Author: Board Members

🔊 Listen

Dry Eye symptoms can flare up periodically or persist for a prolonged period of time. Sometimes important and necessary treatments, like topical medications or surgery, trigger new types of discomfort. With proper care and treatment, all of these symptoms eventually subside and flare-ups can become less frequent.

During times of prolonged discomfort or sudden flare-ups, it can be difficult to find relief while waiting for treatments to take effect or healing. And when there is pain and other discomfort in the eyes, literally everything else recedes into the background. It can even be very difficult to just get through the day.

Some doctors prescribe anesthetizing drugs, like Lyrica, that can mask these symptoms. These drugs may help temporarily. But unless the underlying conditions are treated, symptoms will return. And masking symptoms will not only mask the symptoms from you, but from your doctors as well. Because if you can’t feel it, you won’t report it to your doctors. They won’t be able to treat what they don’t know about, especially if something changes or a new condition crops up. And that could be a problem.

Temporary relief can sometimes be achieved with distractions that direct the mind toward something other than the symptom. This works because the mind is able to really focus on only one thing at a time – whether it’s a sensation or a thought. The object of the mind’s focus will be the one that’s the most prominent, while everything else recedes into the background.

Here are four distractions to help you get through the day.

1. Hold an ice cube wrapped in cloth to your eyebrow or cheekbone.

The sensation of ice on the skin near your eyes is particularly helpful during acute episodes of pain or other discomfort. Here’s what you need.

• Ice cube
• Clean, thin cloth, like an old T-shirt

Wrap one layer of the cloth around the ice cube. Hold the cloth, with the ice inside, to your eyebrow or cheekbone until you feel the coldness of the ice. Leave it there for a few seconds until your eye symptom subsides. Then pull it away. Keep touching the wrapped ice to different spots on your eyebrow or cheekbone as soon as you feel the symptom return.

The cloth shields your skin while absorbing the melting ice. You can try a paper towel, but the paper tends to rip when it gets wet. A thick cloth insulates the ice too much and you won’t feel the cold enough.

Never touch the piece of ice inside the cloth to your eyes, eye lids, or inside the eyes. Cold is the enemy of meibomian glands. It’s best to leave these glands at their normal temperature unless you’re doing a warm compress.

2. Eat something.

If you’ve noticed that your eyes feel better when you eat, you’re not alone. All of the sensations in the mouth – taste, temperature, texture – are great distractions that help to deflect focus from the symptoms in your eyes.

So eat something. Then keep eating.

Try to find something that doesn’t have too many calories and is generally healthy, especially if you’re going to eat for a long time.

One favorite is popcorn. Skip the fat and calories in the pre-packaged microwaveable bags, and make your own air-popped (if you have an air popper) or microwave popcorn.

Microwaving your own popcorn is the easiest thing in the world. Here’s what you need.

• Popcorn, any brand, any kind. Or try organic.
• A brown paper sandwich bag

Put enough popcorn into the sandwich bag to cover the bottom. Fold the opening down two or three times. Place the bag in the microwave with the folded side down. Push the popcorn button. Wait till it finishes popping.

You can eat it plain, or you can add salt or butter. Look for butter from grass-fed cows that is higher in Omega 3 fatty acids. Or try butter-flavored olive oil that mimics the flavor of movie theater butter, with the added benefit of being lower in Omega 6’s.

3. Engage your mind.

Activities that require some mental focus, but low visual focus, are great distractions. Try listening to music, audio books, talks shows… whatever interests you.

Crossword puzzles are one of the best distractions, but you will need a friend to read the clues, tell you how many letters are in the word, and which letters are already there. You’ll have to think about the clue, count the letters, and maybe visualize the word. The harder the crossword puzzle the more your mind will be distracted.

4. Watch or listen to comedies.

If you’re able to watch television without too much discomfort, this may be an option for you. But if not, you can try just listening.

Some movies and television shows are easier on the eyes than others.

Avoid dramas, especially if you cry easily at movies, because emotional tears exacerbate Dry Eye symptoms. Staying calm is also important. So it’s best to avoid horror movies, thrillers, or anything with suspense.

