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Dr. Stevens
Dr. Stevens, Ophthalmologist
Category: Eye
Satisfied Customers: 1404
Experience:  Board Certified Ophthalmologist
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problem has got worse over the years and my eyes tend to become sore

Resolved Question:

I am aged 61. A few years ago my eyes started to water whenever I went outside in winter especially early in the morning. The problem has got worse over the years and my eyes tend to become sore. GP has prescribed natural tear drops. When I remember to use them regularly (about 3 x a day) eyes are less sore but the watering continues - mainly when I am outside. Can you advise? (I am due to speak to my GP on Monday and wonder if there is anywhere I could be referred for example. Any relevant info would be much appreciated.
Submitted: 7 years ago.
Category: Eye
Expert:  Dr. Stevens replied 7 years ago.

Hello Isabel

I suspect you are suffering from something called meibomian gland dysfuntion, also known as meibomitis. It leads to dry eye symptoms and proper diagnosis and management is crucial for long term relief. Lets talk a bit about this now so you know what is happening. You may or may not know, the tears that help lubricate the eye are made of 3 different components. One is the actual watery component made in the lacrimal gland under your brow. It is where the water is made and if you get something in your eye or your eye is irritated, this gland goes in to overdrive and causes tears to be produced excessively. Second, is the mucous component and rarely do patients have a deficiency of this (short of chemical burns to eye, as in lye or acid burns). Third is the oily component of the tears and this comes from the glands at the base of the lashes, called meibomian glands. Those glands are often the culprit in someone with severe dryness, irritation and tearing.....yes, folks with meibomian gland dysfunction have lots of tearing and here is why. Stay with me....

when your hands are dry, you dont put water on them although it makes sense to do so if you think about it in the most basic sense. However, you go get lotion which is oil and water mixed in a precise mixture. Same with your eyes, if you have meibomitis or posterior lid margin disease, oil glands become boggy and they dont drain and it contributes to a tear that is more mucousy, but less oily and the tear evaporates quickly (doc sees a thing called decreased tear breakup time) and the surface of the eye becomes irritated as there is no continuous lubrication. Instead the surface becomes irritated and it causes running of the eyes because the eye things there is something stuck in there, and tries to flush it out. Unfortunately, unless the glands become more functional, the situation never gets better. So the best treatment for this siyuation is the faithful and consistent application of heat packs which help the oils get moving. We are not talking a warm washcloth, that gets cold quickly, rather a heat pack that applies constant heat for at least 3-5 minutes at a time. If this does not provide good relief, your doc may consider an antibiotic like doxicycline, tetracycline or minocycline for 6-8 weeks or longer. These help the glands drain better. Also, use lubricants as you are doing, and even a nighttime ointment may be used, such as Refresh PM. If you have adequate amount of tears, this will help, however some patients also have low tear production and there is something called Restasis which can help address that issue as well. You probably dont need since you have tearing at times.

Take care and let me know if there is any more questions or concerns.

Sincerely XXXXX XXXXX

 

Customer: replied 7 years ago.

Is Refresh PM something I should be able to buy at any chemist and can you say more about what sort of heat pack would appropriate ?

many thanks for your speedy response

Expert:  Dr. Stevens replied 7 years ago.

Hello Isobel

Refresh PM or similar nighttime lubricating ointments may be purchased at drug stores / pharmacists / supermarkets. As for the heat pack, you may purchase one made for say your shoulder and simply place it across the eyelids. You can also make your own using a thick cotton sock and uncooked rice. You can place the rice inside and tie off the end and this can be heated in a microwave and used. Let me know if you have any other questions, Dr. Stevens

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