The Difficult Disease Doctors Hate

It was the disease none of the attending doctors wanted to deal with...

During my ophthalmology residency, I noticed that the senior physicians handed off all their patients with dry eye to the residents.

The attendings saw it as scut work... difficult to deal with and quite common, especially in older women. They simply didn't want the hassle.

But I saw dry eye differently. I've always tried to look at things from the patient's perspective. Chronic dry eye is a difficult disease to figure out and one that can cause painful complications and disruptions in everyday life.

Nearly 16.5 million Americans suffer from dry eye. And it stems from a number of different causes.

Today, I'm going to discuss ideas about why dry eye occurs and who is at risk of it. Then, I'll give you a tip on how to stop it in its tracks so you won't have to settle for burning, red, watery eyes any longer.

What Is Dry Eye?

Dry eye refers to a gritty, burning, itchy sensation in the eyes. It causes your eyes to water and become red. Sometimes it can make your eyes feel like they're glued shut in the morning. It can also make your eyes feel strained and more sensitive to light.

It occurs when you have a disruption to your tear film... the thin, clear, moisturizing coating that spreads out over your eye each time you blink.

Tears are fascinating, though. They're made up of three layers:

  1. A mucous layer that's produced by the meibomian glands under your eye. This layer sits closest to your eye.
  2. A watery layer that's produced by the lacrimal gland above your eye. This layer is sandwiched between the mucous layer and the next one, called the lipid layer.
  3. A lipid (fat) layer that's produced by the conjunctiva and cornea. This is the outermost layer of the tear film.

All three layers are needed to keep your eyes moist and lubricated. If you're having an issue with any of the four eye structures shown above, it can disrupt the moisture balance on the surface of your eyes.

What Causes Dry Eye

In addition to functional issues with your eyes, dry eye can stem from a wide array of issues...

When you reach your 50s, your tear production diminishes, and dry eye becomes more common. In particular, women going through menopause experience hormonal changes that make them more susceptible to dry eye.

The trouble is, the androgen hormone decreases during menopause. Androgen normally helps the lacrimal and meibomian glands produce the oil and fluids your eyes need to make high-quality tears. So declining androgen can redden women's eyes.

Dry eyes aren't limited to menopausal women, of course. Environmental factors like allergies, wind, high temperature, low humidity, high altitude, and air pollution can also cause the same effects. Contact lenses and not blinking enough can contribute, too. And biological changes that include autoimmune disease, inflamed eyelid glands, or allergic eye disease can also trigger dry eye.

Whatever the cause, dry eyes can become much more than a nuisance... They can interfere with your ability to live a normal, comfortable life.

If you're already suffering from this ailment, the right eyedrops can help.

My senior analyst Matt reads so intensely, he occasionally uses eyedrops to fight off dry eyes during the workday. If you want a good eyedrop, follow these rules...

  • You'll want something with glycerin or carboxymethyl cellulose. Keep in mind these make the drops a bit thicker in consistency, thus making it harder to see after using them. So you'll need to find a type that's comfortable for you.
  • Get dry-eye formulas only. Itchy or red-eye formulas contain extra chemicals that won't help.
  • Avoid too many ingredients... the simpler, the better.
  • Avoid anything with preservatives, especially benzalkonium chloride ("BAK"). This chemical not only causes cell damage, but it also triggers allergic reactions in some folks. You'll find the most preservatives in big bottles, so buy small bottles or single-use packets.

Do what I do and use the thick eyedrops at night, right before you go to bed. Depending on your vision, it can make things pretty blurry, so make sure you've gone to the bathroom and closed the house down before dosing your eyes with a heavy lube.

And whatever you do, do not buy any of the following products: EzriCare Artificial Tears, Delsam Pharma's Artificial Tears, and Delsam Pharma's Artificial Eye Ointment.

As of this writing, the U.S. government has linked these products (all from the same manufacturer) to 58 cases of Pseudomonas aeruginosa bacteria. Federal regulators say the manufacturer of these products, Global Pharma Healthcare, had inadequate safety testing and protocols, along with insufficient preservative in multiuse bottles (another reason to choose smaller bottles of eyedrops that don't need preservatives). In eight of those cases, people went blind... and a ninth person died. Global Pharma Healthcare agreed to recall these products.

Here are a couple of the preservative-free ones I trust... Systane lubricant eyedrops and Refresh lubricant eyedrops.

And if thick drops at night along with our other ideas don't work, there's one last thing you could try... using white skin tape to tape your eyes shut at night.

Back in my residency, many elderly women who'd failed everything else often swore by it. They said it really helped but took some getting used to. Just be sure to do one eye at a time and alternate nights.

People also use bubble patches and moisture cups that are meant to keep the eyes from drying out at night. However, most folks will succeed with just thicker lubricants.

Taking care of your eyes now will keep them healthier in the long term – and, for millions of people, much more comfortable even in the short term.

Don't forget the importance of simple steps like good nutrition, blinking frequently, and giving your eyes a break. And use the right eyedrops if your eyes are already bothering you.

It's difficult to diagnose the specific reason for someone's dry eyes, and we can't always control whether we develop them. But by taking these steps, you'll set yourself up for a more comfortable life.

Of course, it's better to prevent problems instead of treating them after you've already started suffering from them... In a recent issue of Retirement Millionaire, I outlined three ways to prevent dry eyes. If you're not already a subscriber, click here to get started today.

What We're Reading...

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
July 13, 2023