Comedies can help keep your mind distracted without exacerbating symptoms the way dramas and other genres can. Comedies might even help you find the humor or irony in your own situation.

Just be sure to blink and take frequent breaks if you’re watching TV or a movie.

These simple techniques distract the mind from Dry Eye symptoms and help you get through the day. Depending on your specific condition, some may work better than others. So try them, and see which ones work best for you.

View more tips for coping with Dry Eye and MGD.

How do you manage your symptoms? Send your tips and comments to blogger@notadryeye.org and we’ll share them with our readers in future blog posts.

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🔊 Listen
Some people have no problem asking for help.

Maybe they recognize that we live in an interdependent society where everyone relies to some degree on others. So they already know that no one can exist without help. Or maybe they know that asking for help isn’t a sign of weakness. It’s simply an expression of need.

Somewhere along the way, we’ll all need someone else’s help. And asking for help is a skill that can be learned. Here a few practical tips that can help you when you need to ask for help.

1. Develop a personal support network that you can turn to in time of need.

For those suffering with extreme Dry Eye symptoms, the thought of developing a support network can seem daunting. It may even seem like it’s too late to start. You might have become isolated when your eye discomfort prevented you from leaving the house and taking part in normal daily activities, limiting your interactions and access to others.

Even if that’s the case, it’s never to late.

Start with basics. Make a list – even if it’s just in your head – of the people you know who you think you can reach out to. Write down their contact information (so you don’t have to look at a screen): name, phone number, and when is a good time to call. Then give them a call. You might not need any help just yet, but let them know you might ask in the future. If you give them a brief update about your eye condition and tell them how difficult it has become for you to do x, y, or z, they might even offer to help you with x, y, or z.

Then add neighbors to your list and give them a call. Or if it’s appropriate, ring their door bell.

When you initially make contact, try not to burden these people with all of your problems. They need to know what’s going on with your eyes, but for now everything else is just noise. Focus on the condition that’s driving you to ask for help – the discomfort in your eyes. Later, when you are better acquainted, and if there’s an appropriate time and place, you can share more.

2. Always be open to making a new friend, especially among your neighbors.

You never know when you’re going to make a new friend. At the bus stop. At the grocery store check out line. While taking a walk.

Introduce yourself. Be friendly and you will make friends.

Neighbors who are friends can be especially helpful once they learn that you need help, because neighbors are right here. They don’t need to drive long distances to get to you.  And because helping each other is something that neighbors already do.

But remember to be a friend as well. Listen. Be positive. Have compassion. Help out when you can. Friendship is a two-way street.

3. Don’t act as if you’re being rejected by someone who can’t help.

Asking for help is not a job interview, a date, or a movie audition. You aren’t being rejected if someone says they can’t help. They just can’t. Accept it, ask if you can ask for help again in the future, and move on. And don’t ever make anyone feel guilty for not being able to help. You’re requesting help, not demanding it (see #10 below).

4. Try asking different people for help.

Even if you have a BFF who’s always available, others might want to help. In fact, for some people being asked to help is an honor. Asking different people for help is a way of nurturing your support network, which is important because you never know when your BFF will suddenly get a new job or have her own medical emergency. Or one person in your support network may feel they can help sometimes, but not always. So ask around.

Apps like the one provided by CaringBridge can help you organize your support network. CaringBridge is a non-profit organization that provides an online scheduling app so everyone in your network knows when you need help and can volunteer their time when they’re available. This way you don’t have to call everyone in your support network individually to let them know you have another appointment with your doctor.

5. Take advantage of government programs for people with permanent or temporary disabilities.

Depending on your country, state, city, province, or local laws and regulations, there may be programs that you can take advantage of without even having to be officially disabled. In the US, for example, there is a federal transportation program that provides door to door transportation services for people who qualify. If you qualify, you won’t have to drive yourself or ask someone in your support network to drive you shopping or to your next local doctor’s appointment.

6. Take advantage of volunteer programs.

Whether it’s volunteers who drive people to the grocery store or pilots who fly patients to medical appointments on the opposite coast, you may qualify for any number of programs offered by volunteer organizations in your area. These can help you resume some aspects of a normal life, or even save you thousands of dollars. It may be worth while to do some research, or ask someone in your support network to do the research for you.

