Dry Eyes

Jan 13, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

A plane flies low and slow over a grassy field. Two tandem parachutists kinda flop out of the plane, fall a couple feet and softly bounce on the field. The slogan comes up. You can't get much for $1.69! I love this McDonalds commercial. I giggle at it every time it comes on the TV. During a Jets games that seems like a lot. For me, January in Dauphin means a lot of watching TV. Thats because January in Dauphin also means cold and wind. At -40C air holds very little water in it. When we warm that air up in our houses, it sucks all the moisture out of our skin and hair. It also dries out our eyes.

It is estimated that up to 30% of people 50 and over have dry eye syndrome. This is also called dysfunctional tear syndrome. Dry eye syndrome is uncomfortable and it can damage the eye. Symptoms of dry eye syndrome include as feeling like you have sand or grit in your eye, irritation, burning and counter-intuitively lots of tearing because the corneal is irritated. The two main contributors to dry eye syndrome are increased evaporation of your tears and a decrease in tear production. Cold dry windy conditions can definitely increase tear evaporation. Reduction of tear production can be from a variety of factors.

As a pharmacist, the first thing I look for as a cause of decreased tear production is medication. Many different medications can dry out your eyes. These can include ACE inhibitors, antihistamines, benzodiazepines, beta-blockers, decongestants, water pills, and many others. If you have dry eyes and are on medication, have your pharmacist go through your medication profile with a fine toothed comb to see if any of your meds are drying out your eyes. There are also medical conditions like Sjorgren's Syndrome that can directly cause dry eyes.

If you are lucky, your dry eyes are caused by a medication and that is a medication you can live without. But in many cases we can't find the cause of the dry eyes or we find it is a medication we can't stop. If we can't cure the dry eyes, there are several things we can do to make them feel better.

For winter in Dauphin, consider using a humidifier to raise the humidity inside your house and wear glasses when you are outside to keep the wind off your eyes. You should also avoid long sessions of reading, computer work or watching TV. Take frequent breaks to give your eyes time to blink and moisturize. Avoid rubbing your eyes. Avoid the air that is blowing directly out of your hot air registers. Adjust your computer screen to below eye level so you don't have to open your eyes as wide to look at it. Avoid drinking too many alcoholic beverages. And quit smoking.

The next step is artificial tears. There really isnt a lot of difference between the various brands of tears. It will probably take some trial and error to find the one you like the best. Have your pharmacist help you pick your artificial tear because the medication names are often confusing. For example Visine Advance True Tears is a good artificial tear, but Visine Original has a decongestant in it and should be avoided. Usually you will start with 1 drop 4 times a day. If your doctor or optometrist determines you should use an artificial tear more than 4 times a day you should probably choose a drop without preservatives. They are easy to spot. They are usually much more expensive and in much bigger boxes. This is because each drop is individually packaged. Too much preservative on your eyes for too long can damage them.

If artificial tears don't work, the next step is eye ointments and gels. These stay around on the eye longer, but they may also blur the vision. Often these are only used at bedtime, so blurred vision isn't a big deal.

If tear drops and ointments dont work, there is a prescription eye drop called Restasis which contains cyclosporin. As a pharmacist, this use of cyclosporin fascinates me. Cyclosporin suppresses the immune system. We use it for things like stopping the body from rejecting organ transplants. So what does that have to do with dry eyes? The answer is inflammation. It can be the cause and consequence of dry eyes. Regardless of what triggers the dry eye, a vicious cycle of inflammation can keep the dry eye going as a chronic condition. The hope is cyclosporin can break the over active immune response in the eye. Restasis is a prescription only product. Like every other prescription it works in some patients and not in others. It is expensive. It can cost over $200 per month depending how it is used. It can take up to 3 months to see if it is going to work.

Thanks to YouTube I dont have to just giggle at TV commercials any more. A friend told me about the True Facts about series. I recommend you start with The True Facts about Sloths. I learned that sloths have razor sharp claws at the end of their fingers and would be the worlds most furious killer, if only the world would slow the heck down. Sloths move an amazing 3 feet per minute, which is 3 feet per minute faster than a dead sloth. We need to do something to get us through January in Dauphin. At least TV commercials and YouTube clips are short, so our already dry eyes dont get strained even more.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

True Facts about Sloths - https://www.youtube.com/watch?v=XrUM8m2rnP0

 


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