Sore eyes?

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Many people describe eyes that burn, sting. tear, itch, and are generally uncomfortable or even painful. These are symptoms of ocular surface disease. This is usually not a serious condition but can be very bothersome for people and have a significant impact on ones quality of life. Ocular surface disease refers to anything that causes inflammation on the surface of the eye which may result in the sensation of pain or discomfort. The main underlying causes relate to dry eye or blepharitis. Often there is a component of both involved. There are occassionaly more serious causes underlying these symptoms so if they don't respond to conservative treatment or are associated with significant pain or loss of vision it is important to seek medical attention.

Dry eye is a very common condition. There are many potential causes for this including medications, aging, autoimmune disease, genetics,  and many others. The reality is in many cases we don't know why people acquire this condition and we just treat it. The main problem in a patient with a primary dry eye, or aqueous tear deficiency, is that tears are inadequately produced. It is very important for both the comfort of the eye and for good vision to have a healthy tear film overlying the corneal surface. 

We generally treat this in a stepwise fashion outlined below:

1. Supplemental lubrication - this is the first step one should take. A good quality lubricating eye drop should be put in the eye 4 times per day. Systane and Refresh are examples of high quality drops but there are many others as well. It is important to avoid Visine type products as these are not tear supplement drops but rather medications to make the eye look white but don't help the underlying condition. If a drop is to be taken more than 4 times per day - which is often required, a non-preserved type of tear drop should be used. This is because the preservatives in regular eye drops can become irritating to the eye if applied too frequently. There are a variety of non-preserved types of systane and refresh products that will come in small individual use vials. The other option is non-preserved drops that come in multi-use bottles. Examples include Hylo and Hydrasense. 
2. Warm compresses - for many dry eye patients there is also an element of blepharitis, which refers to inflammation on the eyelid margins. Warm compresses and described below are helpful for many dry eye patients and should be a consistent part of the treatment regimen.
3. Environmental measures - there are a number of environmental factors that can exacerbate a dry eye and paying some attention to these can often help improve symptoms.  Any activity that requires visual attention, such as reading or watching television, causes your rate of blinking to decrease and can exacerbate a dry eye. It is important to remember to take breaks while doing these activities to briefly close and rest the eyes. A humidifier in your home can be helpful as well. Glasses or sunglasses can be helpful, especially outdoors where exposure and wind can aggravate symptoms.
4. Medical treatment - there are several medications available for patients with more persistent or severe dry eye symptoms that are not controlled with the conservative measures. The main medications are Restasis and Xiidra. More information can be found via the links below.
5. Punctual occlusion - this option involves plugging the small holes, called puncta, on the eyelids that drain tears. By "plugging the drain",  tears are preserved on the ocular surface where they can remain to protect the ocular surface. There are a variety of temporary and permanent options for punctual plugs. A straightforward office based procedure called punctual cautery can also be used to more permanently close the punctal openings for select patients.
6. Omega 3 supplementation - there is some evidence that supplement with omega-3 is beneficial for dry eye patient. The evidence for benefit is somewhat controversial but the risk of these dietary supplements is low and there may be other systemic benefits. Generally this is something one may consider with persistent symptoms or suboptimal control of their ocular surface symptoms despite the standard conservative measures described above.
7. Next steps - While the above steps are effective for most patients when done properly for an adequate amount of time, some patients will require additional treatment. Dr. Leonard will discuss the options with you.

Blepharitis is a common and ongoing condition where the eyelids become inflamed (swollen), with oily particles and bacteria coating the eyelid margin near the base of the eyelashes. This condition causes irritation, itchiness, redness, blurred vision and stinging or burning of the eyes. While the underlying causes of blepharitis aren't completely understood, it can be associated with bacterial eye infection, symptoms of dry eyes, and certain types of skin conditions such as acne rosacea. 

Blepharitis is also  treated in a  step-wise fashion outlined below:

1. Warm Compresses - an effective warm compress requires approximately 4 minutes of consistent heat applied to the closed eyelids. This can be done with a clean washcloth wet with warm water. In order to maintain warmth for 4 minutes this will have to be re-wet several times. There are various products on the market which are good alternatives to this. One of these is the Bruder mask which is heated in the microwave and can then provide 4 minutes of consistent, warm, moist heat which is very effective. See link below to product information. These can be purchased at St Lawrence Eye Centre.
2. Eyelid Scrubs - after the warm compress it is important to clean the eyelid margins. Using a clean washcloth, cotton swab or commercial lint-free pad soaked in warm water, gently scrub the lid margin and  eyelashes. Dilute baby shampoo can be helpful if there is significant crusting on the lashes. 
3. Lubrication - as described above, an artificial tear drop should be used approximately 4 times per day. This can often be decreased later once the symptoms improve.
4. Antibiotic Ointment - there are several topical antibiotic ointments which may provide some benefit. If prescribed, these should be applied using a clean fingertip or cotton swab, gently applying a small amount at the base of the eyelashes before bedtime. It is OK if this goes in the eye, but it should be applied to the lashes primarily.
5. Oral Antibiotics - certain oral antibiotics, most commonly Doxycycline, may be prescribed for you to use. This is not used like a normal antibiotic for infections, but is continued for a 3 month course. If this is prescribed Dr. Leonard will review the potential side effects with you.
6. Omega 3 - Omega 3 supplements may help to improve the symptoms of blepharitis.
7. Next steps - While the above steps are effective for most patients when done properly for an adequate amount of time, some patients will require additional treatment. Dr. Leonard will discuss the options with you.