There isn’t a week that goes by that an eye doctor doesn’t get a call from a patient saying, “There’s blood on my eye!”  While this can have a rather frightening appearance, it is usually quite benign. Most of the time someone else notices the blood red appearance on the eye first. Some patients may complain of mild irritation along with what looks to be blood on the sclera (the white part of the eye), although the majority of patients usually have no symptoms at all.

 The cause of the redness is exactly what it looks like—a broken blood vessel on the surface of the eye is hemorrhaging and blocking the view of the sclera.  This is what is known as a subconjunctival hemorrhage.  It may be the result of coughing or straining too hard, hypertension (high blood pressure), trauma, taking blood thinners (i.e. coumadin, aspirin, or vitamin E), or a bleeding disorder.  Laughing or sneezing too hard, being constipated, vomiting, or lifting too much weight can also cause a blood vessel to break.

If a patient has a history of recurring subconjunctival hemorrhages over a short period of time, the eye doctor will order blood work to determine if the patient has some type of bleeding disorder.  This is rarely necessary.

While no treatment is required for this type of hemorrhage to resolve, artificial tear drops have proven beneficial for relieving any mild to moderate discomfort associated with the condition.  A cold compress applied to the affected eye twice daily for ten minutes can also be helpful.  In addition, any elective use of aspirin or vitamin E should be discontinued for 3-4 days to help with resolution of the hemorrhage.  Patients who have been prescribed blood thinners should check with the prescribing doctor prior to discontinuing any medications on their own.

Subconjunctival hemorrhages usually clear on their own within 7-10 days.  Larger hemorrhages may take several weeks to clear.  Patients should let their eye doctor know if the blood does not clear completely, or if the condition repeats itself, as blood work may be necessary.

For many years we have heard from all the experts that smoking and drinking are bad for your health.  Most everyone has come to accept this as fact and decided on their own accord if they want to maintain those habits even if they are harmful to their well being.

When we see commercials or read newspaper articles we have been told smoking will always affect your lungs, throat, teeth and several other body parts.  When you have heard of alcohol abuse you hear liver, kidneys and brain as the parts of the body that are most effected.  Have you ever really heard of the either of these effecting your eyes?  I am going to guess probably not.  It is a simple fact that goes unnoticed most of the time because your eyes may not be affected most by smoking or drinking.  This is however something that does need to be talked about because our ability to see is definitely one of our most precious of gifts.

The list of eye disorders that can be accentuated by smoking include cataracts, macular degeneration and dry eyes.  Diseases that smoking could increase the affects on your eyes would be vascular disease, thyroid eye disease and optic neuropathy.

Everyone develops cataracts as they age, it is a natural process in your eyes, however when you smoke the antioxidants in your eyes are reduced which could cause the cataracts to develop earlier in life and much more dense (thicker cataract) there by effecting your eyes even more.  Macular degeneration is the leading cause of blindness and people who smoke are four times more likely to develop the disorder than those who do not.  This is a disorder that you certainly do not want to have to deal with.  If you have a vascular or thyroid disease smoking will increase the risks that are associated with those diseases which could ultimately affect your eyes.  For example if you have vascular disease and smoke the hardening of your arteries may contribute to the optic nerve not receiving enough blood flow which could cause significant vision loss.

Drinking in moderation will probably not have a major effect on your eyes and in some cases drinking a moderate amount of wine could lower the risk of macular degeneration. If you choose to drink excessively then the effects could greatly affect your vision.  Unlike smoking where specific disorders could develop, drinking alcohol excessively will affect the performance of your eyes.  Slow pupil reaction, decreased peripheral vision and decreased contrast sensitivity are among the most common performance issues.  Although these performance issues may not affect you through out your normal daily activities when you drive they could have a profound effect.

Any “habit” that you may have which you may feel will have a negative effect on your body and health needs to be researched because you may know off hand what the core effects are however there are multiple other affects that could be endangering your body and especially your vision.