Look for support groups in your area, not just for Dry Eye, but for other conditions or disabilities you may have. You might find people who have had to overcome similar obstacles who can give you advice on overcoming yours.

7. Be specific. Say exactly what you need when you’re asking for help.

If you need a ride to the doctor for an appointment on Wednesday at 2:00 p.m., say exactly that. Don’t make anyone guess what you need. Don’t assume that anyone knows what you need. If you need to go shopping, or need help opening that new sports water bottle, or you just want to talk to someone, say so. Don’t beat around the bush. Just ask.

8. Be positive when getting help.

Consider how well you know someone. If it’s the first time they’re helping or if you don’t know them that well, you don’t want to scare them off with something that’s emotionally charged, too negative, or alarming.

But don’t be afraid to say what you’re feeling. Just try to do it in a positive or objective manner. Most people prefer to be around others who have a positive attitude. And when we’re struggling with Dry Eye, the more supportive people we can gather and keep around ourselves, the better.

After all, we’re all struggling with something. Whether it’s a medical condition or something else, life happens to everyone. It’s how we approach it that matters.

So stay positive. It will help your relationship with your support network as much as it will help you.

9. Listen to others and practice The Golden Rule.

As noted above, even though what’s going on with your eyes may seem insurmountable, everyone has their own problems that to them may seem insurmountable: medical conditions, problems at work, family issues, or whatever else. The list goes on and on. So have as much compassion and empathy for others as you would want others to have for you. In other words, practice The Golden Rule.

When you’re listening, one thing you’ll probably hear is advice for treating your eyes. This advice can sometimes be exasperating. Most people who are themselves unfamiliar with Dry Eye won’t be able to give you very good advice. But they might still try. Be patient with them too.

How to respond when someone offers advice about Dry Eye

10. Never demand. Always request. And remember to say “Thank You.”

Some animal trainers say that when they’re giving an animal a command they aren’t really giving a command. They’re making a request and giving the animal the option of filling that request…or not. If the animal does what it’s asked to do, there’s a reward at the end in the form of food or something else the animal likes, like a belly rub.

It’s a good approach and one that can easily be adapted by anyone asking for help. First, remember that you’re making a request, not a demand. Then always give the option of saying no without guilt. And the reward at the end (no, not a belly rub) can be a sincere, heartfelt “Thank You.” Because who doesn’t like to hear “Thank You?”

11. Get help from professionals when you need it.

Whether it’s a doctor, a mental health professional, attorney, local government representative, nurse, or other professional, don’t hesitate to ask for help when you need it. Waiting too long can make things worse or make problems more difficult to solve. Professional help can sometimes be expensive, so it’s important to be mindful when seeking this help. But if you need professional help, by all means seek it out. Remember that asking for help isn’t a sign of weakness. Asking for help is just an expression of need.

If you are having suicidal thoughts because of your eye pain or discomfort, seek help immediately from your primary care or eye doctor, spiritual advisor, mental healthcare provider, a trusted family member or friend, or a suicide prevention hotline.

• In the US, National Suicide Prevention hotline: 1-800-273-TALK (8255)
• Website: suicidepreventionlifeline.org

 

Send your comments to blogger@notadryeye.org

🔊 Listen
Research on contact lenses and Dry Eye Syndrome has recently been in the news. One study examined the role of the lipid layer in tear film and how that might impact contact lens design. The other looked at the microbiome in the eyes of contact lens wearers.

Contact Lenses and Dry Eye – Research at Stanford

It’s a known fact that contact lenses can contribute to Dry Eye symptoms and it’s not uncommon for people who wear contacts to stop because of the discomfort they feel. In fact, Dry Eye is the most common cause of contact lens intolerance, with about 50% of the 30 million contact lens wearers in the US switching back to glasses.

One Stanford researcher, Saad Bhamla, a postdoctoral scholar in bioengineering, who stopped wearing contacts as a student when they became uncomfortable, decided to do something about it. He and other researchers at Stanford looked at the role of the lipid layer in tear film and determined that it has two primary functions. One is strength. The other is liquid retention. They are using this new understanding of tear film in designing a new kind of contact lens that helps with tear film stability.

