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22 Mar 2018

DRY EYE RECOMMENDATIONS

Dry eye recommendations by Paul Anderson, NMD

Dry eye disease is a very common condition that affects 5–30% of the population.  “Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface”. [Dry Eye Workshop, 2007]  Additionally newer data find that a particular neuropathic phenomenon may additionally be contributory. [Rosenthal, 2014]

Given that “dry eye” can exist in dry and wet eyes a multifactorial approach is warranted and in my clinical experience most efficacious.  The outline below includes topical and internal approaches and may take up to six months to be maximally effective.  Standard ophthalmic therapies are omitted.

Internal Therapies (slow but necessary to re-establish proper gland function):

  • Vitamin A (not beta carotene) – 100,000 IU X 1 month then 50,000 IU for 2 months then 25,000 IU for maintenance.  In pregnancy 10,000-12,500 IU.
  • Flax oil or an Omega 3 source – 2 grams daily
  • Vitamin C – 1 gram TID with meals
  • Vitamin E (Ideally Mixed Tocopherols) – 800 IU daily for 1-2 months, then 400 IU daily
  • Alpha lipoic acid – 200-300 mg BID
  • Appropriate B-Vitamin support to include the B-Complex, Biotin and whichever active forms of folate and B-12 are tolerated by the patient.

Topical Therapies:

  • Calendula tea bags (steep then cool and apply to eyes nightly)
  • Vitamin A oil, with eyes closed put 1-2 drops into the inner canthus and let soak into eyes nightly (blinking the eyelids periodically will move the oil around.)
  • Consider a compounded Vit-A eye drop, and possibly an MSM-Antioxidant eye drop (Lloyd center pharmacy or Key compounding).
  • Even if irritating, continue the ‘artificial tears’ type drops multiple times daily.
  • Some patients respond to use of Similasan Dry Eye drops which are OTC

Selected References:

  • No authors listed. The definition and classification of dry eye disease: report of the definition and classification subcommittee of the International Dry Eye WorkShop (2007). Ocul. Surf. 5(2), 75—92 (2007). •• A chapter of the official report of the Dry Eye WorkShop summarizing the etiopathogenic factors and classification of dry eye syndrome.
  • McCarty CA, Bansal AK, Livingston PM, Stanislavsky YL, Taylor HR. The epidemiology of dry eye in Melbourne, Australia.Ophthalmology 105(6), 1114— 1119 (1998).
  • Shimmura S, Shimazaki J, Tsubota K. Results of a population-based questionnaire on the symptoms and lifestyles associated with dry eye. Cornea 18(4), 408—411 (1999).
  • Stern ME, Gao J, Siemasko KF, Beuerman RW, Pflugfelder SC. The role of the lacrimal functional unit in the pathophysiology of dry eye. Exp. Eye Res. 78(3), 409—416 (2004).
  • Patel S, Boyd KE, Burns J. Age, stability of the precorneal tear film and the refractive index of tears. Cont. Lens Anterior Eye 23(2), 44—47 (2000).
  • Rosenthal P, Borsook D Ocular neuropathic pain. Br J Ophthalmol doi:10.1136/bjophthalmol-2014-306280

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