Shingles, also known as the herpes zoster virus, is simply a reactivation of the virus that caused your chicken pox earlier in life.  The virus lies dormant in the spinal nerve cells and can be reactivated years later when the immune system is challenged or suppressed by fatigue, physical/emotional trauma, serious illness, or certain medications. 20%-30% of the population will be affected by shingles at some point in their lifetime.

The first symptom most patients notice is a tingling or pain similar to having a sun burn on one side of the face or body.  Painful skin blisters begin to appear several days later, also on one side of the face or body.  This skin rash is typically found on the chest, abdomen, back, or face, although it can also affect the neck, limbs, and lower back as well.  The blisters, or eruptions, are very painful, itchy, and tender. If the face becomes involved, eye pain, red eye, headache, fever, or fatigue may precede the rash.   After 1-2 weeks the blisters   begin to heal and form scabs; however, the pain often continues.

When the rash affects the face, it usually affects one side of the forehead and scalp, does not cross the midline of the face, and involves only the upper eyelid.  About 10%-20% of the population will have this presentation at some point.  Upon exam, the eye doctor will evaluate both the surface of the eye as well as the optic nerve and retina looking for any signs of viral involvement in those tissues.  The doctor will also check the pressure in the eye at that time.

After the infection has run its course, some patients will develop a deep pain known as post-herpetic neuralgia that can continue for months and sometimes years.  This is more common in the elderly.

The incidence of shingles increases with age.  Over 50% of cases develop in patients older than 60.  In patients younger than 40, a medical evaluation should be conducted to determine whether the patient may be immunocompromised. Shingles usually only occurs once, although it may recur in some cases.

The treatment for shingles consists of taking an oral antiviral agent such as acyclovir, usually several times a day for a week to ten days.  Treatment will shorten the duration and severity of the illness, but will not necessarily prevent postherpetic neuralgia.  If the condition is severe, the patient may need to be hospitalized on this medication for 5-10 days.  An antibiotic ointment is prescribed to keep the skin eruptions from becoming infected, and warm compresses are usually applied to the skin about three times a day to keep the area clean.  If the eye is involved, we usually recommend artificial tears 3-4 times a day to keep it as comfortable as possible.  Topical steroid eye drops are occasionally helpful as well.

There is a vaccine (Zostavax) designed to help prevent shingles.  It is recommended for persons 60 years old or older, whether or not the patient reported a prior episode of shingles.  Unless a contraindication exists, patients with chronic medical conditions may also be vaccinated. . The vaccine may also be administered with all other live or inactivated vaccines, including those for influenza and pneumococcal vaccines. The vaccine should not be administered to those who are allergic to gelatin, neomycin, or any other component of the vaccine, those with a history of a primary or acquired immunodeficiency state (i.e. leukemia, lymphoma, etc.), those who are receiving immunosuppressive therapy, or those who are or may be pregnant.

In a clinical trial involving more than 38,000 adults 60 years of age or older, the vaccine reduced the overall incidence of shingles by 51% and the incidence of neuralgia by 67%.  The effectiveness of the vaccine was higher in the younger age group (60-69 years) at 64% than the older age group (older than 70) at 38%.  Side effects of the vaccine included redness at the site of injection, pain, and swelling.  No vaccine-related deaths were reported.

Acetominophen with or without codeine is sometimes required during the first two weeks as pain from post-herpetic neuralgia can be severe. In addition, depression can be quite common during the initial phase of infection, so an antidepressant may be prescribed. Antidepressants have been found to also help with postherpetic neuralgia as well.

Shingles is contagious for children and adults who have not had chicken pox, and can be spread by inhalation.  Pregnant women who have not had chicken pox must exercise extreme caution in avoiding contact with a shingles patient.

We all sometimes have seemingly minor symptoms that we rationalize away. We tell ourselves “oh that’s nothing” or “it’ll get better by itself”. Flashing lights is one of those symptoms that may seem unimportant but may be significant. I will address some of the more common causes.

