antigen one
(35:06):
antagonist, an LFA1 antagonist,and it's an eye drop that
reduces inflammatory cellbinding, meaning less eye
inflammation.
Some of my patients say itreally burns when they put it in
their eyes and so theyrefrigerate it to make it cooler
.
That can be more soothing.
I've had some patientsprescribe these expensive eye
drops who find that just bydoing humidification, getting
(35:28):
their hormone balance in order,doing the appropriate eye
hygiene and using thepreservative-free eye drops,
they're able to not needprescription medicine.
In terms of devices, there arescleral contact lenses that are
large, rigid lenses thatsometimes give a temporary
reserve for tears, or ophthalmicmedications that sometimes eye
(35:53):
doctors might prescribe.
There are proceduresoccasionally that might be
recommended.
Surgery might be recommendedfor people that have abnormal
eyelid anatomy or function,people who can't totally close
their eyes to protect the cornea, like people who have seventh
cranial nerve palsy, bell'spalsy.
(36:13):
Corneal transplants or graftsare possible for severe dry eye
disease, but again, that's notsomething that we normally do.
Occasionally a plug is placedin the lower lacrimal gland it's
either silicon or collagen toblock the tear ducts, because
(36:35):
the tears that are made stay inthe eye and it reduces the
drainage of tears to the back ofthe nose.
Now my oldest son, stetson whenhe was born he had blockage of
his corneal ducts and actuallyhad to have surgery because they
were hard like cardboard and healways looked like he was
(36:56):
crying.
And his daughter, artemis, mygranddaughter had the same
condition, but massage openedhers up and she didn't,
thankfully, need surgery.
So we sometimes do the reversefor older people who otherwise
are not responsive.
There's another therapy calledintense pulse light therapy that
(37:18):
might be considered as atreatment for dry eyes caused by
ocular rosacea, and thistreatment requires direct
application of light in variouswavelengths to the skin.
But this is pretty new.
We don't have a lot oflong-term research on the
effectiveness and safety oftherapy and certainly we do like
(37:38):
to have long-term data, butit's very irritating for people
with dry eyes.
I think you need to stay on topof it.
You need to talk to yourregular doctor, perhaps even a
dermatologist, or yourophthalmologist, if you're
suffering from any symptoms ofdry eyes, because we want eyes
(37:59):
that are comfortable andattractive and appropriately
moisturized with good vision,because that's part of us being
strong, being healthy and beingin charge.
So thanks so much for joining mein the Sunflower House.
I'm your host, dr Holly Thacker, the Executive Director of
(38:21):
National Speaking of Women'sHealth.
Please subscribe to our podcastif you don't already.
Anywhere you get podcasts,there's podcast apps on your
phone or computer.
It's free.
Hit the subscribe button, giveus a five star rating and we'll
see you back in the sunflowerhouse.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Becker,the Executive Director of
National Speaking of Women'sHealth, and I'm back in the
Sunflower House for somewhat ofa new episode.
Our faithful listeners mayrecall that in Season one I did
(00:25):
a very important podcast calledDry Eye Symptoms, causes and how
to Get Relief.
Dry eyes is such a commonproblem, especially amongst
midlife women and there's atleast 20 million people in the
United States women and there'sat least 20 million people in
(00:49):
the United States and it seemsto be frequently notoriously
underdiagnosed and undertreated.
And since that original episodeplayed and now that we're into
season three, there have beenseveral updates in the medical
and ophthalmic world on dry eyesand potential treatments.
So we're going to first talkabout mites, demodex mites.
(01:15):
Recently, the FDA approved atreatment called Exdemvi and if
you follow our news releases andhighlights on
speakinginwomenshealthcom orfollow us on social media, like
on Facebook or Instagram, youmay have seen this release and
(01:37):
it's the first and only FDAapproved treatment.
It directly targets demodexmites, which is the root cause
of demodex blepharitis, anddemodex blepharitis impacts one
in every 12 adults and it'scommon, but it's often
(02:00):
misdiagnosed or it'sunderdiagnosed as an eyelid
disease that's caused by aninfestation of demodex mites and
this is the most commonectoparasite that is found on
human skin.
And these demodex mites arenocturnal.
(02:23):
They come out at night to eatand mate and lay their eggs and
I know this sounds so gross, butit's true Expel their waste
products on your eyelids andalso in the glands of your
eyelids, which are called themebobian glands, which are
(02:47):
called the mebobian glands.
