The first thing we think of when we have dry eye symptoms is hydrate the eyes. There are lots of artificial tears on the market. Some are good, and some not so good.

The key is to use a drop that is preservative-free. Preservatives are chemicals that can actually irritate the surface of the eye after the liquid drop evaporates. I always recommend Oasis tears because they provide optimal lubrication to maintain a healthy eye surface and alleviate dry eye symptoms. The vials come in two versions: regular and “plus” , which are just thicker and last longer for more effective relief; however, they may cause a bit of “oily” vision for a few minutes. Oasis makes a more economical version of the preservative-free artificial tears in a bottle, though it may be more challenging to squeeze out the drops.

If you feel you need to use an artificial tear more than once a week, you should have your eyes checked by an eye doctor to find out the cause of your dry eye symptoms. You may need a more complete treatment plan, as artificial tears provide temporary relief but do not treat the underlying condition. We often find that patients who have frequent symptoms need eyelid treatments such as hypochlorous spray, eyelid wipes, fish oil supplements , and possibly lid therapy or procedures such as miboflo, punctual plugs or lid debridement. Find out more about the procedures we perform here.

One of the causes of dry eye symptoms, eyelid redness and itching, is called blepharitis. This is a common eyelid disease that can worsen dry eyes. The cause can be an overgrowth of bacteria. We normally have bacteria in our eyelashes, but if they grow out of control, they can cause itching and redness. Another cause is skin conditions such as acne rosacea, atopic dermatitis, or eczema, all of which require topical treatment to improve. Then there are mites. I can see evidence of these critters using the biomicroscope in the office.

For all these conditions, the right eyelid wipe can help. Eyelid wipes are pre-moistened pads that remove debris and oils released from clogged eyelid glands as well as unwanted bacteria or hardened makeup around the eye lashes and skin. Dr. B prescribes I-lid & lash wipes by I-Med, which are available in regular (for most people), and with tea tree oil (a natural antimicrobial substance used for bacterial overgrowth). Scrub using the eyelid wipe over closed eyes side to side with your finger using gentle pressure for 5 seconds each. Use morning and night.

Tea tree oil is a natural antiseptic for certain organisms that cause eyelid irritation which can lead to dry eyes and styes. Eyelid wipes formulated with tea tree oil are effective at removing bacteria, debris and dandruff, yet not too strong to cause irritation. They also provide moisture and skin-firming hyaluronate to tighten eye wrinkles as an added plus.

Eyelid wipes aren’t just for eyelid mites. The tea tree oil and other ingredients in them keeps bacteria, fungus, and other microorganisms in check, as well as possessing inherent antiinflammatory properties. That’s why I recommend using an eyelid wipe daily for general eyelid hygiene, to remove make-up and hydrate the skin.

Home therapies and remedies are a key part of the success of a dry eye treatment plan, so you have to do your part for it to work well.  I prescribe foams, gels, and sprays as part of our dry eye treatment program.

Eyelid Foam

Instead of using harsh soaps or body wash, which can contain chemicals that irritate eyelids (the thinnest skin in the body), eyelid foams are gentle on eyelid skin and formulated to dissolve hardened oil build-up on your eyelashes and reduce bacterial overgrowth. Among those we prescribe are Zocular’s zocufoam, Ocusoft’s platinum foam, and Oust Demodex foam to use in conjunction with lid wipes by applying to the lid wipe or directly to your eyelids.

Hypochlorous Gel or Spray

Hypochlorous acid is an organic substance found in the body’s neutrophil cells. It is an antimicrobial agent and neutralizes bacteria, toxins, and inflammatory mediators in the body. It also works to prevent biofilm formation as well as deactivate problematic enzymes. I recommend Avenova antimicrobial spray or Oasis hypochlor spray, which may be applied to a lid wipe or index finger to spread across your lashes and left on or rinsed off.

You may feel better right away, or it may take a couple of months to get noticeable and lasting relief. Be persistent and follow through, and it will pay off.

Related Articles:

1. Dry  Eye Treatments Part 1: Artificial Tears
2. Dry Eye Treatments Part 2: Eyelid Wipes
3. Dry Eye Treatments Part 4: Fish Oil
4. Dry Eye Treatments Part 5: Moist Heat

Omega 3 fatty acids (fish oil) are a treatment we prescribe for dry eyes. The reason fish oils can help with dry eye symptoms is because our tears are made up of an oily layer that is produced by oil glands that line our eyelids (meibomian glands). Fish oil improves the stability of the oil layer of our tears, making the tears take longer to evaporate, so they stay in our eyes longer.

When the meibomian glands are inflamed (meibomitis) they don’t produce the oils needed to keep the eyes hydrated. The EPA in fish oil suppresses this inflammation, which dramatically reduces the gritty irritation you might have upon waking in the morning.