Flashing lights usually lasts only a matter of seconds and happens only occasionally. Both of these characteristics can lull us into ignoring it. There are several significant processes that can cause this. Vitreous separation is probably the most common.  The large cavity of the eye is filled with a jelly like substance called vitreous. When we are born it is attached to the back surface of the eye, the retina. As we age the vitreous shrinks. So at some point it has to separate from the retina. This can irritate the retina and cause flashing lights. It can also result in floating spots in our vision. This is because the vitreous surface that was against the retina is now floating in the center of the eye casting a shadow. Most of the time (99+%) this does not cause a problem. Rarely the vitreous separation can tear a hole in the retina which can lead to a retinal detachment, a very serious condition. Unfortunately a retinal tear cannot be diagnosed by symptoms only. An exam is the only way to tell. So, the only way to insure that a tear has not developed is to have an exam as soon as possible following the onset of flashes or floaters.

Other conditions that can cause flashing lights are blood vessel narrowing to the eye or area in brain controlling vision. This usually occurs over age 60 and can be a precursor to stroke. A carotid ultrasound can diagnose blood vessel narrowing due to hardening of the arteries (atherosclerosis). Sometimes the narrowing might be due to an inflammatory condition called Giant Cell Arteritis. This is more rare but potentially devastating and usually requires blood tests and possibly a biopsy to diagnose.

Another cause of flashing lights could be migraine headaches. This is a less serious but still annoying condition. Most migraine sufferers begin having symptoms between teenage and mid twenties. Since the onset is rarer in older people the new onset of symptoms after age 40 should be tested to make sure one of the more serious cause of flashing lights is not the cause.

So don’t just ignore those flashing lights. It is worth getting an eye exam to make sure there is nothing serious going on that may cause not only vision problems but general health concerns as well

Many children cause disruptions in class, do not pay attention during lessons and drop out of school early, leaving parents and teachers wondering why.  The answer in some cases may be an undiagnosed vision problem, which can contribute to poor school performance and delinquency.

National studies show that 20-25% of more than 39 million children are at risk to suffer from undetected vision problems.  Children’s eyes are one of the most basic tools they use for learning.  Impaired vision in children can seriously affect learning abilities and contribute to the development of behavior problems, such as attention deficit disorder. Children with vision problems are often not even aware of their difficulty, nor do they complain or seek help.  They have no point of reference when they’re young, and assume everyone sees as they do. Early discovery and treatment can prevent many of these problems.

Parents are often unsure about when a child should have their first eye exam.  Findings from a study conducted by the Southern College of Optometry in March of 2008 showed that of the 36% of children who had never had an eye exam by the age of five, 91% of their parents stated that they had passed the vision screening conducted by the child’s pediatrician.  In their minds, their child had no visual issue.  About 20% of these same children failed the comprehensive screening conducted by the Southern College of Optometry faculty.  Parents need to realize that the vast number of school and pediatric vision screenings do not test the child’s vision up close, they only test the child at distance.  This reflects the erroneous premise that if a child can see the board at school, then they must not have a vision problem.  Nothing could be further from the truth.

Vision screenings are offered by many schools, and while they represent a positive effort to discover those students suffering from a vision problem, they also miss 30-40% of binocular vision disorders in children.  Binocular vision disorders represent problems with both eyes working together.  Children with these types of problems have no difficulty passing a vision screening.  They can often see 20/20 at distance with each eye individually; however, when using both eyes at near distances (i.e. reading) they may have a problem converging (pulling their eyes in) or accommodating (keeping things in focus at near).  If a child cannot look at something up close without discomfort, they won’t!  Unfortunately, these children are all too often mislabeled as “problem” children because they can’t seem to stay focused in the classroom.  Between 60-80% of my pediatric patients taking attention deficit/hyperactivity disorder medications have been diagnosed with binocular vision disorders, all of which are successfully treated with either vision therapy or glasses.  This is not to say, of course, that some children do not need these behavioral medications, but it is critical to have their eyes examined first.

If there is a family history of vision problems, the first exam should occur around the age of 6 months.  Not every eye doctor offers this type of pediatric examination, so be sure to check with the office when making the appointment to be sure that your doctor is comfortable with this.  If there is no family history of eye problems, the child’s first eye exam should occur around the age of three, and yearly thereafter.  Many parents assume that little can be accomplished through the course of an examination at this age; however, this is not the case.  Much critical information can be easily determined, even in babies.