This, combined with the debrisof their bodies once they die,
causes significant inflammationand mechanical damage.
So it's not necessarily aproblem to have an occasional
demodex mite on your skin or inyour eyelash follicles, because
in small numbers they're commonand benign and they generally
don't cause harm.
(03:08):
I mean, we live with multiplebacteria and fungi in our skin,
our mouth, our gut, and so it'snot surprising that there are
some mites that are along forthe ride.
But if you have an overgrowthand a significant amount of
(03:28):
these mites, they can eithercause or make worse, exacerbate
dry eyes, styes, calasians,blepharitis, mebobian gland
dysfunction, ocular rosaceaa androsacea of the face.
That's thought to be one of thecauses of rosacea of the face
(03:54):
and we've done a podcast onrosacea now.
An infestation of these demodexmites unfortunately can cause
irreparable damage to youreyelashes, eyelids and mebobian
glands if not treated, andthat's why we want to reprise
(04:14):
this episode about dry eyes withthe exciting news of new
treatment for a relativelycommon cause of dry eyes, and
why you need to be empowered tobe strong, be healthy and be in
charge when you're seeing youreye physician, be that your
(04:34):
ophthalmologist, who's usually aMD, or a doctor of osteopathy
or an optometrist and if you'reseeing someone in urgent care or
primary care, they may or maynot feel comfortable evaluating
and treating this.
I also want to talk aboutomega-3s.
(04:56):
I've done columns on omega-3fats.
Basically, the guidelines areit's much better to get it in
food than just takingsupplements, but not everyone
can get enough omega-3 in theirdiet.
We have a great list onspeakingwomenshealthcom of
(05:18):
omega-3 rich foods like pound orounce for ounce.
Mackerel is one of the highestones.
Salmon is an excellent sourceof omega-3s, which isn't
particularly high in purines ifyou tend to run higher uric
acids or gout, many differenttypes of fatty fishes, sardines,
(05:42):
herring, anchovies, caviar, buteven non-fish eating people or
vegetarians.
There are plant-based sourcesof omega-3s, particularly
walnuts and flaxseed and chiaseeds.
There's some vegetables likespinach and Brussels sprouts.
(06:03):
Seaweed is another rich sourceand there are some studies it's
somewhat inconsistent thatomega-3 supplements may help dry
eyes and so high triglyceridesand dry eyes or other
inflammatory conditions that areworse in patients that have low
(06:26):
levels of omega-3, I think ispotentially reason enough to
consider supplementation if youcan't clean up your diet and you
want to get other heart healthyfats in your diet, like avocado
and olive oil diet, likeavocado and olive oil and meats
(06:50):
that are like grass fed orpasture raised chickens that lay
eggs that can have omega-3s.
You can read the labels whenyou're buying eggs.
I always try to look for theomega-3 eggs.
So because some studies andindividually some patients and
some ophthalmologists have foundthat in some people omega-3s,
by reducing inflammation andrestoring kind of a heart
(07:11):
healthy fat balance, can improvedry eyes.
Now, part of the problem withpeople not having enough omega-3
is having too much inflammatoryomega-6.
Some of these industriallyaltered so-called seed oils,
like corn oil and safflower oiland sunflower and palm and
(07:32):
rapeseed cottonseed these oilsare chemically altered and
increase inflammation and Ithink trying to get these things
out of your diet.
I have so many patients tell meoh, I don't ingest those.
And then you ask them?
Are you using regularmayonnaise, regular salad
dressings?
Do you go out to eat?
(07:52):
Because very few restaurantsare committed not to using seed
oils.
If you're eating a lot ofpre-processed foods, things that
have long shelf half-lives, ifyou read label you'll see that I
(08:12):
mean olive oil and coconut oiland avocado oil tend to be more
expensive and don't quite havethe same shelf half-life, and so
you don't see that as often mygranddaughter Artemis loves
popcorn and we don't always havetime to make it and so much of
the pre-made popcorn you knowhas extra sugar and artificial
(08:33):
colors and seed oils.
So I found a brand that doesn'thave any of that and they used
coconut oil.
I was so kind of curious totaste it and it tastes just
absolutely delicious.
I was so kind of curious totaste it and it tastes just
absolutely delicious.
It is more expensive andcertainly many times getting
better quality foods isunfortunately more expensive,
(08:54):
but with planning andorganization you can many times
do this for yourself and yourfamily.