Most health organizations recommend a daily intake of at least 250–500 milligrams of combined EPA and DHA. Even if you absolutely love fish, you would be spending a lot of coin to get your recommended dose. Because most of us don’t consume that much, Dr. B recommends taking a high quality omega 3 supplement such as EZ Tears from Eye Promise. EZ tears by Eye Promise is a high quality omega 3 supplement that contains all the recommended ingredients: a high percentage of DHA and EPA as well as other anti-inflammatory factors (evening primrose oil, turmeric root extract, etc.) to reduce inflammation and improve dry eye symptoms. With a 30 day money-back guarantee, this is Dr. B’s top choice (read about how to avoid the fish burps

If you are vegetarian or not a fan of fish products, Algae Omega by Nordic Naturals is a good alternative to fish oil. Learn more about how fish oil helps the eyes.

Dry eye symptoms are often caused by an eyelid disease called Meibomitis or Blepharitis. The oil glands in your eyelids, called meibomian glands, can become inflamed due to a build up of hardened oils, dead skin, bacteria and make up, among other causes. These glands normally release oils into your eyes to prevent your tears from evaporating. With meibomitis, they get clogged and if left untreated over time, they can disappear permanently. This is why we need to treat it before it gets worse.

Dry Eyes Treatment : Hot Compress

Although there is no cure for dry eyes, there are remedies and treatments that will alleviate the symptoms and improve the condition to give relief. One of the treatments for dry eyes is applying heat over closed eyes which aids in opening the meibomian glands so the hardened oil can make its way out into the eyes. Using a face cloth with hot water can work, but it cools off after just 2 or 3 minutes and needs to be reheated frequently. Our dry eye treatment program at Advanced Vision Care and Dry eye Spa includes an Oasis heat mask  that you heat in the microwave for 20 seconds and it delivers moist heat for up to 15 minutes.

Do you remember what your cell phone was like 5 years ago? Nowadays we have so many reasons to keep staring at our computer or phone screens throughout the day, you might be wondering – is all this staring at our phones harmful to our eyes? This is a topic that seems to be evolving, and will continue to change as new research deepens our understanding of how the seemingly insatiable habit of gazing into digital screens can impact our health.

Up until recently, we thought long term exposure to the blue light emitted by digital devices could harm our eyes in a similar way that UV light from the sun can. It was thought that the constant bombardment of blue light from digital devices could damage the light-sensitive cells in the retina, thereby increasing our risk for a sight-threatening condition called macular degeneration. Thankfully, new research suggests our maculas are not at increased risk of the harmful degenerative disease. But there’s more to the negative impacts of digital screens than the question of macular damage. It affects our brains and dries out our eyes.

By staring at digital screens, we blink less, leading to the eyes drying out. When we blink, the oil glands that line our eyelids normally release small amounts of oil into the eyes with each blink. Since we blink less often – a LOT less often – when gazing into our screens, far less of the precious oils make it into our eyes. As a result, our tears evaporate, leaving the surface of our eyes dry and exposed to the air, which leads to chronic dry eye disease.

.Also, the blue light actually makes us over-focus, causing our eyes to work even harder and thereby causing eye fatigue, strain and tired eyes. This can even lead to chronic headaches. That’s why it’s good to give your eye muscles a break every 10 minutes or so and aim your gaze across the room or out the window. Looking at something in the distance allows your eyes to relax. At AVC we perform tests to measure how hard your eye muscles are working, and we can prescribe a glasses technology called Neurolenses to reduce eye strain, headaches and other related symptoms.

Another impact of staring at our screens is that blue light actually disrupts our sleep by suppressing the production of melatonin. Glasses can be treated with a blue light filter to reduce the amount of blue light that enters your eyes. The filter is transparent, so it doesn’t change the tint of the lenses in your glasses. Interestingly, transition lenses (also called photochromic lenses) also filter damaging blue light even when you’re indoors and the lenses appear clear.

Today I’m going to talk a little bit about the health of the retina, specifically the macula, which is responsible for central vision. So whenever we’re staring at something – like if I’m staring right at the camera – that’s the part of the retina that we’re using. It’s pretty important because central vision – that’s really where we get our detail anytime we’re focused on anything.

In order to preserve the health and provide the maximum nutrition possible for the macula, there are certain vitamin supplements – some are great some are questionable, and so I’d like to go over the different types for the different purposes.

The sun is one of the biggest causes of damage to our retinas, our maculas and our eyes in general and also to a certain degree from blue light emitted from digital devices – are a couple of reasons why are our maculas can break down over time and then we can actually lose the quality of our vision. Generally it happens later on in life, but it can happen earlier. There is a big genetic component so if there’s a family history of macular degeneration or retinal disease that would be a main reason to start an eye supplement for sure.

Supplements can reduce the risk of progression of macular disease. They do help, but it’s definitely not a cure a treatment for macular degeneration. Really, all we’ve got is our diet, and protecting our eyes from harmful radiation. The nutrients that give the pigment layer of the macula specifically what it needs is called zeaxanthin and lutein, and to certain extent, vitamin C vitamin A, and antioxidants like that. But zeaxanthin and lutein are the two main components.

Learn about macular degeneration and what we can do about it in our next chapter, Retinal Health Part 2.