A common visual disorder known as amblyopia (lazy eye) is an example of an ocular problem that can only be prevented if the underlying cause is diagnosed and treated early. The two main causes of amblyopia are 1) one eye being more farsighted than the other (the child will be unaware of this since they will see as well as the “good” eye sees) and 2) one eye being turned in or out relative to the other eye.  Family members will often notice this second cause of amblyopia, but there is no way for them to detect the first cause of amblyopia without taking the child for an eye examination.

Only one eye is affected in amblyopia, and sadly, these children are often not brought in to see the eye doctor until they become aware that they see poorly out of one eye.  If the child is older than 9 or 10, there is very little that can be done to improve their vision beyond what it already is.  Most people with amblyopia function well in life, however, their depth perception is less than what it should be, and may restrict their choice of occupation later in life.

If a child with amblyopia is brought into the eye doctor’s office by the age of 3 or 4, the central nervous system can be stimulated to improve their visual development until they are about 9 or 10 years old.  This is done through prescription of eyeglasses to fully correct each eye, and through patching of the good eye to “force” the brain to use the “weaker” eye more.  This stimulates the specialized vision cells in the brain to develop properly.  Every patient with amblyopia is unique, so the duration, frequency, and outcome of patching therapy will vary.

In addition to checking a child’s visual acuity and eye muscle coordination, a pediatric examination will also include an examination of their overall eye health.  Children are susceptible to many of the same ocular diseases as adults, although at a much lower rate.

Vision is the process of obtaining meaning from what is seen.  It is more than clearness of sight.  Good vision encompasses the ability to use the eyes for extended periods of time without discomfort, to analyze and interpret information, and to respond to what is being seen.  Good vision involves normal binocular vision, accommodation (focusing at near), ocular motility, and vision information processing skills, which allow us to respond to our surroundings.

Just about every parent makes sure that their child has their first dental exam before entering kindergarten.  Make sure to have their eyes examined by an optometrist as well.  After all, this is how they learn.

The affects of vitamin D on the human body has been studied since the 1930’s however research is continuously being performed all over the world.  Studies are now looking at the ability of vitamin D to help combat the effects of aging in your eyes.

The most recent issue of Neurobiology of Ageing reports that a study at the Institute of Ophthalmology at University College London has found some promising outcomes with their research.  Although they are still in the stages where they are working with animals they have found some inspiring results.

Without becoming technical on the findings, the researchers found two main areas in which vitamin D showed promise in helping prevent the aging process in your eyes.  The first area they found promise was that the vitamin D helped in the reduction of potentially damaging cells (macrophages).  These cells have been linked to inflammation which is something that we are all aware that we do not want to have taking place in our eyes.  The second area of encouragement the researches saw was a decrease in the amount of  toxic molecule (amyloid beta) deposits.  The deposits of this molecule will collect in your system as you age.

Together these findings are very encouraging because when these two factors come together they are the main cause for age related macular degeneration (AMD).  As you may or may not be aware AMD is the leading cause of blindness for people over the age of 50.

With information from studies such as this showing encouraging results from vitamin D and the effects in could have on your vision your next question may be where are the best sources for vitamin D?  Well you can achieve your Daily Value by more than just your diet although that is a good place to start.

Pure Cod liver oil is one of the best sources of vitamin D. However, if that sounds like something more than you would like to try you can also enjoy a piece of salmon, mackerel or even tuna fish. Milk can be a good source of vitamin D just make sure it is fortified with the vitamin if you would like to use that as one your sources.

Another great source of vitamin D is the Sun.  When you are out in the sun UV rays trigger vitamin D production in your skin.  Now there are several factors that will affect the amount of vitamin D your skin will produce based on your geography.  For those of us in the sunshine state it is much easier to attain the 10-15 minutes needed for ample vitamin D production.  For those of you in a colder climate or a city where there may be more pollution the time may be a little longer.  If you are wearing a sunscreen over an SPF of 8 it will block the UV rays from triggering the production of vitamin D.

