The weather is becoming crisp allowing us to break out cozy blankets, fleece-lined boots, and snuggle by the fire. The holiday season is approaching. It’s the most wonderful time of the year, right? For most this is true but for many others it means dry, burning, itchy, gritty, tearing eyes. In Game of Thrones they would often say “Winter is coming” quite ominously, well as an eye care professional I always say “Dry Eye season is coming”. Having eyes that are uncomfortable, irritated, and red can put a damper on all the fun activities that can happen between November and March (if you live in the Northeast though you know there’s also second winter, false spring, third winter, etc).
In the past, there was only one option: if your eyes were dry we could offer one prescription drop and if it worked, great. But if not, copious lubrication with over the counter artificial tears was a patient’s only hope. We now know that “dry eye” is multifactorial and because of this there are multiple, more customizable options. Let’s go back a step: what causes dry eye? The two main types of dry eye are: aqueous deficient dry eye (there aren’t enough tears on the eye) and evaporative dry eye (the tears that you have don’t stay on and coat the eye properly). A decrease in tear production can be related to systemic medications, autoimmune diseases, and genetics. Women more than men tend to have dry eye especially with hormonal/estrogen level changes. Evaporative dry eye is related to changes in the oil component of the tear film. Evaporation increases if the oil glands in the eyelids are not functioning properly. Also, blinking less causes less oil to be released from these glands resulting in increased evaporation. When do most people blink less? Certain diseases like Parkinson’s, but more commonly from digital device use. Next time you’re scrolling through Instagram or on TikTok for hours on end check and see how your eyes feel after – studies have shown up to a 50% decrease in blink when on screens!
When people are diagnosed with Dry Eye Disease (DED), it’s usually a combination of aqueous deficiency and an evaporative component. As we’ve learned more about the causes of dry eye, treatments have expanded. Multiple prescription drops exist to help increase tear production like Restasis and Xiidra. For those that have poor dexterity or difficulty with using eye drops (we all know that person that has a blink reflex that would rival Thor’s strength) there’s a nasal spray available called Tyrvaya. If evaporative dry eye is more the culprit, a new drop called Miebo exists and is the only FDA approved drop to improve that top layer of tears and lower the rate of evaporation. Another option that has been available for years is punctal occlusion. This involves putting a small plug up to 2mm in length into the puncta. The puncta is that tiny hole in the corner of your lower lids that that’s where your tears drain. Placing this small plug works like putting a stopper in a sink and mechanically increases the amount of tears on the eye. This can be done solo or in conjunction with prescriptions to give a good one-two punch to dry eye. These plugs come in standard sizes and dissolve within 7-10 days or up to 6months depending on the material. Punctal plugs are inserted in the office within a few minutes and is completely painless. Punctal plugs have evolved as well. Pre-made plugs come in 0.1mm increments but even with different sizes available, if the plug is too small there isn’t adequate relief. If the plug is too big it can fall out. Not everyone’s drainage system was made in 0.1mm increments. For a more customized plug option, Lacrifill is available. Lacrifill is a Hyaluronic Acid gel that when inserted in the puncta fills the space entirely and slowly dissolves. Because the gel fills lower tear draining pipe more completely it can provide a full 6months for relief and eliminate complications with pre-made plugs such as premature loss, dislodgement, infection, irritation, and rubbing. After the gel dissolves it can be repeated as often as needed.
So, as we near the end of October and you’re turning on the heat, using pellet stoves, or enjoying a wood burning fire take note of how your eyes are feeling and functioning. If there are any signs of grittiness, dryness, burning, or even tearing (yes tearing is a sign the eyes are dry and inflamed), call. All the specialists here at Eye Care Northeast can evaluate the ocular surface and create a customized plan of care. Don’t let dry eyes ruin your holiday season.