Decreased tear production is a common occurrence as we all age and may occur secondary to many ocular surgeries. The symptoms may include but are not limited to a dry burning feeling, red eyes, and a sandy, gritty sensation. When patients enter our offices we usually categorize their disorders based on a variety of factors including age. Dry eye patients are not usually children and as a result this very common condition may go undiagnosed.

When a child rubs his/her eyes there may be a number of reasons, but while dry eyes are not often included in the differential diagnosis, it should be. The underlying causes of their symptoms and thus eye rubbing may be dry eyes caused by several anomalies. Inflammatory disease caused by such conditions as Sjogren’s, juvenile rheumatoid arthritis and viral disease may be just a few causes. Congenital disorders and poor nutrition including vitamin deficiencies can also cause dry eyes in the young. More serious diseases like diabetes and other vascular conditions may also be the reason.

In short, we must always consider dry eyes when a child enters our office with ocular symptoms. Excluding this common condition simply because of age will result in a misdiagnosis and very unhappy child and parent.

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Patients’ complaints of burning, dry and red eyes are often passed off as either nothing significant or a side bar of dry eyes. Many eye doctors simply recommend artificial tears and hope for the best. When these same individuals return with contact lens discomfort and related symptoms, they are more difficult to deal with.

While dry eyes are in many cases the etiology of the symptoms, the cure is more complex. The underlying reason for the dry eye condition must be determined in order to fully correct the problem. An often overlooked cause is Meibomian Gland Dysfunction (MGD). The Meibomian gland is responsible for secreting a very important component of the human tear, the oil component. Oil protects the tears from immediately evaporating. Without this important component, the tears would evaporate immediately, and the eye would be painfully dry. Therefore, in order to relieve an individual’s symptoms and, in some cases increase contact lens comfort and wear, this lid condition must be remediated.

The first step is to clean off the lids. This is best done by aggressive lid hygiene using diluted baby shampoo and a Q tip to perform lids scrubs on a regular basis. This should be followed by warm compresses and lid massage to express collected and trapped mucous and debris in the glands. Following the lids scrubs Azasite, a prescription medication, should be instilled as this new antibiotic performs two functions. The first is bactericidal and the second is anti-inflammatory. It rehabilitates the lid margins. Additionally, omega III supplements should be taken as they will increase tear production. The patient must be told that this effect will take 2-3 months to begin and they must take the omega III regularly. Artificial tears should also be used on a regular basis as these will bridge the gap until the other therapies take hold. Finally, Restasis can be prescribed in certain cases to further increase the tear production. As with other medications, proper instructions must be given.

Avoiding contact lens wear during the initial phases of this therapy is recommended and can be modified on case by case basis. Of course, proper lens fit, hygiene and wearing schedules are a must.

Since MGD is a chronic condition, regular follow ups are recommended and regimen modification may occur.

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Exercise and good dietary habits have long been used as a way to improve health, lose weight and even reduce or eliminate certain medical conditions. Adult onset diabetes and hypertension are two conditions that significantly improve through exercise.

A recent article published in the BioMed Central Ophthalmology journal concluded that moderate aerobic exercise, such as running or cycling will temporarily reduce intraocular pressure (pressure in the eye). The study followed 7 groups of individuals including non medicated patients with normal intraocular pressures, patients with normal pressures taking Timolol Maleate (Timoptic; glaucoma medication), people with normal pressures taking Latanoprost (Xalatan; glaucoma medication), folks with normal pressures taking Brimonidine Tartrate (Alphagan; glaucoma medication), glaucoma patients taking Timoptic, glaucoma patients Xalatan, and glaucoma patients taking all three glaucoma medications.

The study concluded that all individuals demonstrated statistically lower intraocular pressures during and immediately following moderate aerobic exercise. The result was only temporary and therefore can not be used as a therapeutic modality, but does open the door to a multi-plan approach to treating glaucoma and bears further investigation. Exercise alone should not be the only method employed to lower the pressure, but as an adjunct to glaucoma therapy, all patients are advised to exercise at least 30 minutes per day.

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Seasonal allergies are a constant companion for many individuals and represent a major health factor for millions of Americans. Symptoms include sneezing, coughing, red itchy eyes, sore throat and even dark circles under the eyes.

Hay fever is often caused by pollens which are at the highest counts in higher heats, humidity and carbon dioxide concentration. Ragweed is the most common allergen in the fall which causes our immune system to release histamines and other inflammatory mediators. The spring is dominated by tree contributions, followed by flowers, weeds and molds. These all cause the same immune system response. In the United States about 75% of allergy sufferers are to ragweed and 10% are to trees.

Since we can not cure allergies, we must change our environment to best deal with them. When the outdoor allergens are high, try and stay indoors keeping the humidity below 50%. Change the filters on the air conditioners at least once a month and wear a mask outside when working in the garden. Be sure to wash hands immediately after out door activities, shower and change clothes often.

Contact lens wearers should consider reducing their wear during high allergen times and while working out doors. If contacts are worn then rub and rinse them frequently and use hydrogen peroxide systems like AOSept or OXYSept.

Medications can also be very helpful. Eye allergy drops like Patanol or Pataday are great at relieving the symptoms, and severe allergy suffers can benefit from mild topical steroid drops as well such as Lotemax or FML. Systemic antihistamines that can be purchased over the counter are useful as well, Claritin, Allegra, Benadryl etc.

Always inform your health care provider and eye doctor of all the medications that you are taking even the OTCs. They can interact with prescriptions that may be detrimental, or antagonize conditions such as glaucoma.

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