If you are not a fan of eating fish or being out in the sun you can always find vitamin D supplements. With some simple research on the internet you can find the Recommended Daily Intake for vitamin D.

Periodic testing by your doctor will help you ensure that your vitamin D levels are consistent to where they need to be.

With encouraging findings from researchers and a relatively simple way to acquire the necessary vitamin D that your body need we hope that you attain these levels required and give yourself the best chance for combating the effects of aging in your eyes.

Approximately two million Americans have been diagnosed with Glaucoma , and another 2 million have it but are unaware of their condition. Glaucoma is a chronic degenerative optic neuropathy considered to be the most common neurodegenerative disease in the world. As nerve damage progresses, the patient’s side vision begins to fail. T  here are no early warning signs with this disease. Glaucoma progresses slowly and the visual fields of each eye overlap significantly; therefore early field defects are hidden from the patient.  Patients with early symptoms may notice that parts of a page are missing; however, the classic symptom of “tunnel vision” only occurs when both visual fields are severely damaged.  Central visual acuity is preserved until the late stages of the disease.  This is why some patients may retain good vision and unknowingly be on the verge of blindness at the same time.  Glaucoma can be detected easily through a dilated eye examination with vision loss being preventable in the majority of cases.

According to the September, 2009 issue of Primary Care Optometry News, the most efficient way to detect primary open-angle glaucoma may be by screening first-degree relatives with the disease.  Screening of high risk groups may yield better results for detecting glaucoma than by screening the population in general.  Patients with family histories of glaucoma should be evaluated for this condition on a yearly basis, as up to 26% of these patients will have glaucoma compared with only 6% of patients who have no family history of this disease.

The most common type of glaucoma, primary open angle glaucoma, represents 60%-70% of patients with the disease.  These patients have a higher than normal intraocular pressure, and the eye doctor may note thinning of the optic nerve rim upon examination.  Bleeding within the nerve fiber layer may be seen, as well as an absence of nerve fiber within the retinal tissue.  Visual field defects may be observed on visual field examination.

Normal pressure glaucoma represents 30%-40% of patients and does NOT present with a high intraocular pressure.  This type of glaucoma is not as obvious on initial examination since an abnormal pressure reading is not observed.  The doctor will still note thinning of the optic nerve, visual field abnormality, or both.

Your eye doctor must determine the appropriate treatment for each individual case because not all three elements of increased intraocular pressure, optic nerve damage, and visual field loss may be present in every case.  Treatment is based on the patient’s overall physical health.  Your eye doctor has to consider the amount of damage already present, the apparent rate of damage progression, and the estimated life expectancy of the patient.  The goal of treatment is to at least maintain the patient’s health.  Optic nerve damage must be stopped without causing other health problems for the patient.  The only proven method of halting or slowing optic nerve damage is by reducing the intraocular pressure, preferably by about 30% to have the best outcome.

Three main treatment options exist for reducing intraocular pressure in glaucoma:  medications, laser treatment, and filtration surgery.  For many patients, medications are the first-line therapy used, although laser treatment (specifically SLT) is now considered to be just as safe and efficacious as glaucoma drops.  More advanced surgical techniques are reserved for intraocular pressure uncontrolled by other methods.

Patients need to be reexamined about three weeks after starting a new medication to determine its efficacy.  Once the intraocular pressure has been adequately reduced, the doctor will reevaluate the patient every 3-6 months depending on the severity of the disease to ensure the treatment continues to work.

Those with a high risk for glaucoma  should undergo a comprehensive dilated eye examination on a yearly basis.  This high risk group consists of blacks over 40; everyone older than 60, especially Mexican-Americans; and those with a family history of glaucoma (as mentioned previously).  Other risk factors for glaucoma include high blood pressure, age, and near-sightedness.  If a patient has had a previous history of high intraocular pressure or chronic steroid use, they may be at a higher risk for the disease.  Medical conditions also associated with glaucoma include asthma, congestive heart failure, heart block, renal stones, and allergies.

