Apr 5, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I think all the Twilight Movies must have it wrong. I think vampires must be short. All that time in the dark must stunt their growth, don't you think? Eric just spent the week of spring break locked in a dark room playing video games. I agree it wasn't really warm over spring break, but aside from the occasional dog walk, Eric didn't see the sun. My new plan for getting him outside is creative lying. Eric's almost 14 year old cousin Bailey came out over Easter. Bailey is now pretty much the same height as 16 year old Emily. For the moment, the girls are leaving Eric behind. I told Eric he needs to get outside and eat vegetables to grow.

It really hasn't been nice outside lately. Despite it being April, winter isn't letting go of us yet. 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 isn't 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 don't work, there are now two prescription eye drops for dry eyes. The newest prescription is called Xiidra or lifitegrast. Lifitegrast is a lymphocyte function associated antigen-1 (LFA-1) antagonist. This means is specifically effects one type of white blood cell which is part of your immune system. The older dry eye drop is called Restasis or cyclosporin. Cyclosporin is a calcineurin inhibitor and generally suppresses the immune system. Why are we using drugs that effect the immune system for 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 lefitegrast and cyclosporin can break the over-active immune response in the eye.

So how do the two immune suppressing eye drops compare? It is probably too soon to say which one works better. Lifitegrast seems to work faster. You should get relief with Lifetegrast in 6 weeks to 3 months, whereas cyclosporin takes 3 to 6 months. Lifitegrast can leave a bad taste in the mouth and be more irritating to the eye than cyclosporin. Wait at least 15 minutes after either lifitegrast or cyclosporin before putting in any other drops or contact lens. If bad taste is an issue with lifitegrast, press the side of your nose near the corner of your eye when using the drops. That may lessen how much of the drop makes its way to your throat.

A big down side to both lifitegrast and cyclosporin is their price. They can both cost over $260 per month. So they are both usually reserved for second line treatment after artificial tears.

Many years ago, on a family trip to England, we were on a train. On that train a fisherman told me that my younger sister looked like she was going to grow taller than me. That really worried me. To the point that I considered following his advice and putting manure in my shoes. I'm sure my parents were grateful I didn't have easy access to manure on that family trip. I'm not telling almost 13 year old Eric to put manure in his shoes. Don't tell him about this diatribe. He might manure his shoes to just to spite me. And I'm not saying he has to give up video games. He just needs to go outside once in awhile. How else is he going to triumph over a fictitious, mythical night creature from a series of books and movies he's never seen and win the heart of Bella, a fictitious heroine he's never heard of?

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.

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