Eugene C. Salvo, Jr., M.D.
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Ophthalmologist
Ophthalmologist
My Blog
Blog
Dry eyes may not be.
Posted on October 11, 2011 at 7:49 PM |
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In most cases the problem that exists when someone has "dry eye" is not a
problem with dryness at all, although there definitely are people who
actually do have a true tear deficiency. These people are the ones that
will probably be helped with the use of punctal plugs which prevent the
normal drainage of tears and keep more tears on the eye. They are also
likely to be helped with the use of "Restasis" eye drops which are a
drug which actually stimulates the production of more tears. To better
understand what the true nature of the other condition, which seems to
be more prevalent, and is a problem with the oil layer of the tear film,
it is necessary to explain the nature of the tear film on the eye. The
tear film of our eye is made up of three layers. The first layer and the
one closest to the eye is the mucin layer which coats the eye and
allows the second layer, which is the aqueous layer to spread out
evenly. The mucin layer is produced by specialized "goblet cells".The
aqueous layer is the thickest layer and makes up at least 90% of the
total tear film. It is the layer that is produced by the lacrimal gland
and what people call "tears". The top layer which floats on the aqueous
layer is the oil layer and is produced by the meibomian glands in the
eyelids. The oil layer is very important because it prevents the aqueous
layer from evaporating, from breaking up, and from flowing right off
the eyeball. In order to help people with "meibomian gland dysfunction"
there are several things which are tried before going on to other types
of treatment which may be more problematic to implement. The first thing
is to apply heat to the eyelids in order to get the meibomian glands to
open and put out more oil. The easiest way to do this is to take a
nylon stocking and make a small sack which is filled with Uncle Ben's
converted rice. This will be placed in a microwave and heated for one
minute and will stay hot for the 10 to 15 minutes two or three times a
day that it will be applied over the closed eyelids. After that, it is
helpful to lightly massage the eyelids with the fingertip to express
more oil. The third thing which must be done is to use an eyedrop as
needed to help replace the oil layer when the eyes feel dry, or when
tearing since tearing means that the oil layer is not keeping the
aqueous layer in place. The best drop at this time is one called
"Systane Balance" since it is the first to actually mimic and replace
the oil layer. Artificial tears in the past were only lubricants. The
last intervention added to this regimen is Erythromycin ointment which
is placed inside the lower eyelids at bedtime in order to lubricate the
eyes while sleeping and to help keep the meibomian glands open. It may
also have effects on the meibomian glands that improve their function
through a mechanism which has not been totally elucidated. It is also
recommended that fish oil be taken daily as well as a multivitamin in
order to support the basic physiology of the eye including the oil
glands. Beyond these treatments are such things as the punctal plugs and
Restasis which may also help if there is also a component of aqueous
deficiency. This can be determined with the "Schirmer test" which uses a
strip of filter paper to measure tear production over several minutes.
Oil layer function is assessed by looking at the oil as it comes out of
the glands when pressed by the examiner at the biomicroscope in the
office. A normal oil is clear and thin. Abnormal oil is thicker and
cloudier. It can get to a point where it resembles toothpaste coming out
of the tube. Another way of testing the oil layer is to measure the
"tear break-up time". This involves placing a fluorescent dye in the
tear film and measuring how long it takes to start breaking up. A time
of less than 15 seconds is indicative of a dysfunctional oil layer. Oral
Doxycycline can be taken as a short course as it has been found to
improve meibomian gland function as well. As a last thought, it can be very good for the eyes as well as the skin to use some type of humidification system to put more moisture in the air especially during the winter months. |
Eye thought
Posted on August 9, 2011 at 12:23 PM |
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Believe only half of what you see. The trick is to be able to tell which half. |
Eye thought
Posted on August 9, 2011 at 12:18 PM |
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If the eye were simple, we wouldn't understand it. |
Eye thought
Posted on July 29, 2011 at 11:27 AM |
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From the eyes, sight; from the mind, vision. |
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