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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3176
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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hi. i went to an opthamologist and was tested for everything

Customer Question

hi. i went to an opthamologist and was tested for everything and do not have any signs of blepharitis. i was found to have some degree of dry eyes, for which i got drops that helped after four days. the doctor tested for tear production, which is excellent. only thing he found was what he said were very small tear openings, punta i think they are called. he was going to do a lacrimal irrigation if the drops didn't help but they have.

the compresses you recommended felt good but your diagnosis was incorrect. thank you for your time very much.
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 2 years ago.

Doctor DanB :

Hello and thanks for your question. You're welcome. I'm glad you were able to see someone and get help. Good luck.

Customer:

thank you. even though you weren't right about what i "have" -- which is never just one thing anyway or almost never -- you still made me feel better that day so i thank you. meanwhile, i don't understand how i can have excellent tear production and still have dry eyes? not sure the diagnosis is correct but the solutions are working so i am thinking positive.

Doctor DanB :

I certainly understand the conundrum--dry eye syndrome is really a catch-all phrase for what should rightfully be called tear-film dysfunction. When one or more of many different conditions exists that affects the integrity of the layer of tears that coats the front of the eye, this leads to tear-film dysfunction and subsequently the symptoms that you've had plus others. Decreased tear production is just one of several things that can lead to tear-film dysfunction, as is blepharitis, but just because you don't have decreased tear film production or blepharitis, doesn't mean you don't still have other factors that lead to it. That whole distinction is really where being able to examine your eyes is helpful. Does that make sense?

Customer:

truly does not clarify. i was tested for everything and found to have very healthy eyes. the only thing the doctor could see that might be causing problems was small puncta, hence the idea to do the irrigation but seemingly not needed now because drops have helped. i would just let it all go and hope to except it was such an ongoing really bad problem that i want to try to be sure i don't have to deal with it again. i don't feel that i have any solid answers yet. also, i've been using homeopathic drops at the same time and they seem to help more than anything. they are for allergies but there is nothing obvious that i am allergic to. would simply having sensitive eyes cause so much tearing? fyi, they are not tearing any more, since the bout of using drops, except for normal minor a.m. first getting up.

Doctor DanB :

I think that if you don't have any significant itching, then allergies is an unlikely cause for the tearing. Also, if small puncta were the problem that was cauisng tearing, then using artificial tears would not improve the tearing. The use of tears cauisng an improvement in symptoms tells me without a doubt there is a dysfunctional tear state. One thing I can also say for sure is that there are many causes of a dysfunctional tear film and that many ophthalmologists either don't know all of the tests to do for this, don't care to do the work to find the reason why, or they don't care to look (diagnosing and treating a dysfunctional tear state is neither exciting, rewarding, or lucrative). That's not to say that your ophthalmologist is any of these, but just that it is common to find an ophthalmologist that "dry eye" is just not their thing. But without a doubt, the fact that artificial tears helps your situation speaks to a dysfunctional tear state. If I were you, I would want to know, as well, what the cause of this was so I could make sure it was properly treated. In order to get the ultimate answer on what exactly is causing your dysfunctional tear state, a corneal specialist would be the person to consult. There is no other more authoritative expert than this ophthalmology sub-specialist. If, however, you are happy to just continue your current course, there's nothing wrong with that, as long as you're better off. Having sensitive eyes can cause tearing, but eyes are usually sensitive for a reason--there must be something causing it. That's why I think seeing the corneal specialist is the route to obtain the answers you seek.

Customer:

thank you for this considered information. appreciate it. only question i have is that the allergy homeopathic drops seem to help the most, more than the other drops. perhaps i will see a corneal specialist. is a person called a tear duct specialist the same thing?

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3176
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
Dr. Dan B. and 2 other Eye Specialists are ready to help you
Expert:  Dr. Dan B. replied 2 years ago.
No, not really. Strictly speaking, a tear-duct specialist would probably be a oculoplastics specialist.

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