Sounds promising. Right?

But even these new and improved contact lenses could, like all other contacts, stress meibomian glands and interrupt the blink feedback loop.

And then there’s the question of the eye microbiome.

Contact Lenses and Dry Eye – Changing the Eye Microbiome

Last May, researchers at NYU Langone reported that the microbiome in the eyes of contact lens wearers is more like the microbiome of the skin than the eyes of those who don’t wear contact lenses.

Reporter David McNamee wrote:

The team found three times the usual proportion of the bacteria Methylobacterium, Lactobacillus, Acinetobacter and Pseudomonas on the eye surfaces (conjunctiva) of contact lens wearers than on the eye surfaces of the control group.

The study’s senior investigator, NYU Langone microbiologist Maria Gloria Dominguez-Bello, PhD., said that putting a contact lens in the eye is, “not a neutral act.”

And Dr. Jack Dodick, the study’s author, professor, and chair of ophthalmology at NYU Langone, explained:

A common pathogen implicated has been Pseudomonas. This study suggests that because the offending organisms seem to emanate from the skin, greater attention should be directed to eyelid and hand hygiene to decrease the incidence of this serious occurrence.

And Dry Eye symptoms are only exacerbated when there’s an infection.

So if you’re going to wear contact lenses, be sure to practice good hygiene, rule out aqueous deficiency, and have your meibomian glands monitored periodically with meibography to be sure they’re healthy and doing their job well.

Send your comments to blogger@notadryeye.org

References

Alterations to the eye microbiome of contact lens wearers may increase infections
McNamee D.
Medical News Today
31 May 2015
View the full report

Instability and breakup of model tear films
Bhamla MS, Chai C, Rabiah NI, Frostad JM, Fuller GG.
Investigative ophthalmology & visual science
2016 Mar 1;57(3):949-58. doi: 10.1167/iovs.15-18064.
View the full report

New insights into human tears could lead to more comfortable contact lenses
Medical News Today, Adapted Press Release
29 March 2016
View the full report

 

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Even if you have an excellent doctor treating you for Dry Eye or meibomian gland dysfunction (MGD), there are lifestyle changes you can make to help improve your symptoms. These range from getting a good night’s sleep to washing your hands before touching your eyes. Some lifestyle changes can be hard to make. But when the discomfort from Dry Eye or MGD takes over your life, even small changes can add up to make a big difference. Remember, you can play a big part in managing Dry Eye and MGD symptoms.

1. Sleep with moisture chamber goggles.

If you have aqueous deficiency, MGD, or sleep with your eyes opened (nocturnal lagophthalmos) moisture chamber goggles can help to prevent your tear film from evaporating. Choose goggles that block out light or clear ones that you can see through. Be sure to wash them every day according to the manufacturer’s directions. If your goggles are uncomfortable, contact the manufacturer. If the pair you have is under warranty you should be able to exchange them for a more comfortable pair.

2. Don’t touch your eyes unless you have just washed your hands.

Introducing bacteria to the eyes only exacerbates symptoms. So wash your hands right before you touch your eyes for any reason, even when you’re just putting in an eye drop. And blot them dry them with a fresh, clean, low-lint paper towel. Keep a roll of paper towels on your bathroom counter or wherever you take care of your eyes most often so they are always within reach when you need them.

3. Avoid foods that cause inflammation.

Some foods are known to cause inflammation such as foods that contain high levels of Omega 6 fatty acids. This includes chicken and turkey. Inflammation is not always a bad thing – it’s how the body fends off disease. But chronic inflammation, which is associated with MGD, is the last thing you want to increase when you’re trying to improve eye comfort. Some experts recommend eliminating dairy, sugar, and wheat. But without actual food sensitivity testing, you might be eliminating some foods unnecessarily while not eliminating foods that cause your inflammation. For more information, see our page on food sensitivity testing.

