What Causes Dry Eye DiseaseOct 8, 2013
Host: Fall? Dry eye season? What do you do about it? First of all, we're going to find out what causes it. Second of all, we're going to find out what you can do about it, including maybe some things you've never heard of before.
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Host: We're talking to Dr. Majid Moshirfar from the Moran eye center. So tell me, dry eye syndrome. I know this seems like a simple question and a silly question but, what is it?
Dr. Majid Moshirfar: No, there is no silly question. Indeed, dry eye syndrome, or what people call dry eye disease, is an inflammatory disease process. Very interestingly, we all thought that if somebody had a dry eye, it simply meant that they have insufficiency of their tear film. That was the naive thinking that we all had in the 1960's and 1970's and 1980's. But thanks to some very good clinicians and symposiums, now we believe that dry eye disease is an inflammatory process that happens on the surface of the eye on the ocular surface.
It doesn't have to do necessarily with lack of tear film, but it can be also the poor quality of the tear film. It could be that the electrolytes, or the sodium or the potassium that are in our tear film, they could be abnormal. Or the immunoglobulins that are in our tear film could be abnormal. So this naive thinking that dry eye is simply a lack of tear is a very wrong misconception that we all have. I think that we should believe that this is an inflammatory process that requires us to pay a lot of attention to how to prevent it or how to improve it.
Host: That's interesting. It's a disease; it's not just a condition.
Dr. Majid Moshirfar: No, it is actually a disease.
Host: So, redefining what it is really probably redefines what I would do about it. I would think, if I have dry eyes, I go to the store, I get some eye drops. I keep dropping them until I feel better.
Dr. Majid Moshirfar: And that's actually the wrong that you can do. Because when you go into the store and you look in the hygiene section and look at the eye section, and you choose some of those artificial tears, that's what you're talking about. Some of those artificial tears, many of them actually have preservatives in them. And if you keep putting those artificial tears with the preservative inside your eye, you're actually going to create a secondary allergic reaction to the preservatives that are inside it.
Host: You're making it worse.
Dr. Majid Moshirfar: Yes. You did the right thing by choosing artificial tears, but you have been putting in tears that have a lot of preservatives in them and that is not the right thing to do. You need to look for artificial tears that are preservative-free.
Host: And those are okay?
Dr. Majid Moshirfar: Those are absolutely what we recommend our patients, that's our first line of defense against dry eye disease.
Host: So then would you, if you had dry eye disease and this is the first line of defense, is this something that you would use for the rest of your life then, or just as...
Dr. Majid Moshirfar: It's very interesting, because it's just like any disease, any prevention that we can do. I think nowadays medicine is about prevention and about educating. If you see my patients who are in their 30s and 40s, if these individuals approached them nicely in the beginning, all you need is maybe one or two drops a day. Maybe in the morning and maybe in the afternoon. But when you see somebody who is 80 years old, and they've had all these problems for years and years, they've already destroyed a lot of the surface integrity, a lot of those stem cells, a lot of those what we call goblet cells or mucocele cells. So what happens is that it's very important that we start tackling ocular surface inflammatory disease early on.
Host: I had Lasik done, and they did something. They plugged my tear ducts. Is that something that can be done?
Dr. Majid Moshirfar: Right. And as I told you, when people have dry eye disease because of whatever reason, whether it was Lasik, or thyroid eye disease. When you have a bad flu or pneumonia and you're taking a lot of sinus medications to get rid of your nasal congestion.
Host: What about foods that you eat? Could that cause dry eyes? Alcohol? Stuff like that?
Dr. Majid Moshirfar: Absolutely. Poor diet. I really really believe that people who have a very poor diet with a poor balance of their nutrition can have dry eyes. And I see this many times. Patients who come to me and they've been on a rigorous diet, to lose 50, 60, 100 pounds. And I see them, they actually develop what I call a secondary ocular surface dryness. So you need to have a well-balanced diet. We recommend a lot of our patients to take fish oil in order to improve the status of their tear film.
Host: Okay, so we talked about the proper eyedrops, without the preservatives, we've talked about possibly plugging the tear ducts which is something else that can be done. What are some other procedures if those aren't working?
Dr. Majid Moshirfar: One of the things that we do is first of all you need to catch the patients at the earlier stages of dry eye, and then -
Host: Yeah, because it gets worse as you go on.
Dr. Majid Moshirfar: Absolutely.
Host: I mean, if you don't catch this right away, it's just getting worse and worse.
Dr. Majid Moshirfar: It's like a patient who has a bad joint or a bad rheumatoid arthritis.
Host: That's new, that's news to me.
Dr. Majid Moshirfar: Yes. And so rheumatoid arthritis, if you don't take care of them, they get to a point where they need to have a total knee replacement and more. So it's important to catch that earlier stage. So to answer your question, we are very fortunate because now we have some medications that we actually prescribe by prescription that you can actually pick up from a pharmacy, and these medicines are very good at improving the secretion of your tear film. So we are actually not encouraging people just to use artificial tears. We actually make your own glands to make tears in your eyes. And one of them is called Restasis. We use very safe cortical steroids to put inside your eyes to encourage the secretion of your tear film and also reduce the inflammation of the ocular surface. So, yes, there are medications we can implement, there are punctal plugs, humidifiers at the working environment or at home, some little humidifier next to your bedside. A lot of these things can also help as well.
Host: And I read, this sounds crazy to me, about an implant that actually, you called it a little gummy bear.
Dr. Majid Moshirfar: That's right. They're called Lacrisert, and they're amazing. There are some patients that need this little tiny gel, almost like a little tiny capsule if you want to think about it. Like a very small, small, small, small gummy bear that you actually put underneath your lid. You tuck it underneath there, and it's like a little tiny capsule of gel that secretes a lubricating substance throughout the day and keeps your surface completely moist. And all you have to do is, you put this Lacrisert in at the beginning of the day, and it goes all the way, 24 hours. So they're very rewarding for some patients.
Host: Oh, so that's just something that a person puts in every day.
Dr. Majid Moshirfar: That's right. Yes.
Host: So I go into my eye doctor, what do I need to tell them so they know what I'm talking about?
Dr. Majid Moshirfar: First of all, I think when you see your doctor, most of the eye care physicians are very astute about this. They know what to do, they have some tests.
Host: It's a fairly common thing now.
Dr. Majid Moshirfar: Yes. As a matter of fact, 80% of most ophthalmologic visits, one of the complaints that the patients have is in a way related to ocular surface dryness. Now maybe not the disease, but a mild spectrum of that.
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