Technological advancements in Ophthalmology continue to amaze me even after 25 years in practice.  In the past few years there has been an explosion in new intraocular lenses (IOL) available.  These allow patients to experience better vision and more eyeglass independence.

A cataract is a clouding of the natural occurring focusing lens of the eye.  In order to remove the cloudiness the entire lens must be removed.  Therefore a method to replace the focusing ability of the eye is required.  The most common method is the IOL.  In the past the only style available was one that corrected the major focusing power.  It could not correct astigmatism, reading vision or other optical aberrations of the eye. We now have IOLs that can do all of these things. However it is still not possible to do all of them at once.  We expect an IOL available within the next year or so that will be able to correct all three of these errors.

Astigmatism is a focusing error in the eye that traditionally has been corrected with glasses or contact lenses.  It is a condition where instead of the eye being round like a basketball it is oblong like a football.  This creates two axes of focus and requires a special toric lens to correct it.  As mentioned earlier there is now an IOL with toric surfaces to correct astigmatism.  When a patient receives this IOL they usually do not require glasses for distance vision.

As everyone over forty knows at that age they begin to need reading glasses. There are currently several choices available to obtain useful reading vision without glasses following cataract surgery.  The method familiar to many contact lens patients called Monovision corrects one eye for distance and one eye for near.  Many people have been using this method successfully prior to cataract surgery and are good candidates to do it with IOLs.  The only difference is that it is permanent with IOLs unless further surgery is performed.  A variation on this method involves correcting the near eye for intermediate vision instead of near vision. We have found that this is better tolerated by most people.  It does not create as much of a disparity between the two eyes and allows better depth perception than full Monovision.  These patients might not be able to go fulltime without glasses.  They may need to wear them to drive at night and for prolonged reading.  However, in our digital society they can usually see their cell phones and computers and function approximately 75-80% of the time without glasses.

Another method to correct reading vision is multifocal IOLs.  These implants allow distance, intermediate and reading vision in each eye.  They work by creating multiple zones of vision.  Another method is the accommodating IOL.  It works buy purportedly changing shape with focusing effort.  As mentioned earlier neither of these IOLs are available with astigmatism correction.  However the multifocal IOL with a toric surface is in FDA studies and may be available within a year.

In addition to the focusing problems I have already discussed there are additional aberrations inherent in every optical system.  They are less significant but nonetheless can degrade image quality.  None of the so-called Higher Order Aberrations have previously been correctable with glasses, contact lenses or IOLs.  Recently aspheric IOLs have become available which can correct the next most significant aberration, called spherical aberration.  Without getting into an overly boring and technical discussion of optics these IOLs can provide better image quality and enhance vision.

At Eye Specialists of Mid-Florida we are offering all of these IOL choices to our patients in an effort to provide them with the best vision possible after cataract surgery as well as the lifestyle convenience of less dependence on glasses or contact lenses.

In order to determine which IOL is appropriate for each patient we use advanced equipment to perform individual measurements and do a thorough history and physical exam including a lifestyle questionnaire.  We have been impressed with the results these new IOLs provide and look forward to advancing our practice as technology continues to improve.

Dry eye syndrome is a multifactorial ocular disease that is poorly understood by most people. This condition is noted by discomfort, visual disturbance, and tear film instability, with possible damage to the surface of the eye. Left untreated, dry eye syndrome is usually progressive in nature.  An estimated 14%-30% of people in the U.S. are believed to have dry eye syndrome.  Women are affected twice as often as men, and the disease appears to be more common in those 45 years of age and older.  Those with diabetes or immunocompromised conditions also have a higher incidence of dry eye syndrome.  Patients with arthritis, smokers, contact lens wearers, and those who have undergone hormone replacement therapy (in particular, estrogen) are more likely to suffer with this condition.

Reduced levels of sex hormones, especially androgen, are considered to be a major component in the pathophysiology of dry eye syndrome.  Decreasing hormone levels with age appear to be the “breaking poing” at which women, in particular, begin to suffer from the effects of dry eyes.

