Stop The Burn

Treating dry eye

I never thought I would be involved in treating patients with dry eye problems.  I am an oculoplastic surgeon and neuro-ophthalmologist.  Treating tearing ok, but dry eye symptoms belong to the cornea and external disease specialists. However these patients present to the neuro-ophthalmologist with undiagnosed complaints ranging from pain in the eyes to fluctuating or decreased vision.  These symptoms are very often undiagnosed and subsequently the patients suffer for a prolonged period of time when help should be readily available.

As I have mentioned in previous articles, the key to accurate diagnosis and treatment is the use of a vital stain (Lissamine green) at the beginning of the examination.  Vital stains (which lissamine is) stain devitalized tissue.  Dry eyes stain with speckled spots of  lissamine green stain.  If the conjunctiva stains you have moderate dry eye, if the conjunctiva and cornea stain you have severe dry eye.  It is really that simple.

Artificial Tears

Conventional wisdom and the party line is treat mild dry eye with some artificial tear preparation.  This sound good and cost effective but artificial tears are not real tears.  Your tears are composed of a very complex mixture of proteins, antibodies, enzymes and lubricants.  You can’t find these in a bottle of tears.  After a trial of tears most patients are not happy.  Tears are expensive and have to be dropped in the eyes many times during the day.  This is especially hard for seniors who may have some arthritis problems and difficulty using eye drops.

Alternative Options for Dry Eyes

Why not keep your own tears around longer?  This is easily accomplished by partially occluding the tear drainage system with a punctual plug.  These are tiny devices that are eventually dissolved by the body that delay the drainage of tears from around the eye.  This keeps the tears with all their valuable ingredients in contact with the eyes longer and very effectively and conveniently alleviates dry eye symptoms.  They can be placed in the office during the examination with little or no discomfort.   The effects can be amazing.

How Important is Dry Eye Treatment

Early in my dry eye career a patient was referred to me for an unrelated surgical procedure.  During her complete examination I noted significant lissamine green staining of her eye indicative of severe dry eye.  I placed plugs in all four of her drainage holes (puncta) and scheduled her for her unrelated surgery.  When I saw her in the pre-operative holding area she gave me a huge, tearful hug stating that she felt so much better and why could not the 6 previous ophthalmologists do what I had done for her.  This is the value of lissamine green and punctual occlusion.  This scenario plays s out in the office almost every day.  Dry eye is common and usually easily treatable with simple office procedures.

If these symptoms sound familiar to you please call 941-921-5335 to see one of our dry eye specialist.Tom Spoor, MD

Oculoplastics and Neuro-ophthalmology
Sarasota, Florida

Tom Spoor,MD
Oculoplastics and Neuro-ophthalmology
Warren, Michigan

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