So for my patients, if they havedry eyes and particularly if
there's other reasons toconsider omega-3 supplements, I
(09:14):
tell them that the researcherssay that the risks are limited,
but there can be an increasedrisk of bleeding linked to very
high doses of omega-3.
So usually we don't go morethan three grams a day and
anytime you swallow something todo something to make yourself
(09:36):
feel better, there is a strongbrain effect and placebo effect
and researchers have pointed outthat patients have to usually
take like several, like at leastthree large capsules a day to
get the recommended doses.
And this also includes havingcalories.
So if you're doing intermittentfasting, which I recommend for
(09:57):
so many of my patients, you takethese capsules when you are not
fasting and a lot of peopledon't like to burp fish oil.
That can be unpleasant.
Some of them have some lemon orlime added to kind of take that
fish down.
(10:18):
Some of the most practical waysto deal with dry eyes are
artificial tear lubricants.
So for a 30 day supply,depending on usage you're
talking about, you know, atleast $10.
Warm compresses, environmentalchanges, like having a good
humidifier, particularly in thewinter, um, if you're planning
(10:42):
on trying to take omega-3s fordry eyes and you've already been
evaluated and it isn't mightcausing your dry eyes, then I
think you should talk to yourclinician about doing this.
Other tear care if you havevery extremely dry eyes and
(11:08):
known Mabobian gland dysfunction, which is caused by dysfunction
of some of these really tinyglands that make up the oil
layer of tears, and this layeris one of three that keeps the
eye surface from drying out tooquick quickly, which is critical
, and if your mebobian glandsget clogged, you have less oil
(11:32):
naturally reaching the eyesurface and tears dry out too
quickly.
There is an FDA tear care,which is a procedure has to be
done in three months and itdoesn't negate the need for
(11:55):
drops or other medication, sothat is something that you might
want to look into.
There is some evidence that lackof androgens the more
masculinizing hormones thatmales and females have women
just have much less.
If you're low in that becauseof age, ovary removal, sometimes
(12:20):
higher doses of oral estrogencan drop down the androgen
levels, then you don't makequite as much natural oils, and
that can make dry eyes worse.
That's why, certainly, hormonaltherapy in general helps skin
dryness, vaginal dryness andskin elasticity.
(12:43):
But some women notice when theygo on oral hormone therapy that
they may have more dry eyes,and so sometimes I readjust
things or I check the adrenalhormones and testosterone.
None of this, you know.
Supplementation with androgensis FDA approved, though for dry
eyes, but I do mention it Now.
(13:04):
If you lose tears too quickly,it can make this chronic cycle
of inflammation, friction in theeyes and actual damage to the
ocular surface of the eye, andit can disrupt that very
intricate balance among the manyimportant layers of eye
function.
(13:24):
For some people it causesdryness, itching, stinging or
like there's some foreign bodyin the eye, or infection.
Studies have shown that Mebo,which is a prescription eye drop
, directly targets the excessivetear evaporation instead of
(13:47):
just tear formation, and forsome people this can be highly
effective.
The solution in it isperfluorohexaloctane and it's a
substance that's designed tomimic a key natural function
where the mebobian glandsproduce a lipid-rich secretion
(14:08):
that forms the tear layer andhelps maintain a healthy ocular
surface.
Now another solution calledTyravivie is varanacillin
solution, and this offersanother option for patients
(14:32):
whose eyes don't make enoughtears, and it's a nasal spray
that starts your own body toproduce its own natural tears,
and this solution works byactivating the glands and cells
connected to the nerves insideyour nose, and it's part of a
(14:53):
pathway for controlling tearfilm production and in some
cases it can help relieve thesymptoms for people who have not
had success with othertherapies.
There's also sometimesdifferent types of light
stimulation therapies that havebeen used, and there are other
(15:18):
things in investigation.
Because this is such a chronicproblem, it's very important to
take care of your special senses, and once you're over 50, you
really should be seeing an eyedoctor and having an exam at
least every one to two years,and certainly once you're over
60 to 65, yearly and so up.
(15:43):
Next is the dry eye podcast fromseason one, with all these
additions we've talked abouttoday, and I hope that you enjoy
listening to this episode,whether it's for the first time
or the second time, and thankyou so much for joining me in
the sunflower house and I'll seeyou next time.
(16:03):
Be strong, be healthy and be incharge.