4. Eliminate allergens.

Allergens cause allergic reactions and inflammation, and inflammation is the enemy of the meibomian gland. See tip #3 above. Eliminating allergens completely can be very difficult. For example, dust is almost impossible to completely eliminate or avoid. And it can be extremely difficult, and even heartbreaking, to eliminate it if the allergen is a beloved pet. But the more you can avoid allergens, the less you will exacerbate any symptoms.

5. Increase Omega 3 consumption.

Adding Omega 3 to your diet helps to offset the inflammatory effects of Omega 6’s. You can either increase the foods that have a beneficial Omega 3 to Omega 6 ratio or take a good Omega 3 supplement. If you choose to take an Omega 3 supplement, be sure it’s tested for contaminants.

6. Stop wearing eye makeup.

If you’re used to wearing eye makeup, stopping can be very hard. It might take some extra courage to go out without any on. But tiny particles of eye makeup can flake and fall into the eyes. Powders can rim the eye lid margin, the site of the opening of the meibomian glands. Makeup brushes, sponges, and mascara tubes harbor bacteria. And we don’t even want to imagine the colonies of demodex mites in there, so on to the next tip.

7. Get a good night’s sleep.

Eye tissue is restored when we sleep. When we don’t get a full eight hours, the cells don’t have time to regenerate and we end up exacerbating any eye discomfort. Eight hours is usually recommended. So put on those moisture chamber goggles and go to bed early.

8. See your doctor. Don’t delay.

Doctors can’t help if they don’t know what’s going on. So if you’re not getting better, or you’re experiencing some new symptom, don’t delay and make an appointment. Some doctors will communicate via text or e-mail once you’ve established a doctor/patient relationship. They may even take your call, especially if you’re experiencing acute symptoms. So if you’re experiencing something new, or something you’re pretty sure shouldn’t be happening, let your doctor know. The sooner the better, and before it gets worse.

Managing Dry Eye and MGD symptoms can be challenging, but remember that every little thing you do can add up to help a lot.

View more tips for coping with Dry Eye and MGD.

How do you manage your symptoms? Send your tips and comments to blogger@notadryeye.org and we’ll share them with our readers in future blog posts.

Subscribe to our blog to keep up with Not A Dry Eye.

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🔊 Listen
If you’ve had your meibomian glands probed, you probably remember hearing loud “pops” as the probe pierced through a band of fibrotic tissue (periductal fibrosis) somewhere along the length of the gland. Or it could have felt as if the probe was passing through several bands of fibrotic tissue, producing a gritty sensation and a sound like a short machine gun round.

Of course there was no machine gun.

The pop was just amplified in your head, the way a tuning fork can seem very  loud when it’s held up to your ear, or the way flossing your teeth can seem very loud, but only to you.

The doctor can also feel the fibrosis with the probe as it meets resistance. And he feels a “pop” or something “gritty” when the probe pierces through.

Pop, Gritty, and Periductal Fibrosis

Given how many of us who have been probed have heard and felt “pop” and “gritty,” it’s puzzling that a recent paper published in Bio Med Central Ophthalmology completely misses this essential aspect of meibomian gland physiology and dysfunction (MGD).

The paper claims that evaporative dry eye is thought to be caused by “ductal hyperkeratinization, plugging and obstruction” but doesn’t discuss the role of periductal fibrosis in MGD, something that hyperkeratinization may cause indirectly through obstruction and meibum stasis (stagnation) with inflammation.

(Keratinization is the production of keratin, a protein, by ductal epithelial cells. In meibomian glands, this happens in the cells lining the ducts and at the opening. Hyperkeratinization refers to an excessive production of keratin by these cells. Too much keratin blocks the normal flow of meibum, leading to obstruction, stagnant meibum, inflammation, and eventually periductal fibrosis).

We’re not disputing the fact that hyperkeratinization occurs in meibomian glands. It does. But missing is what it may cause, or what may develop concurrently, from any cause of inflammation – periductal fibrosis. Missing periductal fibrosis means missing an essential fact of MGD, a fact that can alter greatly diagnosis and, ultimately, treatment.

