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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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My wife is 64 and a Type 2 diabetic. Over the past week she

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My wife is 64 and a Type 2 diabetic. Over the past week she has had two episodes of sudden burning in both the eyes with tears flowing out.
She feels as if acid has been put in her eyes. It is quite an upsetting experience. She has never had this before.
She has been checked recently for spotting floaters in her eyes with occasional flashes of light. She has been checked out for this and declared not in need of any emergency treatment e.g. for possible retinal.
Any advice most welcome
Doctor DanB : Hello and thanks for your question. Are you available to chat?
Doctor DanB : Does she do a lot of reading, computer work or spend a lot of time outdoors?

She does only a limited amount of reading and computer work mainly before going to bed. She spends her time mostly indoors

Doctor DanB :

Does she have any tearing, discharge, foreign-body or gritty sensation, redness, mattering or caking of her eyelashes, or intermittent vision changes?


She has experienced sudden burst of tears with the burning sensation as if acid has been put inside her eyes. She has not complained of any discharge, gritty sensation, foreign body, redness of eyes, , or caking of her eye lashes or intermittent visual changes other than the foaters and very occasional flashes

Doctor DanB :


The most common reason for the eyes to be causing these symptoms is due to a dysfunctional tear film syndrome.

The front of your eyes has a layer of tears coating it called the tear film (this layer of tears is different from the tears you produce when you cry or have an irritation in your eye). The tear film normally provides a healthy environment for the front of the eye (the cornea and conjunctiva) and also contributes significantly to clear vision. When the tear film is unstable or unhealthy (there are many reasons why this can be so, which I will get to) it becomes dysfunctional and can produce uncomfortable symptoms and blurry vision. This is called a dysfunctional tear film.

People with a dysfunctional tear film can have multiple different symptoms ranging from redness, dull aching or pressure, sharp or stabbing pain, morning tearing, burning, and often eyelash mattering to tearing, stinging, itching, burning, a gritty/foreign-body senstation or just intermittent vision fluctuations. Their symptoms sometimes get better as the day progresses or they can often times worsen throughout the day, but they can get intermittent blurring when they use their eyes heavily in activities such as reading, watching TV, computer use or driving.

A dysfunctional tear film can be due to many different factors. Different medicines such as psychiatric medicines, antihistamines, cold medicines and others can contribute to a dysfunctional tear film. Allergies in the eyes can also contribute (and or make 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). Any kind of eye surgery can actually cause and/or worsen this 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.

Her symptoms sound consistent with blepharitis; I would recommend starting this treatment, while concurrently using 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 I would recommend using artificial tears 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.

If she is a person that doesn't make their own tears very well, then she may also benefit from taking that 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 at least 10-12 weeks before its effect kicks in (takes awhile to change the immune response in the body).

If she is 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 at least 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 she's tried these recommendations and still don't feel better then you should consider seeing a corneal specialist for a dry eye evaluation. Does this make sense?

Doctor DanB :

Do you have any other concerns or questions about this topic?

Doctor DanB :

Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.

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 see an eye doctor. Thanks for your inquiry!


You have been most helpful in giving what appears to be the correct diagnosis in the case of my wife's conditions.


I truly appreciate your prompt help in the matter. I have explained your analysis to my wife and she feels very reassured by it. From my reading of the relevant literature particularly The Definition & Classification of Dry Eye Disease

Guidelines from the 2007 International Dry Eye Workshop, by MICHAEL A. LEMP, M. D. AND GARY N. FOULKS, M. D., F.A.C.S., it would appear that my wife's condition according to the symptoms suffered by herself at this stage is classifiable as mild. I will follow through your kind advice as to its management and report back. I have one question which you can perhaps answer. Is the body's general hydration status a relevant aetiopathogenic factor in any sense? r

Doctor DanB : The standard line is that overall body hydration does not play a significant role in dry eyes syndrome or dysfunctional tear film syndrome. For that reason I do not routinely make it a point to recommend to patients that they be vigilant in hydration. That being said, I believe that every person is different and that some patients may actually respond well to keeping their hydration status optimized.

Thank you for your feedback on possible relevance of the hydration status of the body to the tear film syndrome. I would also like to take this opportunity to thank you for your overall expert advice and guidance, and sign off. If it is feasible I will try to give a follow-up feedback on my wife's condition after I have given her the treatment recommended by you. Best wishes

Dr. Dan B. and other Eye Specialists are ready to help you
My pleasure. I'm glad this has been helpful. I will check back in with you in a couple of weeks to see how your wife is doing. Good night.