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Dry Eye Remedies and Surprising Irritants

By Omar Robinson
Posted On Jul 23, 2014

Not a Dry Eye in the House

New research shows that cosmetics may cause irritation that compromises our eyes’ health. Jeepers!

BY Shirley Venice PHOTOGRAPH by Getty Images

The grittiness and stinging in her eyes refused to abate. Mary Haskins knew she could no longer bat away her vision concerns. Haskins, then in her mid-thirties, noticed the burning sensation was becoming more frequent. Her doctor assured her that her vision was normal,
and encouraged her to obtain some over-the-counter eye drops. Still, the discomfort continued. “I sought out several more eye specialists who could not make an accurate diagnosis,” Haskins said. “I also tried every over-the-counter eye drop available, with no relief.” Finally, a friend referred her to a specialist, and at long last Haskins was correctly diagnosed as having “dry eye.”

For millions of people, dry eye is an uncomfortable and painful problem. According to Dr. Benjamin Sullivan, chief scientific officer at TearLab Corp., a research and development company for ocular technologies, dry eye is one of the most under-diagnosed eye diseases in the country, yet the most common reason why patients visit their eye care professional. “Your eyes need a constant layer of tears to protect and lubricate the surface,” says Dr. Benjamin Sullivan. “In dry eye disease, people do not produce the right quantity or quality of tears. Surface tears evaporate within a few seconds, often entirely drying out an eye between each blink.” He says that underlying changes to the health of the tear-producing glands can lead to a tear film that no longer provides enough nourishment to the surface of the eye. This then leads to damage of the eye’s surface, and a reduction in vision quality.

Recent years have seen a surge in the popularity of cosmetic surgery, including blepharoplasty (or eye lifts) and fillers around the eyes. If incorrectly administered, some of these procedures can lead to ocular surface complications, according to Dr. David A. Sullivan, associate professor at the Department of Ophthalmology at Harvard Medical School and a senior scientist at the Schepens Eye Research Institute. He is also founder of the Tear Film and Ocular Surface Society (TFOS; tearfilm.org). “Dry eye can result from inadvertent Botox infiltration into the lacrimal gland, and may lead to corneal inflammation, blurred vision, and the feeling of a foreign particle stuck in the eye,” says Dr. David Sullivan. “If used for lid spasms, Botox may induce diplopia, face droop, corneal exposure, and visual blurring.” And in the case of an eyelift, Dr. David Sullivan notes that “possible adverse effects can include inability to close your eyes properly, corneal drying, infection, and uneven lid margin contour and creases.”
Studies have also shown that it is possible for cosmetics to cause ocular damage. Mascara, for example, may accumulate on the eye’s surface and cause conjunctival pigmentation. “This typically occurs at the lower edge of the upper lid,” says Dr. David Sullivan. “Also, eyeliners that contain significant amounts of lead will increase blood lead levels, while materials in eyelash dyes may elicit hypersensitivity reactions, contact dermatitis, dry eye disease, and blepharitis.” Blepharitis is a common and chronic inflammatory condition of the eyelids that can cause symptoms such as itchiness, redness, stinging, and burning of the eyes. “Keeping the eyelids clean reduces the contamination of the normal tear film,” says Fort Lauderdale, Florida optometric physician Robert M. Easton, Jr., OD, FAAO.

Doctors have no cure for dry eye—only temporary solutions such as artificial tears. However, great strides have been made in understanding the causes—including the role played by inflammation. Aside from the usual culprits such as age, staring too long at the computer screen without blinking, and menopause, new research shows that some medication and anti-aging eye creams can cause dry eye.
As Debra Schaumberg, ScD, OD, MPH—a professor of ophthalmology at the Moran Eye Center and the University of Utah School of Medicine—sees it, some forms of dry eye are related to the use of topical medications that treat glaucoma or systemic medications for the treatment of blood pressure or allergies. “As medication use increases, we are also seeing an increase in dry eye,” says Dr. Schaumberg. “Beta blockers, which are very commonly prescribed, are now also associated with an increased risk of dry eye.”

How close, then, should a person apply eye cream to the eye? The key ingredient of many anti-aging cosmetics is retinoic acid, which comes from vitamin A. Retinoic acid is also known as Retin-A, regularly used for acne treatments and other skin problems. “Exposure to retinoic acid may be associated with tear film instability, dry eye symptoms, and lid inflammation,” says Dr. David  Sullivan. To reduce the chance of developing such unwanted issues, anti-aging skin creams containing retinoic acid should be kept a healthy distance away from the eyelids.
Thanks to new research, dry eye treatment is evolving. “Before TFOS, there had been very little research on dry eye on the ocular surface,” says Dr. Schaumberg. “All new treatments have come from the later understanding of the mechanisms in dry eye. TFOS can take a lot of credit.”
When it comes to the treatment of dry eye disease, there are a few options. People generally start with artificial teardrops, where there have been real improvements in terms of quality compared to 20 years ago (for example, new hypoallergenic drops for mild dry eye patients). Some people, however, don’t respond well to these drops and prefer to try and keep their natural tears longer in their eyes by plugging tear ducts with tiny silicone or gel-like plugs. Mary Haskins, the patient seeking relief for her symptoms, insists that the prescription eye drop, Restasis, works best for her. “My new eye doctor suggests that I will get even more relief if I refrigerate the Restasis vials.”

For inflammation around the surface of the eyes, there are new treatments designed to apply heat effectively, through lid massage and via ointments. “You have to do it for at least five minutes, with the hottest water on a cloth, and hold it until it’s not hot anymore before you repeat the process,” advises Dr. Schaumberg.

Regular blinking while at a computer or reading, wearing sunglasses outdoors, avoiding dehydration, and increasing one’s intake of omega-3 fatty acids are all important self-care steps to reduce symptoms of dry eye. It is also important to maintain eyelid health because of the potential contamination. Dr. Easton recommends a hypoallergenic mild soap such as Johnson & Johnson’s Baby Wash. “Use your forefinger and thumb to wipe across your eyelid horizontally, and clean the lid margin and lashes during every shower,” he says.
A new, non-invasive test developed by TearLab can diagnose dry eye in seconds. This proven test requires only 50 nanoliters of tear fluid to instantly analyze the quality of the tear film. “Early treatment is the key to preventing problems later in life,” notes Dr. Benjamin Sullivan.
Dr. Schaumberg adds:

“People should be aware of dry eye disease, and that it is associated with the symptoms of dryness, irritation, and fluctuating vision. If people have those symptoms, they should see their eye doctor—there are ways to manage and decrease its impact on a person’s quality of life.”
Increased awareness has brought evermore effective treatment. “The TFOS campaign Blink Around the World is a fun and innovative campaign to remind people to think to blink,” says Dr. Schaumberg. “People tend to blink at a much less frequent rate while using electronic devices, and this may contribute to people’s sensation of ocular discomfort and fluctuating vision. While it won’t cure dry eye disease, blinking more frequently could help some people feel more comfortable, especially when performing tasks requiring sustained visual attention.”  So, if  you experience such symptoms, do what comes naturally: blink.