Because if you don’t accept that there’s fibrotic tissue inside the gland, which can be caused by numerous factors that involve inflammation, you’ll never comprehend why probing is an essential treatment. You’ll believe that all you need to do is clear the stagnant and hyperkeratinized cells with warm compresses and lid massage. And you’ll completely miss the fibrotic tissue that can neither be heated, nor massaged, away.

That fibrotic tissue requires a completely different treatment approach – a tiny probe the width of a hair to pierce it.

Send your comments to blogger@notadryeye.org

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Question:
Pop, Gritty, and Probe” is very interesting. Does the probing take care of the problem forever or is it necessary to repeat it and how often? Can the block be prevented or at least its build-up slowed down? If so, is there a self-help approach that the doctor could recommend?
Walter, New York

Answer:
Walter, we posed your question to Dr. Steven Maskin. He said:

Probing establishes that the meibomian gland duct is opened. Repeating the procedure is not always necessary, but this depends entirely on the patient and any other conditions or co-morbidities they may have which creates inflammation leading to periductal fibroses and re-obstruction. Our studies show that about 33% of lids are reprobed at an average of 18 months with 67% reprobed at average greater than 2 years. Any other conditions that may cause inflammation of the meibomian glands should also be treated at the same time, including aqueous tear deficiency, or allergies that may require topical treatments, infections, or infestation by demodex mites. Other considerations include oral medications such as Periostat (doxycycline) that can reduce inflammation, supplementation with Omega 3 fatty acids which may reduce inflammation and improve the quality of the meibum, and systemic treatments for autoimmune conditions that can cause systemic and periglandular inflammation. If it is well tolerated and there are no contraindications, warm compresses that can be done easily at home can help to liquefy the meibum, helping to prevent meibomian gland obstruction.

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References

Meibomian gland dysfunction: hyperkeratinization or atrophy?
Jester JV, Parfitt GJ, Brown DJ
BioMed Central Ophthalmology
2015 Dec 17;15 Suppl 1:156. doi: 10.1186/s12886-015-0132-x.
View the full report

Intraductal Meibomian Gland Probing to Restore Gland Functionality for Meibomian Gland Dysfunction (MGD)
Maskin SL
May 2012

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🔊 Listen
Dr. Robert Wachter gets our vote.

At TEDMED 2015 he told the audience that professional intuition is under assault.

That’s how we feel when some doctors disparage meibomian gland probing, saying it’s too new or citing a lack of evidence as the reason why they’re against it, even while we’re sitting in front of them with our probed (and now functioning) meibomian glands.

When they say it’s too new, we say yes, probing might be relatively new. But just because it’s new, doesn’t mean it doesn’t work. Because the way we see it, newness and effectiveness are not mutually exclusive. Besides, meibomian gland dysfunction (MGD) has been around a long time. There’s nothing new about that disease.

Common Sense, Intuition, and MGD

And, fundamentally, doesn’t it just make sense that if a meibomian gland is blocked (think periductal fibrosis – vascularized bands of tissue around the duct that constrict it) something (dare we say a probe?) would need to pierce through that blockage to open up the gland, the way a balloon angioplasty widens and clears obstructed and constricted veins or arteries? So to us, meibomian gland probing as a treatment is obvious, and intuitively makes sense.

And even if it is relatively new, that doesn’t mean there isn’t any evidence of its effectiveness. Its inventor, Dr. Steven Maskin, has plenty of evidence. Plus other independent studies have been conducted all over the world – Japan, Spain, China, Russia, New York State. A double-blind clinical trial was even completed at Harvard last year, but the results haven’t been published yet. (Let’s hope competing interests aren’t suppressing its publication – which, sadly, sometimes occurs in the medical field).

Because, although there’s a place for evidence-based medicine, there’s also a place for intellect, experience, wisdom, common sense, and intuition – elements of science and medicine at their best.

After all, once upon a time, nothing was “evidence-based.” Not even an aspirin.

Send your comments to blogger@notadryeye.org

Reference

Professional intuition is under assault, Wachter says
M. Frellick
Presented November 20, 2015
Medscape Medical News from TEDMED 2015.
November 24, 2015.
http://www.medscape.com/viewarticle/854925

🔊 Listen

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