Treatment of dry eye disease explored at expo

Monday, Sept. 19, 2005 | 10:05 a.m.

As a young eye doctor, Douglas Devries spent some time exploring the deserts of Saudi Arabia wearing rigid contact lenses.

With daily desert temperatures between 125 and 135 degrees, combined with blowing sand, "I had a lot of red eyes over there," said the doctor who practices at EyeCare Associates, a company with offices in Las Vegas and Reno. Both cities have hot, dry air and plenty of dust.

At last week's International Vision Expo West in Las Vegas, Devries and other ophthalmologists and optometrists shared information about treating dry eyes.

The Food and Drug Administration, as well as medical researcher, are searching for solutions to prevent and control the disease.

Medical researchers have identified dry eye disease, or ocular surface disease, as a growing problem in the United States. It occurs in all age groups.

"For many years doctors thought that it was a normal part of aging," Devries said, but what researchers have discovered is a more complex problem.

Several conditions in and around the eyes are involved with the potential for developing dry eye disease with accompanying infections based on certain triggers, Devries said.

Blurring, itching, dry and scratchy eyes are symptoms.

Studies have found that women are more likely to have dry eyes than men, and menopausal women are at the highest risk for the disease.

But living in a desert adds an environmental factor that crosses gender and age lines, Devries said.

Dr. Jack Abrams with Southwest Medical Associates in Las Vegas said he estimates that 15 percent of adults suffer from dry eyes.

"Vegas is very dry and the winds make it worse," Abrams said.

For some people, dry eye disease can be devastating, interfering with daily tasks such as reading, driving and working at a computer, Abrams said.

Some of those activities also aggravate the symptoms of dry eyes.

"During certain activities, such as computer use or driving, people spend a lot of time concentrating and blink less frequently, about three times less than normally," said Michael Slusky, a Chicago-based optometrist.

Failing to blink is particularly bad for contact wearers because it dries the contact lenses quickly, leading to discomfort from a lack of tears.

Tears are not just salt water. They contain electrolytes, proteins and growth factors that help the tissues of the cornea heal -- fast. A rip in the cornea heals overnight, Devries said.

The eyelids also have glands that secrete oil, which helps reduce the evaporation of tears and mucous that floats on the eye's surface, keeping the tears in the eyes longer.

The outer coating of the eyeball is not as thick as the cornea, but it sheds 10 percent of its surface daily and helps protect the eye from infection, Devries said.

However, dry eye disease can make the eyes vulnerable to infections by increasing the sloughing of the surface cells.

If a person suffers from allergies, that makes dry eye worse, part of a cycle of discomfort. On the other hand, if you have dry eye disease, it makes allergies worse, Devries said.

"Prevention is best," he said.

One of the simplest ways to protect eyes involves washing the eyelashes off with plain water to clear the gunk caught between the lashes and preventing the oil glands from becoming infected with bacteria. Some doctors advise their patients to use baby shampoo once or twice a day on their eyes and lashes.

Prescription eye drops designed to fight the problem are available as well, including one version containing Cyclosporin, and they can be effective, Devries said.

But over-the-counter eye drops can make dry eyes worse, he said. Preservatives in some drops, antihistamines for allergies and other medications may exacerbate the dryness.

Another simple solution involves blinking more often.

Staring at a computer screen, television or reading a book too long can irritate them because people blink less when concentrating on a task.

"Look away and blink more," Devries said, an action that allows natural tears to refresh the eyes.

Doctors also need to pay attention to how much water their patients drink. Eyes are affected by the lack of moisture, just like the rest of the body, Devries said.

If all else fails, doctors can treat the disease more aggressively. They can plug a tear duct in each eye, preventing the tears from draining away, "just like a stopper in a sink," Devries said.

Each eye has two tear ducts, so by plugging one duct in each eye, many patients get relief. That approach is used by many people who get laser eye surgery to correct their vision. The duct plugs dissolve eventually.

In the most severe cases of dry eye, doctors can use lasers to close tear ducts permanently. The laser is used to close the ducts with scar tissue.

There are some promising contact lenses being developed that preserve natural tear production as well, the experts said.

Those with symptoms of dry eye disease should make an appointment to see their eye doctor, both Devries and Abrams agreed.

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