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John C Hagan III, MD, FACS, FAAO  
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Kansas City, MO

Specialties: Ophthalmology

Interests: Eye-Medical Blog

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General information on dry eyes/tears dysfunction syndrome

Dec 11, 2009 - 21 comments

General Information on Dry Eyes-Now known as Tears Dysfunction Syndrome.

September 2013 UPDATE:  Restasis has become the #1 most prescribed eye drop in the USA and most other developed countries. It is the preferred treatment for moderate or severe dry eyes. Improvement can occur for up to 1 year.  It works for the eye with no tears or the eye that waters all the time. If often stings or burns when first starting and many ophthalmologists use a mild steroid eye drop for a couple of weeks to reduce swelling. Restasis is not an artificial tear but is cyclosporin. Over 4-6 months Restasis reduces inflammation on the surface of the eye and improves the quality and quantity of the tear  (which has a protein, a fat (lipid) and a watery (aqueous) component.

Also recent research has documented the effect of omega 3 fatty acids taken orally 2 or 3/day.  This includes high quality enteric coated fish oil or other ocean based Omega 3 such as made from krill or calamari. Omega 3 helps dry skin, dry mouth and dry hair.  This also often takes 3-6 months to get maximum benefit and needs to be continued. Important to understand NO IMPROVEMENT MAY OCCUR FOR 4-6 MONTHS.

Both Restasis and Omega 3 are normally taken for life.  A recent study stating fish oil increased risk of prostate cancer in men is wrong.  Omega 3 does NOT increase the risk of prostate cancer *See Missouri Medicine medical journal July/August 2013.

END OF UPDATE 2013

ORIGINAL POST 2009
a Schirmer test of zero indicates that severe dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical compies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops. Eye drops for dryness are classified as preserved drops (individual vials that must be used within 24 hrs), preserved drops, gels and ointments. The preserved drops are more expensive and usually only help the small percentage of people that are really allergic to preservatives. Gels and ointments are normally used at night since regular tears won’t last all night.   There is also an over the counter spray for dry eyes called “Tears Again”.  Tears may need to be used as often as 6 times/day.

If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 6 months of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes four months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. Improvement often continues for up to 12 months.

If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.

Be sure to try Nature’s Tear’s Eyemist a spray for dry eyes that works for many people. It is available without a prescription.  http://www.naturestears.com/

Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.

Ask your ophthalmologist (Eye MD) about Lacriserts. These were unavailable for several years and are now on the market by Aton Pharma. They are very tiny pellets of hydroxypropyl cellulose that are placed between the eye lid and the eye and slowly dissolve over 24 hours coating the eye with a moisturizing coat.  They are a prescription medication.

In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.

If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.

If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise. A final new treatment that they can often do is “Autologist Platelete-rich plasma” therapy. This uses eyedrops made out of your blood products. (reference Ocular Surgery News: November 1, 2007 page 46  lead author Jorge Alio MD.

Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.


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by toughilou, Aug 05, 2011
This is a very enlightening article. I enjoyed it very much.

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by Dalubaba, Sep 11, 2011
I was operated for cataract in April10. I have dry AMD in left eye. This operation was successful. I can read with my glasses and a magnigying glass or magnified text (This Posting's size, i can read without magnifying glass) The right eye is useless for reading because of failed operation)
My new proble; Since last two or three months-when i read a text in a computer, words emerge one by one in the last but one line of a paragraph. Beginning half line will be OK.The last half line shows emerging words. It happens Once or twice a day. It is not creating any problem at present. However it is a unheard problem.It will be always in the last but one line of a paragrph and start from the second half of the line. Operation was done by FECO (spelling?) procedure. I am 81. Surf for about 5 or 6 hours a day.I do not do any other activity.Would you plase comment on this? I know It is a tardy presentation. I hope you will be able to infer what my problem is. thanks.

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by John C Hagan III, MD, FACS, FAAOBlank, Nov 07, 2011
TO: Dalubaba: You need to see an ophthalmologist Eye MD. You should have an amsler grid test and visual field. You could have a visual field defect or you may be having transient ischemic attacks (TIAs) causing the problem. It's not normal, its new and it needs a full work up.

JCH MD

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by sapphire88, Jan 30, 2012
Dear Dr Hagan, I am a 56 yr old female and i've had severe dry eyes for 3 years now.. i also have lots of floaters and also have glaucoma.  

I tried Restasis for my dry eyes but because of the stinging effect, my opthalmologist said to stop it.  So instead, he has put 2 punctal plugs on each eye and i've had these on for maybe over 2 years now.  I am now concerned with the disadvantages or side effects of prolonged use as my doctor has not explained to me anything.   Additionally, he told me about a year ago that one plug must have "popped out" because it is not in my eye anymore.  I have read that plugs can get 'lost' in the eye and might need to be removed surgically.  Now i am very much worried that I have 1 plug that may still be in my eye somewhere.  Is this possible ?    

Currently,  my eyes are constantly tearing all day which is really so uncomfortable.  I just saw my opthalmologist today because yesterday all day my eyes were stinging and burning.   I have told my opthalmologist all my discomforts but he said i have to just suffer through it because of the severe dryness of my eyes.  I am really getting so frustrated because there seems to be no cure given to me by my doctor..  

I appreciate any advice you can give me.  Thank you very much in advance.