Various environmental factors affect dry eye syndrome.  Visual tasks such as computer use, reading, or watching T.V. will exacerbate symptoms.  The amount of time spent reading or watching T.V. is directly correlated to the severity of a dry eye condition.  One’s blink rate decreases during activities, such as driving or reading.  Patients also need to be aware of the location of air conditioner vents, ceiling fan placement, exhaust fumes, and smoke in their environment, as all of these can worsen the effects of dry eye syndrome. Low humidity will also intensify the symptoms of dry eye. Dry eye syndrome is the most frequently reported complaint after having LASIK done, and there is evidence to suggest that regression of vision correction after LASIK may be due to chronic dry eye.

Systemic medications including antihistamines, blood pressure medications, thyroid medications, antianxiety medications, antidepressants, diuretics, and hormone replacement therapy aggravate dry eyes.  Drinking alcohol or living in a dry, arid locale are other risk factors.

The tear film that coats the eye is composed of three layers:  a lipid layer, an aquaeous (water) layer, and a mucous layer.  If any of these becomes unstable, the result will be a dry eye.  Symptoms of dry eye syndrome include sensitivity to light, foreign-body sensation, red eye, burning, excess tearing, or sharp, stabbing pain.  Amazingly, some patients present with no symptoms, but have obvious superficial corneal damage on examination.  This is why you cannot treat dry eye syndrome effectively based on how you feel.  By the time you begin experiencing any of the above symptoms, you have usually been unacceptably dry for quite some time.  Once diagnosed, you must faithfully treat your condition whether you have symptoms or not.  Just as with dry skin, you don’t cure it, you manage it with daily therapy.

Tearing, as mentioned before, is a common complaint in patients with dry eyes, and also a source of confusion in this syndrome.  It simply represents a protective reflex in the ocular system. Your eyes will reflexively “water” on a dry windy day and this is the same reflex that kicks in when your eyes naturally become to dry.  If a patient complains of tearing as their primary symptom, chances are that their eyes are “screaming” for lubrication.

There are many uncontrollable dietary, environmental, and genetic factors that make it more difficult to determine the impact of diet specifically on dry eye syndrome.  It is important to remember that a single nutrient cannot prevent or treat any ocular condition; however, a balanced diet may preserve a patient’s visual acuity as well as improve their ocular comfort.

Recent research indicates that an increased intake of poly-unsaturated fatty acids (PUFAs) can slow or prevent the progression of dry eye, among other ocular conditions.  There are two types of PUFAs:  omega-3 and omega-6.  Both are responsible for regulating metabolism, stimulating skin and hair growth, and maintaining healthy bones and vision.  Fried and processed foods are high in omega-6 while foods such as fatty fish are high in omega-3.  A healthy ratio is recommended to be two to five omega-6’s to every one omega-3.  In our culture, it’s often as high as 10:1 to 25:1.

Therapeutic approaches for mild to moderate symptoms include artificial tears, use of hypoallergenic products, patient counseling, and increased water intake.  In cases of moderate to severe symptoms including superficial corneal damage, treatment may include gels, topical immunosuppressive medications, topical steroids, unpreserved tears, nutritional support (i.e. flaxseed oil supplements), and ointments.  Severe dry eye syndrome may require oral tetracycline and/or punctal plugs.  Punctal plugs are simply tiny devices placed within the nasal opening of the eyelid to prevent what little lubrication the eye is producing from draining out of the eye as quickly.  Topical and systemic PUFAs are being investigated for treating/preventing dry eye.  Patients presenting with severe symptoms and severe corneal damage may require oral immunosuppressive medications, surgery, punctual cautery, moisture goggles, or oral anti-inflammatory medications. Contact lens wear should be discouraged for those patients with severe dry eye syndrome.

Patients usually need to be followed every few weeks, depending on the severity of the symptoms, until an effective management plan can take effect.  Those with an underlying chronic systemic disease (i.e. rheumatoid arthritis or sarcoidosis) may need to be monitored more closely. These patients seem to struggle more with dry eyes than those that aren’t immunosuppressed.