A Common Affliction Often Overlooked Why And How It Should Be Treated
By Jeffrey B. Minkovitz, M.D.
Dry Eye is one of the most common eye conditions. It is not only bothersome, but it can cause significant damage if left untreated. Proper diagnosis can also lead to discovery and treatment of other related conditions in the body. Simply defined, Dry Eye is a condition in which one’s natural tears do not adequately lubricate the eyes to keep them comfortable and healthy. Symptoms may include stinging, burning or scratchy feeling, as well as light sensitivity, blurring and eye fatigue. Ironically, dry eye induced irritation may also cause excessive compensatory tearing.
Dry Eyes may be caused by either insufficient tear production or excessive tear evaporation. Diminished tear production (Aqueous Deficiency) is commonly caused by aging (especially over 50), hormonal changes (especially women), drugs such as antihistamines and certain blood pressure medications, medical conditions including rheumatoid arthritis and Sjogrens Syndrome, and occasionally trauma or laser vision correction (especially when done with LASIK flaps – one reason I have transitioned to laser vision correction WITHOUT FLAPS). Excessive tear evaporation may be environmental (dry heat in the winter, or air blowing directly on the eye), behavioral/structural (poor blinking due to lid abnormalities, sleeping with eyes slightly open, or failing to blink while concentrating for long periods of time reading or in computer work) or due to an imbalance in the tear composition. The normal tear film has three important layers (watery, oily and mucus). Correct balance is required to ensure adequate wetting, good tear spread, and slower evaporation from the surface of the eye.
In addition to discomfort, Dry Eye can cause blurry vision, infection, abrasions, inflammation (which causes further damage), and scarring of the surface (which can lead to permanent vision loss). Dry eyes can also complicate planned ocular surgeries performed for other reasons, such as cataract and refractive surgery.
Testing for dry eyes is important not only to properly diagnose and guide treatment, but also to identify possible systemic diseases, (diseases in the body) which may be associated. These conditions include rheumatoid arthritis, Sjogrens Syndrome, and other autoimmune and collagen vascular diseases such as Lupus. Evaluation includes a careful patient history, examination of the ocular surface (with special dyes testing for damaged surface cells), and if indicated a measurement of tear volume and production. Recently, several new tests have been developed including tear osmolarity and measurements for inflammatory markers associated with dry eye. These tests may further assist in directing treatment.
Treatment options include environmental and behavioral changes (humidifiers, avoiding wind or direct exposure, taking breaks from extended periods of reading/ computer work, smoking cessation), instilling artificial tears (choices dictated by disease severity and type (aqueous deficient or evaporative), plugging tear ducts (to keep tears in contact with the eye longer), anti-inflammatory medication (steroid drops or Restasis), omega 3 fatty acid pills and diet, special therapeutic contact lenses, and several other less common options for severely affected patients.
Although often overlooked or disregarded when compared to “more serious” ocular conditions such as cataract, macular degeneration, and diabetic retinal disease, dry eye is one of the most common ocular diseases and can profoundly affect ocular comfort and visual performance. Regular examinations are a valuable way to screen for this and other conditions.
Jeffrey Minkovitz, MD is an ophthalmologist with Eye Physicians and Surgeons in Wilmington, Delaware. Dr. Minkovitz specializes in cataract and refractive surgery, and is one of only a few Delaware surgeons specially trained in corneal transplantation. He completed a cornea and refractive surgery fellowship at the renowned Wilmer Eye Institute of Johns Hopkins. Previously, he graduated magna cum-laude from Harvard, earned his medical degree from the University of Massachusetts, completed internship at Harvard’s Mt. Auburn Hospital, and served his ophthalmology residency at Washington University.
Dr. Minkovitz participated in the early research on Excimer Laser refractive surgery, and has offered this procedure to Delawareans since FDA approval in 1996, before Delaware had its own laser. These early pioneering individuals travelled to Wilmer Institute with Dr. Minkovitz, where he maintained his teaching and clinical appointment. In addition to introducing laser vision correction to Delaware, he also introduced NearVision CK to eliminate reading glasses, DSAEK (a newer, less invasive type of corneal transplant) and most recently the newest advance: laser cataract surgery.
Dr. Minkovitz is a co-founder of the Center for Advanced Surgical Arts and serves on its medical advisory board. He is also on active staff at Christiana Care. While on staff of Wilmer at Johns Hopkins University, Dr. Minkovitz received the Outstanding Teacher award. He was also named Top Doc in ophthalmology by Delaware Today Magazine six consecutive years, and has been an invited instructor at American Academy of Ophthalmology Annual Meetings.
For further information or to schedule an appointment please call 302-656-2020 extension 1.
“Best surgeon ever! Dr. Jeffery has the greatest staff from the receptionist to the surgical nurses. Wonderful results.” ~ Rosalie R.
“It finally occurred to me what has been missing during the last 2 days. Since Richard’s surgery, he isn’t complaining about his inability to read something on the fly without searching for his glasses. He wired 6 recessed lights (NO GLASSES), he read the Sunday paper sections A & B and menus (NO GLASSES), and is using the computer (NO GLASSES). I suppose for Richard, needing to look for glasses when he wanted to see something, has been the hardest adjustment of becoming older. His dependence was so gradual that I never related to why he would get so angry over needing them. My house has been quieter. I now have 2 less things to do everyday: find the glasses and make sure they were clean!”