Chapter 7- Dry Eyes and Refractive Surgery

Dry eyes are very common after LASIK and Advanced Surface Ablation. In a normal eye this can occur for about two months following surgery. For an eye already dry before surgery, treatment must be undertaken to help the dry eyes situation. The following is a discussion of the causes and treatment of dry eyes.

CAUSES

1. EVAPORATION —omit air blowing across your eyes from a ceiling fan or CPAP machine.

2. HUMIDITY —humidify the air with a room humidifier. Heaters are also a cause of dry eyes.

3. BLINK RATE —if you blink less, your eyes may bother you more, as when using the computer.

4. MEDICATIONS —medicines for allergy, sinus, stomach, bladder, depression, high blood pressure, hormone supplements (Premarin, Estrogen) and oral contraceptives (birth control) can reduce tear production.

TREATMENTS

DRY EYES

1. DROPS —over the counter preservative free drops, such as GenTeal, Systane, Tears Again or Refresh Endura. Use one drop as frequently as needed during the day when the eye is dry.

2. OINTMENTS and GEL —over the counter preservative free preparations, such as GenTeal Gel or Tears Again gel at bedtime to lubricate the eye when asleep.

3. THERATEARS NUTRITION —a capsule of flax seed oil, vitamin E, and fish oil. 120 capsules cost $13.00/month at Walgreen’s, Target, K-Mart, Eckard Drug, Wal-Mart and others. Dosage is four capsules every morning.

4. PUNCTUM CLOSURE —each eyelid has two openings to the nose, one above and one below. Most of the tears exit through the lower punctum. A temporary lower lid plug lasts for several weeks. If this is beneficial, permanent closure can be completed with a cautery in the office.

5. Restasis 0.5% (cyclosporine ophthalmic drops) --Stimulates the lacrimal (tear) gland and oil glands of the lids. It is used twice a day and may take one to two months to see results. This medicine is used with severe, chronic, symptomatic dry eye without relief. The cost is $50.00 per month.

INFECTIONS

1. LID SCRUBS —removes the oil and bacteria from the lid margins.

2. DOXYCYCLINE —an antibiotic used with eyelid infections such as meibomianitis. Dosage is 50 mg twice a day for 14 days.

3. ANTIBIOTICS —such as Zymar (gatifloxacin) or Vigamox (moxifloxacin) for eye infections.

ALLERGIES

1. NON-STEROIDAL DROPS —can be used such as, Alocril (nedocromil sodium ophthalmic solution) , Zaditor (ketotifen fumarate ophthalmic solution) , Patanol (olopatadine hydrochloride ophthalmic solution) , or Elestat ( epinastine HCI ophthalmic solution). The symptoms are usually itching and may be accompanied by conjunctival edema and papillary conjunctivitis.

2. STEROID DROPS —these drops can cause glaucoma, cataracts, and enhance infections of the eye. Low-dosage with infrequent usage can be valuable in treatment of dry eye associated with allergy. Such eye drops are Alrex (loteprednol), Vexol (Rimexolone Ophthalmic Suspension) , or FML (fluorometholone) .

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