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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I hope you can help with my problem. My eyes react with many

Resolved Question:

I hope you can help with my problem. My eyes react with many supplements, makeup - it will result in one eye ( not always the same one ) becoming so dry it is unbearable - had to use steroids initially - now I can tell the signs in the beginning and it becomes a game of elimination unitl I determine what I have ingested or otherwise contacted - it will take about three days to correct in the eye. My concern, other than the irritation, is the problem I will have with prescribed medication. Presently I take no prescriptions but I am 62 and the likelihood that I will need something is obvious. I have researched this exhaustively without finding the answer. My opthalomologist offers dry eye solution only. I have regular checkups - do not wear glasses other than reading fine print.
I don't have trouble with dry eyes if I don't expose myself to anything my eye considers" foreign". I am an RN of 40 years - began with this problem twenty years ago.
I certainly hope you can help
Thank you,
Submitted: 7 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 7 years ago.

Hello and thanks for your question.

Your situation sounds very familiar to me. This is often a pattern I see in people who have a subclinical dry eye syndrome. Unfortunately, when this is the case, any instigator (makeup, supplement, allergen, foreign-body, medicine) can tip the scales.

Dry eyes can be due to many different factors. Different medicines such as psychiatric medicines, antihistamines, cold medicines and others can contribute to dry eyes. Allergies in the eyes can also contribute (make dry eyes worse). Some people have an innate deficiency in making their own tears (these people may also have other dry mucus membranes, such as their mouth, nasal passages, or genitalia). Many people have an inflammation in the eyelids called blepharitis which causes the tear film that is supposed to coat the front of the eye to not function as well, and then the eyes dry out. People with blepharitis have morning tearing, burning, and often eyelash mattering. Their symptoms get better as the day progresses, but then they get intermittent blurring when they use their eyes heavily in activities such as reading, watching TV, computer use or driving.

Because blepharitis is so under-diagnosed and the treatment for it is relatively benign, you might consider starting this treatment, while concurrently continuing artificial tears. In order to treat blepharitis, everyday in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are called Ocusoft or Sterilid which are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water), you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done.

It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working. Also the eyes are still significantly dry during this 3-4 weeks so use the artificial tears you bought 4x/day in both eyes (one drop per application). After 4 weeks you should be able to start tapering off of the tears to as you need them.

Just doing the artificial tears, hot compresses and eyelid scrubs alone would likely start to help you after three or 4 weeks--but remember it could take this long of doing it everyday before you see a significant effect, so don't stop it thinking it's not working.

It may also be necessary to take an antibiotic and/or steroid combination drop to help reduce inflammation and bacteria that may be present in the tear film if this baseline therapy is not sufficient alone. The steroids that you have taken are an effective short term solution to interrupting the inflammation that can be part of dry eye, which is the reason why they have been helpful in the past.

If you are a person that doesn't make their own tears very well, then you may also benefit from a prescription drop called Restasis, which actually modulates a person's immune system to help them make more of their own tears. This drop actually requires constant usage on a daily basis for up to 10-12 weeks before its effect kicks in (takes awhile to change the immune response in the body).

Because there are numerous reasons for dry eye, if not all the reasons that exist in one patient are treated, it can seem as though the ones that are being treated are providing no benefit. If you've tried these recommendations and still don't feel better then you should consider seeing a corneal specialist who can give you a thorough evaluation and treatment plan for dry eye.

Does that help address your concerns?

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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must be examined by your doctor.

Customer: replied 7 years ago.

With this approach , will I be able to tolerate medicines , etc.- or will I continue to have the same problem with the painfully dry condition ?

And do you have insight into why it is not always the same eye ?

Expert:  Dr. Dan B. replied 7 years ago.

Those are both good questions.

The reason that it is not always the same eye is because both eyes are affected and either eye can be symptomatic at any one time, or both for that matter. It is very common, when dealing with the eyes, for one eye to be more symptomatic than the other; that just tends to be the way the eyes react.

As far as tolerating medicines and other parts of your life you have had to fore go, I would expect that with the proper dry eye treatment, that you likely would be able to tolerate these things again.

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