Dry Eyes

Dec 30, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Don't let the cat out of the bag! I haven't taken my Sorells out of the basement yet. That's crazy because it is officially winter, and January 2016 is almost here. Now, I know it is an El Nino year. I know almost all of Canada east of Thunder Bay had a green Christmas. But I'm still worried that if I talk too loudly about what a fantastically warm November and December we had, Mother Nature will slap me with -35C in a heart beat. Maybe I'm worried because of the sinister origins of Don't let the cat out of the bag. Today it means don't reveal the secret or you'll ruin the surprise. But in the days of sailing ships and the Royal Navy, it meant something different.

Winter in Dauphin means dry lips, dry skin and dry 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. Dry eye symptoms include as feeling like you have sand or grit in your eye, irritation, burning and counter-intuitively lots of tearing because the cornea 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. Decrease of tear production can be from a variety of factors.

As a pharmacist, I suspect medications first as the cause of any symptoms. 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.

Sometimes your pharmacist will get lucky. We might find a medication you are taking that can cause dry eyes and that you don't need anymore. We'll talk to your doctor, get it stopped and your dry eyes will go back to normal. But in many cases we can't find the cause of the dry eyes or we find it is a medication that 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 or tablet screen to below eye level so you don't have to open your eyes as wide to look at them. 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. You may want to ask your pharmacist to help you pick your artificial tear because the medication names can often be confusing. For example Visine Advance True Tears is a good artificial tear, but Visine Original has a decongestant in it and should be avoided for dry eyes. Once you've chosen your artificial tear, 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.

The nasty surprise of the cost of Restasis is almost as bad as the original meaning of letting the cat out of the bag. In the Royal Navy, the British Naval Officers had a hard core instrument of discipline. It was called a Cat o Nine Tails. It was a nine tailed whip. The Cat o Nine Tails came out of its bag when someone spoke out of turn or said something they shouldnt have. Here's hoping 2016 doesn't have any nasty surprises for you and that El Nino keeps our usually brutal January's more on the moderate side. Happy New Year everyone!

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


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