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by jipulmodi, Apr 18, 2012
Dear Dr Hagan, I am a 29 years old male, I have problem last three years to seeing opposit my eye some black clouds, Also deficiecy of Vitamin B12. I treated good doctors & retina specialist but they were said nothing in your eyes. In sunlight I am not able to see very clearity the eye is closed. Can you give me any remedies for this type of matters & guide me sir wat I will do for next step. I dont want loose my eye.

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by nolanryder, Oct 23, 2012
Thank you Doctor for the information!  I like your suggestion of using natural elements to help in the process. I take fish oils to help me.  I believe that after a surgery and the proper medicaments, that natural oils or vitamins really help our body recover and improve exponentially. Finding a proper  eye doctor in Chicago was the first thing on my mind.  Nature's Tear's Eyemist is available without a prescription, are there any prescription eye products that you would suggest?

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by John C Hagan III, MD, FACS, FAAOBlank, Nov 21, 2012
The definitive medication for dry eyes (either the no tears or the tears all the time type) is Restasis. Restasis has become the most widely prescribed eyedrop of any kind in the USA.
JCH MD

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by cristina2012, Jan 18, 2013
I am very concerned about my eyes. I was told i have severe dry eyes. After using many different eye drops, i find thera tears the best for my eyes. I also use restasis twice a day. I just haven't seen any improvement. It has me so worried that i can not seem to concentrate on anything but my eyes. It has taken over my life. I am not able to spend more then twenty minutes if that on any one thing. Examples are reading, tv, or my computer. Even without doing those activities, just sitting or getting dressed my eyes start shutting little by little. I want to scratch my eyes at times, when i wake up they are glued and i have to touch my walls till i reach my bathroom where i use baby shampoo with water to clean them. After twenty minutes later my eyes feel tired as if i have been straining all day. I am 51 and i am hoping someone can give me any advise. This is my first post. Please help me. Thank you for taking the time to read this. Be safe and God Bless !

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by ansammousa91, Feb 04, 2013
thank you Dr for your beneficial informations

I'm an optometry student in my 4th year and I want to know about CIEs and If you can put a lecture that includes how to diagnose  and manage those pts with CIEs due to contacl lens wear and what are the suitable questions that we should ask for the pt also what  are the main Symptomes that can be so obvious for CIEs


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by ansammousa91, Feb 04, 2013
thank you Dr for your beneficial informations

I'm an optometry student in my 4th year and I want to know about CIEs and If you can put a lecture that includes how to diagnose  and manage those pts with CIEs due to contacl lens wear and what are the suitable questions that we should ask for the pt also what  are the main Symptomes that can be so obvious for CIEs


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by adriana229, Mar 21, 2013
I need some help my husband woke up with a swollen eye for three days now its really swollen now and he  feels a burning feeling in his eye please can you tell me what is wrong ?and what can I do to help my husband please it urgent

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by olokereke, Nov 24, 2013
Dear Doctor,
My left eye is cloudy and I do not see much looking straight, can only see slightly on the sides. What could be done to correct this defect?
Okereke

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by michael830, Nov 27, 2013
Dear Dr. Hagen, I am a 69 year old male that is contemplating cataract surgery. One of my concerns is that I have had rather severe dry eye for several years. I have been treated with punctual plugs, fish oil and Optive artificial tears. I tried Restasis three different times but always discontinued it because of the burning sensation. Having read this blog I realize that I and my doctors have given up on that medication way too early and I need to try again. Though I have not had a confirming biopsy, my PCP tells me that he suspects my dry eye, dry mouth, frequently clogged salivary glands, Raynaud's and joint pain are likely the result of Sjogren's. Would that diagnosis significantly affect my decision regarding cataract surgery?

Michael

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by John C Hagan III, MD, FACS, FAAOBlank, Nov 27, 2013
M  830  Your physicians can use a steroid drop like lotomax for 4-6 weeks if you go back on restasis again. Usually the stinging stops after a couple of months.  No it is not likely that the risk of cataract surgery will be much higher than normal
JCH MD

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by csondone, Jan 10, 2014
What would you suggest for dry eyes other than Restasis?  It is to expensive even with my Part D Medicare. With all the other medications I take this is not good money wise.  I am 69, had cataract surgeries 4 years ago then diagnosed for dye eyes.

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by John C Hagan III, MD, FACS, FAAOBlank, Jan 10, 2014
Read my article on Dry Eyes on my blog or Today's Pulse

JCH MD

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by memorymaker, Jan 31, 2014
Im am 43yrs old and was told Ive got really bad dry eyes and oddly enough my eye dr, found that my right eye is actually drier then my left. This condition is very annoying and uncomfortable question is, will it ever go away?

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by John C Hagan III, MD, FACS, FAAOBlank, Jan 31, 2014
No one can say for sure. In younger individuals less than 40 it can wax and wane but in those older than 40 especially females it tends to get worse. You would do well to re-read the article and engage and ophthalmologist to start working through the treatments

JCH MD

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by memorymaker, Feb 01, 2014
Thank u very much for ur timely answer Dr,Hagan. Wish it was better news but I am going to take ur advice:-)

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by Dalubaba, Feb 26, 2014
when I awake in the morning, some time I may see a geometrical design on the wall and ceiling of the room. It disappears when I close my eyes for some time. I searched in the internet and found Charles Bonnet Syndrome. It matches my symptom.Do I need to worry about this symptoms???

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by John C Hagan III, MD, FACS, FAAOBlank, Feb 26, 2014
That symptom does not suggest CBS.  See an ophthalmologist for an evaluation.

JCH MD

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