Welcome to the Speaking ofWomen's Health podcast.
I'm your host, dr Holly Thacker, and I'm glad to be back in the
Sunflower House, and today'spodcast is on dry eyes.
(16:25):
In fact, I needed to put eyedrops in my eyes.
Just reading over the materialwas making my eyes dry.
It's such a common problem,especially amongst midlife
women's health, and a lot ofwhat I'm going to be discussing
is really nicely encapsulated bya terrific column on our
website, the nonprofitspeakingofwomenshealthcom, and
(16:49):
it was authored by one of ourgraduated specialty women's
health fellows who I hope to beable to recruit back to the
Cleveland Clinic, dr TiffanyCochran.
She's just a fabulous woman.
She's an internist and awomen's health specialist and
she is practicing internalmedicine and specialty women's
(17:11):
health and seeing patients rightnow at Port Royal Medical
Center in Port Royal, southCarolina.
She's originally from Alabamaand she is such a well-mannered
Southern lady and her patientsjust adored her.
She got her Bachelor of Sciencefrom Valdosa State University
(17:32):
and her Doctorate in Medicinefrom Morehouse School of
Medicine and she also has aMaster's of Arts in Healthcare
Administration and I really hopeto interview her live later in
the month on women's health,hormones, blood clots, dvts.
(17:55):
She authored an excellentchapter on this.
She's also authored chapters inosteoporosis and menopause.
So a couple of her columns Ithink we really need to
highlight, and one includes dryeyes.
Now, dry eye disease is a reallycommon reason for needing to
see an eye doctor, like anophthalmologist or even an
(18:15):
optometrist or even your generalphysician, because it can lead
to eye discomfort, lowereyesight and a reduced quality
of life, particularly for peopleover age 50.
And dry eyes affect over 350million people worldwide and
over 50% of all, perimenopausaland menopausal women experience
(18:36):
dry eyes, dry eyes, dry skin,dry mouth, dry vagina, and this
disease can impact the qualityof the tears, leading to overall
poor eye health.
And if you don't treat dry eyes, you can get a higher risk of
eye infections, abrasions,inflammation of the eye
(18:57):
structures, which can lead todamage to the cornea, the front
surface of the eye, and this canresult in eye pain, ulcers,
even permanent vision problems.
In fact, one of my girlfriendswho has this cute Boston Terrier
Napoleon Bonaparte is his nameand he's got a big personality
(19:18):
and he's a little dog heapparently was attacked by a pit
bulldog and got a corneal ulcerand was in danger of losing his
vision, and so they had to setan alarm clock around the clock
every four hours to put eyedrops and ointment to save the
dog's vision, and luckily he'smuch better.
So we all have to protectvision.
(19:41):
Your eyes are very important.
Any kind of trauma, infection,pain, drainage, foreign objects
need to be taken care of rightaway.
In fact, I remember my husbandtelling me oh, just go ahead and
treat your two-year-old sonEmerson, he's got another ear
(20:02):
infection.
No, let's not take him to thedoctor, you already know what is
and I'm like no, I'm not apediatrician, I think we really
should take him in and we allthought that he had an ear
infection.
He actually had a foreign bodyin his cornea that the
pediatrician astutely picked up.
So in children who aren't thatverbal or you know, can't
necessarily describe what'swrong with them also, including
(20:24):
pets or elderly people oranybody with any communication
skills you have to be alert tosymptoms that actually might be
from the eyes.
So, getting back to dry eyes,what are some of the causes?
Well, there's a lot ofdifferent factors that have been
elucidated.
Certainly, autoimmune diseasesare right up there and women
(20:46):
suffer from more autoimmuneconditions than men, and some
common autoimmune conditionsthat can cause dry eyes are
Sjogren's syndrome, rheumatoidarthritis, systemic lupus
erythematosus, which isinflammation of the blood
vessels from an overactiveimmune response.
Systemic sclerosis, also knownas scleroderma, and also people
(21:10):
that have primary biliarycirrhosis, which is autoimmune,
can also cause dry eyes.
Lots of medicines can cause dryeyes Antihistamine, beta
blockers, diuretics,antispasmodics like baclofen and
flexerol, used for musclecramps or muscle disorders,
bentil, used for irritable bowelsyndrome.
(21:32):
All of these can lead to driereyes.
Certainly, differentantidepressants, especially some
of the older ones, the NSRIs,like amitriptyline and
nortriptyline are notorious fordry eyes.
