PHOENIX (3TV/CBS 5) – When your eyes are red and watery and are so irritated and gritty that you want to claw them out of your face, you probably blame allergies, right? I know I do. But our eye problems might stem from something altogether different. Something that has nothing to do with the pollen count. Something your average eye drops won’t fix and might even make worse. I’m talking about dry eye disease. I know what you’re thinking. “Dry eyes. Big deal.” It is a big deal. A very big deal. It’s such a big deal that one Arizona optometrist has dedicated his practice to it. “That’s literally all I do,” said Dr. Arthur Epstein of the Dry Eye Center of Arizona. We’ll get back to him in a minute.
“Mildly annoying to completely disabling and life-altering”
Dry eye disease is a progressive condition that can become extraordinarily painful and wreak havoc on your life. Vicki Robinson knows this first-hand. She said it got so bad that her coworkers were concerned that she might have pink eye, which is contagious. She said the whites of her eyes were noticeably red, and she was using eye drops several times a day to try to get some relief. “I was convinced I must have had a bacterial infection,” she recalled.
Vicki Robinson lived with dry eye disease for more than year before getting a proper diagnosis and treatment.
That in mind, she threw away all of her eye makeup – everything – and replaced it. Eye makeup can be a breeding ground for bacteria. About the same time, her eye doctor put her on steroid drops. “And that was like the worst thing I could have done,” she said. “So, things just kept getting worse.”
Robinson said she heard people in her office thought she had been crying. A lot. In a real estate office full of men, the perception of an emotional woman can be bad for business. “You do not want to be a female that people are thinking, ‘Oh, she’s having a bad day tough [or] negotiation, so she’s in her office crying. … That’s not the image I wish to project.”
It would be about a year before Robinson found her way to Epstein and the Dry Eye Center of Arizona. A year of colleagues and friends thinking she had a contagious disease, was crying all the time, or worse, had developed a drinking problem. A year of red, gritty, irritated eyes and blurry vision. A year in which she grew increasingly uncomfortable as her undiagnosed disease progressed and frustrated with her doctor’s apparent inability to help.
Pervasive, complex, and difficult to diagnose
According to Epstein, dry eye disease affects between 15 million and 30 million people in U.S., and he believes that number is “grossly underestimated.” What’s more, it’s gotten worse in recent years, partially because of advances in technology. Epstein believes it started with the invention of the printing press and has progressed with the advent and eventual ubiquity of computers and then mobile devices.
Once upon a time, when we were hunters and gatherers, we looked into the distance, watching for both prey and predators, blinking in the relentless sunlight. Today, our focus is generally mere inches in front of our faces, looking into light that’s anything but natural for hours at a time at all hours of the day and night. You already know that harsh blue light from electronics is not our friend.
Because man’s ingenuity changed the way we live, it also changed how our bodies operate – in this the case of dry eye disease, we’re talking about blinking. “The blink drives a lot of these incredibly complex systems that maintain normal [eye] function and normal ocular surface health,” Epstein explains. So, basically, as we got more technologically advanced, our eyes didn’t. They weren’t made to deal that with the way we function today. The way we use our eyes means we’re blinking less, and that’s a problem. “An inhibited blink … really [has] have impacted the way the eyes function and have resulted in dry eye disease because the [eye] system is, you know, is unable to function properly in the existing environment.”
When dry eye disease, which basically did not exist two generations ago, first showed up, it affected mostly postmenopausal women. Epstein says the average age of his patients has dropped from the mid-to-high 60s to the mid-to-high 40s, and he’s seeing more men.
Not as simple as it sounds
The name dry eye disease is deceptively simple. It sounds like it should be easy to fix. It’s not.
When your eyes are dry and irritated, red and gritty, or it feels like you have something in your eye like a grain of sand or an eyelash, your first instinct is probably to find some artificial tears or soothing eye drops. If your dry eyes are due to allergies, those can do the trick. But with dry eye disease, any relief you get is fleeting at best. At worst, those drops can exacerbate the problem.
“It’s not as simple as going to the local pharmacy or supermarket and buying some artificial tears,” Epstein said. “It’s actually a crippling, disabling, all-consuming disorder that literally takes over and turns lives upside down. It goes from a minor annoyance to a significant issue to a complete disaster for some patients.”
There’s no cure for dry eye disease, but there are treatments that can make a world a difference. But let’s back up a minute and cover the basics of dry eye disease.
Brief biology lesson (It’s painless. I promise.)
Dr. Arthur Epstein of the Dry Eye Center of Arizona
To say Epstein is enthusiastic about his job is an understatement. There is a reason he is No. 1 on Newseek’s 2021 list of America’s Best Eye Doctors. (His partner, Dr. Shannon Steinhauser, is in the top 10.) Passionate might be a better description of Epstein, and his passion is contagious. Eye biology might sound like a dry topic, but he makes it fascinating and easy to understand. An hourlong conversation with him felt more like 10 minutes.
One of the most important things to know is that your eyes make two kinds of tears. At least, they’re supposed to. Most of us are familiar with the watery tears that come from our lacrimal glands, also known as tear ducts. Those tears cleanse and protect your eyes. “[Watery tears are] essentially a built-in emergency eyewash station, which is brilliant,” Epstein explained. You get something in your eyes, and the tears wash it away.
Now you might think dry eye disease is the result of a problem with these glands. That seems logical, but it’s not quite right. With dry eye disease, the issue is usually with the meibomian glands, which run through the upper and lower lids of your eyes. These glands produce an oily secretion to lubricate your eyes and prevent the tears from your lacrimal glands from evaporating. This oily film covers your eye, not only focusing light precisely, which is how you see, but also protecting delicate eye tissue from the harsh environment.
When your meibomian glands are not working properly, the result is dry eye disease. “Dry eye isn’t a disease of a lack of tears, it’s actually a disease of the lack of function of the tears,” Epstein said.
“This was so interesting to me,” Robinson said. “We always think there’s just these tear ducts and that’s what produces the tears. You know, the waterfall tears that we get when we cry. But there’s also tear ducts in the glands of your eyes and mine were completely blocked.”
Symptoms can be chalked up to other conditions
Many of the signs of dry eye disease can easily be attributed to other conditions. That’s one reason it’s so difficult to diagnose and is often missed. The symptoms are diverse, but fall into three main categories, according to Epstein.
Most common symptoms
- Grittiness
- Dryness
- Irritation
- Sense of heaviness
- General discomfort
“Each blink can be painful,” Epstein said. “It could be quite, quite uncomfortable.”
Another symptom is blurry vision that no prescription reliably fixes. The issue there involves those oily tears that are supposed help your eyes focus. When those tears are not present, your eyes do not focus properly and your visions goes wonky.
The third main symptom is the one that’s most visible to others – redness. It’s aesthetic, but constantly red eyes can lead people to incorrect conclusions about you, as Robinson learned the hard way.
Epstein said symptoms of dry eye disease tend to be like most things in the body – “bilateral, but asymmetrical.” Both eyes are affected to different degrees.
If left untreated, dry eye disease can lead to abrasions on your eye, which is a much bigger problem.
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