In part 1 we gave an overview of how damage to our retinas can increase the chances of developing macular degeneration (MD).

What Is Macular Degeneration?
In our maculas, we have pigment cells, similar to in our skin. Pigment absorbs the harmful radiation that can damage our retinas, so it’s a good thing to have. When our retinas stop functioning properly, these pigment cells can stop processing lipids, causing them to build up. In time, it can damage the light receptors in the eyes, which causes decreased central vision. When this happens, we call it macular degeneration.

Two Types Of Macular Degeneration

Dry
One type of macular degeneration is dry, and the other is wet. The dry type generally advances and progresses more slowly, and there is less threat to sudden profound vision loss. However, as it advances it can still lead to central vision blindness, just not as quickly as the wet type. The image above this article shows an ocular CT scan of the layers of a macula with dry macular degeneration.  The wavy orange and red lines are drusen, which is lipid debris build-up and can cause reduced vision.

Wet
We call it wet because blood vessels grow in areas that block our vision, and they are fragile and can leak, leading to liquid and blood in our retinas. This wet type is more aggressive, and generally causes quicker worsening of the central vision.

Treatment
For dry MD, there is not any effective treatment. For wet, there are certain eye injections that can help reduce the severity of the leakage of the blood vessels in the retina, and some stem cell therapies that can help, but they don’t reverse the damage done.

Prevention
Since there really are no treatments that cure or remove the damage done by MD, we must make every effort to reduce our risk factors. MD is hereditary, but we can’t change our genes, so that is out of our control. It doesn’t mean you will get it if you have a family history of it, but it does mean you have more risk of getting it. The other risk factors are smoking, obesity, and exposure to the sun. Diet has been shown to affect your risk for MD as well. Taking a supplement of Zeaxanthin and Lutein has been shown to reduce risk. There are many different “eye” vitamins on the market. Some are great and some not so great. Check out Retinal Health Part 3 for details on what foods and supplements I recommend to “maximeyes” the health of your retinas.

When it comes to macular degeneration, there is not a lot we can do to prevent it, but certain lifestyle habits can reduce our risk. Let’s start with exposure to radiation. Limiting your exposure to the sun, and for sure wearing quality sunglasses when outdoors is the best habit we can have to lessen the harmful effect of the sun’s rays on our eyes over the years.

Since smoking adds to your risk of MD, that one is a no brainer – don’t do it. If you do, at least reduce the amount you smoke or quit altogether.

Just as for overall health and avoiding cardiovascular disease and diabetes, keeping as active and fit as possible has a direct effect on the health of your eyes in the long run. Obesity has been shown to have an association with MD.

And just as your parents told you, eat your veggies! Diet can have a significant protective effect on the health of your maculas. Antioxidant vitamins called zeaxanthin and lutein, found in many dark green and colorful vegetables, are what the retinal cells use to stay healthy, and when you eat enough, can have an impact. These vitamins contribute to the formation of pigment in our retinas. Pigment is good, because it absorbs the harmful radiation from the sun and blue light-emitting devices. It’s found in veggies like collard greens, mustard greens, spinach, kale, swiss chard, orange and red peppers (yes, carrots as well), and others.

Because we would have to eat 8-10 portions of them to get enough, and that’s not as likely as we would hope, I always recommend a daily supplement. Not to mention it would cost much more to buy the veggies you would need to get the desired effect. When we see early signs of macular damage or if there is a family history or a combination of risk factors, I prescribe either a vitamin called AREDS 2 by Eye Promise, or another called Macuhealth. Both are outstanding and provide our eyes with what they need to reduce some of the risk of developing, or progression of, macular degeneration.

What can we do to avoid developing MD early in life? Dr. B explains how in Retinal Health Part 4

Macular Degeneration can have a devastating effect on our central vision, and we don’t have effective treatments once damage has been done. That makes it crucial to do what we can early on to prevent and reduce the risk of the disease, similar to protecting your skin from the sun to reduce risk of skin cancer. In part 4 we covered the risk factors that can contribute to macular disease. Now we will cover what we can do to help prevent it.

Since children are outside more than adults, and these days they are staring at their devices for so many hours, they are even more at risk than adults for retinal damage. We can start by teaching our children about good habits to protect our eyes, such as wearing quality sunglasses that block 99% of harmful UV light, getting a blue light filter on their prescription glasses, and encouraging physical exercise.

The other factor that can make a big difference in our retinal health over the years is our diet. Because it’s not likely that our children will eat the necessary 8-10 helpings of green leafy vegetables, I recommend supplementing our childrens’ retinas with an age-appropriate eye vitamin like Eye Promise Screen Shield Teen, which is a chewable multivitamin that tastes good and contains zeaxanthin and lutein formulated for kids and teens.

For students, professionals (and everyone else) who use digital devices throughout the day, the one I prescribe for optimum retinal health is Screen Shield Pro. For older adults without early signs or significant risk, Eye Promise Restore provides the appropriate levels of zeaxanthin and lutein.