Vitamin deficiencies can alsotrigger dry eyes, as well as
contact lenses, seasonalallergies, lower humidity, high
(21:54):
windy areas, certain types ofoutdoor job exposures and, of
course, aging.
We kind of get drier as we getolder and have less fluids.
Now there's other reasons thatone can have dry eyes.
If there's something wrong withthe mebobian glands, and
(22:17):
anytime that the blink rate islowered, there can be drier eyes
, because when you blink youactually stimulate some movement
of tears, and it's thought thatperimenopausal and menopausal
women produce less androgens,which we know that they do just
with age, and women have muchless androgens than men, and
(22:40):
that can cause fewer secretionsfrom mebobian oil glands as well
as lacrimal tear glands in theeyes.
The mebobian glands produceessential oils for tears, and if
you have less oil in your eyes,you just have less tears.
Now estrogen plays a criticalrole and women can experience
(23:01):
dry eye symptoms at certaintimes of their monthly cycle.
Dry eyes can be a side effectof certain hormonal
contraceptives, especially ifthey lower the androgen levels.
Now rosacea is a commoncondition and we'll do another
podcast on rosacea and otherskin disorders that are so
common in women, but rosacea isa skin inflammatory disease that
(23:24):
can affect not just the face,the nose, but also the eye
anatomy, and serious eyeproblems can develop, even if
the rosacea on the skin ispretty mild.
So ocular rosacea is arelapsing inflammatory condition
of the eyes and its structuresand it often requires continued
(23:44):
treatment.
Now, remember this is notmedical advice.
We are just empowering you tobe strong, be healthy and be in
charge and understand commonconditions that might affect you
or your family members or yourfriends.
And rosacea is a frustratingskin condition and particularly
(24:04):
when it affects the mebobianglands and if there's scarring
of the opening of these glandorifices sometimes there's also
telangiectasias or dilation ofthe blood vessels the eyes can
become very irritated and dry.
And unfortunately, sometimesocular rosacea is overlooked
(24:25):
because people think the eyesymptoms are simply allergies or
problems from contact lenses orcontact lens solution.
So 50% of all people withrosacea will develop symptoms in
their eyes and when I seesomeone with rosacea who doesn't
have eye symptoms, I justremind them of that.
And really anyone over the ageof 50 should see an eye doctor
(24:47):
every year.
So what are dry eye risk factors?
Well, we told you, femalegender is certainly one, being
over the age of 50, having anykind of connective tissue
disease like Sjogren's orrheumatoid arthritis.
Use of contact lenses, whichare very popular.
Medications, including thediuretics, the antihistamines,
(25:10):
the antidepressants, as well asAccutane isotretinoin, which is
used to many times, give acnecures dramatically reduces oil
gland secretion.
People who've undergone bonemarrow transplant, any person
with lower testosterone levels,as well as, of course,
perimenopause and menopause.
(25:30):
Lower testosterone levels, aswell as, of course,
perimenopause and menopause.
I get a lot of calls frompatients saying oh, their eye
doctor said that you know theirhormone regimen is causing their
dry eyes and I think sometimesit's a little bit misinterpreted
.
Certainly, being low inhormones or having a hormone
imbalance may make thatpredisposition or condition
worse.
So what are some of the signsand the symptoms?
(25:50):
Well, swollen red eyes arecommon.
There can be bloodshot eyes andI think using things like
Visine, which just causevasoconstriction, aren't really
a good idea.
If there's pink eye, it can bea sign of a viral or bacterial
infection and you need to seekmedical attention.
There can be crusty eyelids oreyelashes.
(26:12):
In fact, my cat, my cuteelderly, almost 19 year old
ragdoll kitty cat, she, everymorning I would clean out her
crusty eyes and once I got myair filtration and duct system
cleaned in my house, my airfiltration and duct system
cleaned in my house.
She has no more crusty eyes, soreally good quality air that's
(26:35):
also humidified, and she likesto come into my bedroom and put
her little face and whiskersright in front of the humidifier
.
But, come to think of it, shereally doesn't do that behavior
now that we've cleaned out theair ducts.
Getting back to symptoms, therecan be burning, itching,
sensitivity to light, blurryeyes or feeling like there's a
(26:56):
gritty sensation or foreign bodyin the eye.
Anytime there's any recurrenteyelid infections, you need to
worry about these mebobianglands and the tear ducts.
