Tear duct plugs or
cauterization can be
considered in patients with
inadequate tear flow as
measured by the Schirmer
test, to help keep the ocular
surface more moist.
Source: Esen K. Akpek, M.D.

Meibomian gland dysfunction
leads to an evaporative type
of dry-eye syndrome. These
patients particularly complain
of pain, discomfort, and
burning. The symptoms are
usually out of proportion
with the signs.
Source: Esen K. Akpek, M.D.

You may have to overcome some questioning looks from patients when you explain dry eye to them.
“About half the patients come in and complain of excess tearing,” said Esen K. Akpek, M.D., associate professor of ophthalmology, and director, Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore. When she tells these teary patients they have dry eye, she gets some strange glances. She then explains that their irritation and inflammation causes the tearing.
In addition to this dry-eye contradiction, patients are not always happy that the condition potentially needs lifelong treatment.
“I tell them we can treat it and make it better, but we can’t cure it. They get upset at first but then understand it,” she said.
To make patient education easier, physicians that frequently treat dry eye share below how to best explain the condition and treatment to patients. The talking points come from Dr. Akpek; Roy S. Chuck, M.D., Ph.D., Tom Clancy professor of ophthalmology, director of refractive surgery, Wilmer Eye Institute; Robert L. Latkany, M.D., Dry Eye Clinic, New York Eye and Ear Infirmary, New York; Marguerite B. McDonald, M.D., F.A.C.S., clinical professor of ophthalmology, Tulane University, New Orleans; and George M. Salib, M.D., Los Angeles.

What is dry eye?

—Dry eye is a condition in which the normal moisture on the top of the eye is lacking in quality, quantity, or both.
—Your tearing is caused by irritation or inflammation on the ocular surface.
—As you grow older, you lose a certain percentage of your body water. The skin and the eyes dry up. Twenty percent of those age 70 or older have dry eye.
—Both men and women can have dry eye, but women are two times more likely to have it because of hormone changes. Estrogen can especially aggravate dry eye.
—You may have dry eye because you are perimenopausal, menopausal, or you have rheumatoid arthritis or Sjögren’s syndrome.
—More than 40% of Americans will experience dry-eye symptoms at some point in their life.
(Note: Dr. McDonald explains the cause of dry eye and how it is treated in an eight-minute video geared toward her patients. A technician places the patient in a room to watch the video after they are diagnosed with dry eye.)

Environmental changes

—Wind, airplane cabins, heating, and air conditioning can all make dry eye worse.
—To curb the effects of dry eye, wear sunglasses, eyeglasses, or a hat when you are outside.
—Do not leave your ceiling fan on at night.
—Light a match in the room you are in to check for a draft that may exacerbate your symptoms.
—If you are riding in a motorboat, ride behind the windshield to avoid excessive wind exposure.
—Remember to blink when you are reading, working on the computer, or doing any task that requires concentration. This refreshes the eye.
—Your dry-eye symptoms will usually feel worse in the winter if you live in a colder climate, because of exposure to indoor heating systems. Humid summers can lessen dry-eye symptoms, although air conditioning may affect them.
—Some patients that wear contact lenses and have severe dry eye may be advised to stop wearing them. However, it is often fine to resume contact-lens wear once the dry eye is under control.

Artificial tears and medications

—Artificial tears are safe and preferred by patients that do not want to take prescription medicine. You can use them up to three to four times a day as long as you need them.
—If your dry eye is moderate or severe and it is not treated, your inflammation can get worse, leading to permanent damage on your secretion glands. If this is the case, you will need more than artificial tears. You may need an anti-inflammatory medicine or steroids.
—Cyclosporine ophthalmic emulsion (Restasis, Allergan, Irvine, Calif.) is an anti-inflammatory medicine that will help improve your symptoms, help your eyes produce more healthy tears, and reduce your inflammation.
—Insert a drop of Restasis into the eye once in the morning and once in the evening.
—Restasis is not a quick fix; it can take a month or more before you will feel improvement from it.
—Store Restasis in a cool place such as the refrigerator. This will help avoid bacterial reproduction if you are reusing the vial.
—There is some anecdotal and research support for omega-3 acids improving dry eye. Some patients try omega-3 supplements to increase tear quantity and quality. Although this is not a cure for dry eye, you may notice an improvement within a few weeks if you use the supplements two to four times a day.
—Some patients have a type of dry eye that affects the quality of their tears. Massaging and cleansing your eyelids will help alleviate some of the symptoms caused by this form of dry eye.
—As dry eye can be chronic, you may need to use these treatments regularly or in spurts or for the rest of your life.

Punctal plugs

—There is a direct connection between the eyes, nose, and throat. The drain that connects these areas is one way tears can leave your eyes.
—There is not much we can do to stop the evaporation of tears, but we can block their drainage with something called punctal plugs.
—Two kinds of punctal plugs are available. One kind of punctal plug is temporary. If we insert this and it appears to help, we can insert the more permanent plastic plugs.

Editors’ note: Dr. Akpek is on the Speaker’s Bureau for Allergan (Irvine, Calif.) Dr. Chuck has affiliations with Allergan, Alcon (Fort Worth, Texas), and Ista (Irvine, Calif.). Dr. McDonald is a consultant for Allergan, Refractec (Irvine, Calif.), Santen (Napa, Calif.), and other companies. Drs. Latkany and Salib have no financial interests related to their comments.