Finding relief for these old (not) cryin' eyes
June 1, 2020
I can't see clearly out of my right eye, I have a headache and in spite of blinking, the eye is uncomfortable. I have extreme dry eye. I went to an ophthalmologist who plugged the tear ducts into which the tears drain. Didn't help.
He gave me a sample prescription of Xiidra which would have cost $600 a month if it worked. It did not. In fact, I awoke feeling as though I'd dipped my entire eyeball into sand.
A second ophthalmologist prescribed prednisone drops which helped the irritation but not the blurry vision. What the heck is happening to my eye?
In my next appointment with him, I said, "I suspect low estrogen is the culprit."
"Absolutely," he agreed.
"What should I do about that?" I asked.
"Talk to your gynecologist," he replied with a shrug, "I do eyes."
He wrote directions for diluted baby shampoo eyewash, five-minute warm compresses, eye drops 4x a day, eye gel at night, a prescription for prednisone drops, and fish oil or flaxseed oil supplements.
He fixed me with a stern gaze, "You have a scratched cornea. You've lost vision. Stick to the treatment to try to recover it."
This doctor knows the cause is estrogen but treats the symptoms. Oh well, estrogen replacement research turns up conflicting information regarding whether it helps dry eyes, and I'm not inclined to take it anyway.
Let's see what's behind his treatment:
Baby shampoo wash: Removes dirt and makeup, a step toward eliminating "blepharitis," a dandruff of the eyelids which can cause dry eye.
Warm compresses, gentle massage with clean cloth: Loosens accumulated oil blocking eyelid glands. "This treatment is most important of all," he emphasizes.
Over-the-counter eye drops: Mayo Clinic and the doc both recommend preservative-free eye drops, applied four times a day to lubricate the surface of the eye.
Over-the-counter eye gel: Apply at bedtime as the thick coating causes blurred vision for a short time.
Anti-inflammatory meds: I was on a tapered dose of Prednisolone. Week one, four drops tapering to a single drop on week four. The very first drop magically reduced eye irritation and continued to diminish the scratchy feeling with each dose. Relief! After a month, he prescribed one drop a day for another month. Quick cure though prednisone is, I'm anxious to stop it, as it causes glaucoma and cataracts. Short duration, recommended.
Fish oil, or flaxseed oil or dietary flaxseed: I've opted for two tablespoons of ground flaxseed in my morning oatmeal. I've read that people benefit more from dietary sources of omega 3s than supplements.
Last week, late to watercolor class at the senior center, I told fellow artists I'd been to the doctor for dry eye. All around the table males and females had the same diagnosis. I shouldn't have been surprised to read a 2014 Journal of Ophthalmology article which tags dry eye's overall societal burden at $55.4 billion. Because so many people over 50 have dry eye, the health care system spends "$3.84 billion to support cost of ocular lubricants, cyclosporine, punctal plugs, nutritional supplements, and doctor visits as well as loss of workplace productivity."
Dry eye "raises the risk of falling twofold...risk of hip fracture, threefold," and the risk of depression doubles. Untreated dry eye can result in permanent vision loss.
The journal continues with a discussion of causes of dry eye including "polypharmacy," referring to senior's growing list of prescription drugs responsible for dry eye, including anti-hypertension drugs, diuretics, antihistamines, antidepressants, and ibuprofen among others. Lasik surgery can also contribute.
Some practical suggestions to alleviate dry eye include wearing wraparound sunglasses/visors, ball caps outdoors, taking blink breaks from screen time, using a humidifier inside during dry times, and no smoking.
Since I typed the first paragraph above, six weeks have passed. My eye has improved. One morning recently, I could see clearly out of it. As I type this, the cloudiness returns. Yes, I follow the regimen outlined by the doctor and will continue to do so, but my job is to sit in front of a computer. I love research and writing. My eyes don't. And, yes, I'm blinking.