So certainly, if you have thesesymptoms, talk to your primary
care physician.
You might need to see adermatologist or an
ophthalmologist.
(27:16):
So what are some of thetreatments?
Well, the main goal oftreatment for dry eyes focuses
on restoring the tear production, and so you might need to
approach it from multipledifferent ways.
Eye hygiene is very important.
Using a very soft like babywashcloth with maybe some baby
(27:37):
shampoo and warm water gentlywashing around the eyes, warm
compresses can help improve oiland tear production.
Keeping your eyelids clean andapplying a warm cloth or pad
several times a day may berecommended to keep the debris
away and the gland ducts open.
(27:59):
Be careful not to overexfoliate, though, because that
can really irritate the skin,and if you're in front of a
screen like many of us are infront of phones and computers
and electronic devices take somebreaks.
Blink frequently, because we doknow when people are on the
screen they don't blink as much,and blinking does improve tear
(28:21):
production.
Protect your eyes.
Wear sunglasses with UVAblocking to block harmful
sunlight.
Also, really dry, windyconditions can be hard on the
eyes and avoid triggers likepollen.
Listen to one of our priorpodcasts on allergies and
pollens and physical things youcan do to your home.
(28:43):
Try to avoid smoke.
Bad air quality In fact, I amrecording this at the end of
June of 2023, where many areasof the country have had
dangerous air conditions becauseof all the Canadian fires.
In fact, you know, on abeautiful day like today, the
(29:05):
kids in the summer camps wereinside because of the air
quality in the summer camps wereinside because of the air
quality.
Alcohol causes dehydration andmakes a lot of things worse Heat
, dry air, certain cosmetics youknow the eye doctors usually
recommend changing your eyecosmetics anytime there's any
eye irritation or infection andjust regularly getting new eye
(29:31):
makeup Again.
Considering that humidifier tomoisten the air around you I use
one year round Exercise, lightaerobic exercise might actually
improve tear production.
Many of my patients say theydon't have any dry eyes during
the day, when they're movingaround, but they get it at night
(29:52):
.
Certainly you should eathealthy foods, mediterranean
type diet rich in omega-3s, andavoid processed foods, sugary
foods and getting enough vitaminA, which is a real vitamin, as
opposed to vitamin D, which is apro-sterile hormone.
You can become toxic on vitaminA, so you need to avoid
(30:12):
anything more than twice theupper recommended daily
allowance, especially pregnantwomen.
But vitamin A is good for theeyes, so it's in foods like
carrots and pumpkins and squash,yellow and orange foods and
omega-3 foods, which we'll havean upcoming podcast on omega-3,.
(30:33):
They also help with tearproduction and some women find
that higher doses of omega-3really do help their dry eyes.
Now it's extra calories.
It can sometimes cause breastcysts and breast tenderness, so
I think you really should get aphysician's advice before doing
that.
(30:53):
Now there are manyover-the-counter lubricating eye
drops and ointments.
Artificial tears in the form ofdrops or even thicker ointments
can provide some relief for dryeyes.
They can maintain the moisturein the eyes, but in general they
can make ocular rosacea worse.
So again, you need to see yourphysician.
(31:14):
Generally, drops should not beused more than four to six times
per day because if you'reexposed to a lot of the
preservatives it can damage theeye surface and lead to
conjunctivitis.
Preservative-free artificialtears are less irritating to the
eye surface and can be usedmore frequently, and because
(31:34):
they don't have preservatives,they're usually like in single
application.
Autologous serum tears orplatelet-rich plasma can be a
treatment option because itcontains both anti-inflammatory
factors and growth factors thatcan help in treating dry eye
disease and support healing ofthe eye surface.
(31:57):
Now tetrahydrolizine, which Ihad mentioned earlier, the
vasoconstrictor that narrows theblood vessels, can lead to
rebound redness with chronic use, so in general I don't
recommend it.
Now there are some emulsionformulated eye drops that
replace oil to tear production,which can help reduce the
(32:20):
evaporation of just the liquidH2O water, and so these emulsion
formulated eye drops might be agreat choice for people who
have the blurry vision, andsometimes it actually improves
people blinking.
There are lubricating eye gelsand ointments.
(32:40):
Generally they're used at nightbecause they can cause blurry
vision.
Steroid eye drops.
Corticosteroid eyedropssometimes are prescribed but
they're only prescribedgenerally by ophthalmologists
because they can causedrug-induced glaucoma, which is
an increased pressure of the eye.
They can increase cataractformation, especially if they're
(33:04):
used for more than four weeks,so it should be restricted and
generally not routinely used.
Hormonal related dry eyetreatments it's a little bit
debatable about using systemichormone therapy because we don't
really have consistent results.
I think it's kind of individual.
Certainly there is some studiesin using androgen formulations
(33:32):
in patients showing someimprovement, so I think that's
something for us to watch in theliterature.
Some medications can reduceeyelid inflammation, including
antibiotics.
So sometimes antibiotics areused not to treat bacterial
infection but to actually reduceinflammation, and a common one
(33:55):
is doxycycline, which is atetracycline-based antibiotics
and it can be used daily for upto six weeks.
If someone is tetracyclineallergic, occasionally
erythromycin or azithromycin areused.
Certainly these antibiotics,especially doxycycline or any
tetracycline, cannot be used ina pregnant woman because it can
(34:16):
affect the developing baby'steeth.
There are otheranti-inflammatory prescription
treatments.
One of the first ones wasRestasis, which is topical
cyclosporine and that acts toincrease tear production due to
eye inflammation because itinhibits the activity of certain
inflammatory immune cells inthe lacrimal tear ducts and
(34:41):
glands.
Topical ivermectin, which is ananti-parasitic medicine and
cream, can be applied to rosacea, face and eyelids and
dramatically reducesinflammation.
Zydra is the brand name for thegeneric Lifidagrast, which is
an ophthalmic lymphocytefunction associated antigen one
(35:06):
antagonist, an LFA1 antagonist,and it's an eye drop that
reduces inflammatory cellbinding, meaning less eye
inflammation.
Some of my patients say itreally burns when they put it in
their eyes and so theyrefrigerate it to make it cooler
.
That can be more soothing.
I've had some patientsprescribe these expensive eye
drops who find that just bydoing humidification, getting
(35:28):
their hormone balance in order,doing the appropriate eye
hygiene and using thepreservative-free eye drops,
they're able to not needprescription medicine.
In terms of devices, there arescleral contact lenses that are
large, rigid lenses thatsometimes give a temporary
reserve for tears, or ophthalmicmedications that sometimes eye
(35:53):
doctors might prescribe.
There are proceduresoccasionally that might be
recommended.
Surgery might be recommendedfor people that have abnormal
eyelid anatomy or function,people who can't totally close
their eyes to protect the cornea, like people who have seventh
cranial nerve palsy, bell'spalsy.
(36:13):
Corneal transplants or graftsare possible for severe dry eye
disease, but again, that's notsomething that we normally do.
Occasionally a plug is placedin the lower lacrimal gland it's
either silicon or collagen toblock the tear ducts, because
(36:35):
the tears that are made stay inthe eye and it reduces the
drainage of tears to the back ofthe nose.
Now my oldest son, stetson whenhe was born he had blockage of
his corneal ducts and actuallyhad to have surgery because they
were hard like cardboard and healways looked like he was
(36:56):
crying.
And his daughter, artemis, mygranddaughter had the same
condition, but massage openedhers up and she didn't,
thankfully, need surgery.
So we sometimes do the reversefor older people who otherwise
are not responsive.
There's another therapy calledintense pulse light therapy that
(37:18):
might be considered as atreatment for dry eyes caused by
ocular rosacea, and thistreatment requires direct
application of light in variouswavelengths to the skin.
But this is pretty new.
We don't have a lot oflong-term research on the
effectiveness and safety oftherapy and certainly we do like
(37:38):
to have long-term data, butit's very irritating for people
with dry eyes.
I think you need to stay on topof it.
You need to talk to yourregular doctor, perhaps even a
dermatologist, or yourophthalmologist, if you're
suffering from any symptoms ofdry eyes, because we want eyes
(37:59):
that are comfortable andattractive and appropriately
moisturized with good vision,because that's part of us being
strong, being healthy and beingin charge.
So thanks so much for joining mein the Sunflower House.
I'm your host, dr Holly Thacker, the Executive Director of
(38:21):
National Speaking of Women'sHealth.
Please subscribe to our podcastif you don't already.
Anywhere you get podcasts,there's podcast apps on your
phone or computer.
It's free.
Hit the subscribe button, giveus a five star rating and we'll
see you back in the sunflowerhouse.
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