Relief from Dry, Scratchy Eyes

Comprehensive Care Restores Clear Vision.

Martha “Marcy” McClanahan loves books so much, she could read from morning till night, but her dry, scratchy eyes caused her to blink and squint a lot.
Her optometrist prescribed drops to improve her eyes’ natural ability to produce tears, but she didn’t find consistent relief.

Photo by Nerissa Johnson.

Marcy McClanahan

“I tried not to drive myself crazy scratching my eyes with my hands,” the Port St. Lucie resident remembers.
Her doctor eventually referred her to Clifford L. Salinger, MD, founder of The Dry Eye Spa & V.I.P. Laser Eye Center in Palm Beach Gardens. He diagnosed Marcy with dry eye disease, which afflicts millions of Americans and causes such symptoms as intermittent blurry vision, excess tear production, itching, burning and stinging.
Dr. Salinger provides extensive testing and comprehensive treatment for dry eye disease. For Marcy, the board-certified ophthalmologist opted first to install biocompatible punctal plugs in the tear ducts to block drainage and increase each eye’s tear film and surface moisture. Marcy’s eyes sometimes watered too much, however, so Dr. Salinger next suggested medical treatments to improve her tear film production and quality.
Those treatments included hot compresses, lid massage, vitamin supplements containing Omega-3 and Omega-6 fatty acids, and anti-inflammatory steroid eye drops. Marcy showed improvement from the treatments but she still had some dry eye symptoms, so Dr. Salinger turned to the LipiFlow® Thermal Pulsation System from TearScience® to relieve blockages of her eyelids’ oil glands.

Revolutionary Breakthrough

During LipiFlow, which Dr. Salinger calls a “revolutionary breakthrough’’ for treating chronic dry eye disease, an eyepiece contacts the outer eyelid and contains a soft, flexible bladder that intermittently inflates to provide controlled pressure and massage. Heat is also applied to the inner surface of the lid because of its proximity to the glands. The procedure takes 12 minutes for each eye and is performed in his office.
For most patients, “the realistic expectation for symptomatic improvement of dry eye is seventy to eighty percent,” Dr. Salinger acknowledges. “In baseball terms, that’s a double or a triple. The only way to hit a home run is to turn back time. While we can see great improvement, it requires ongoing treatment for a chronic condition.
“The worse it is, the longer it has been there and the longer it will take to turn it around,” he adds. “Once we’ve improved the situation and stabilized the dry eye condition, it usually requires a lot less treatment to maintain that benefit. But if we fall off the wagon and stop treatment altogether, it’s only a matter of time until things get worse again.”
That’s because dry eye and other ocular surface diseases are progressive conditions attributed to numerous factors, including age, hormone changes such as menopause, diet, medications and “the chronic insult to our bodies that we perpetuate every single day in our environment,” Dr. Salinger elaborates.
A year after having LipiFlow, Marcy remains delighted with her results. Drops help her eyes stay lubricated, and sometimes she forgets to use them “because my eyes feel absolutely wonderful! Everything is moist, and there are no problems.”
Marcy calls LipiFlow “a very valuable way to help people have comfortable vision again.”

Freedom from Contacts

After nearly a lifetime of wearing corrective lenses, Judy* decided they didn’t work for her anymore.
Sometimes, her contacts literally fell out of her eyes, and she suffered from burning and other discomfort that forced her to remove her lenses to get relief.
Worse, her world went in and out of focus. For someone who had cataract surgery on both eyes, that was especially disconcerting.
“Sometimes, my vision would get blurry, and it was because the contacts were not staying in place,” recalls Judy. “I was just not happy with them.”
She complained to her optometrist, who recommended she see Dr. Salinger. He determined that Judy suffered from chronically dry eyes.
To alleviate her condition, Dr. Salinger inserted punctal plugs into Judy’s tear ducts to block drainage and increase moisture.
“There are three different kinds of plugs,” Dr. Salinger explains. “One is the test plug that lasts a week, just to make sure the person doesn’t have excess moisture that becomes so unpleasant, it’s undesirable. Then, there are two long-acting plugs. One dissolves slowly over three to four months, while another version is made of a silicone plastic that doesn’t dissolve and is potentially a forever plug.
The permanent plug would not work for Judy because her tear ducts rotate slightly inward. As a result, she would feel the silicone plastic plug on her eye every time she looked down and in the direction of that plug. That’s why Dr. Salinger turned to the LipiFlow treatments he’d recommended for Marcy.
Stock photo from istockphoto.com.Once Judy’s dry eye was stabilized, Dr. Salinger was ready to correct her vision using one of several procedures – PRK, LASEK, LASIK or iLASIK™ – that he performs in his office using eye-drop anesthesia.
Through gentle reshaping of the cornea with a laser, which allows light to be focused differently by the eye, he can improve nearsightedness, farsightedness and astigmatism.

Safe, Painless Solutions

After meticulous evaluation of Judy’s eye health, medical history and unique circumstances, Dr. Salinger determined that LASEK, or laser epithelial keratomileusis, was the best choice.
LASEK combines elements of PRK, or photorefractive keratectomy, the original laser vision correction, and the more popular LASIK. For certain patients, LASEK can offer some advantages over LASIK.
During conventional LASIK, the eye is pressurized and the surgeon makes a small cut in the cornea which creates a flap. With bladeless iLASIK, the flap is created with an ultra-fast laser.
“LASIK heals more quickly,” Dr. Salinger points out, “but it’s not ideal for individuals with pre-existing dry eye or who previously had some type of surgery, like the cataract surgery Judy had.”
LASEK involves loosening and removing the surface epithelium, the outermost layer of the cornea, with a diluted alcohol solution. The exposed surface is then treated with the laser. A protective, soft contact lens is placed over the cornea to make the eye comfortable while it heals.
LASEK eliminates the need to pressurize the eye to make the flap, as with LASIK and iLASIK. Firming up or pressurizing the eye too much carries a risk for patients like Judy who’ve had previous cataract surgery, Dr. Salinger notes.
The epithelium usually heals fully within days or several weeks. Because the return to functional vision is longer than with LASIK, some LASEK patients prefer to have one eye treated at a time.
Thanks to such laser surgeries, it’s possible for patients like Judy to improve their near or distance vision after cataract removal, Dr. Salinger emphasizes.

Fascinating, Fantastic Results

“We can set each individual’s eyes at whatever focal distance they might desire after cataract surgery,” he notes.
Judy decided she wanted monovision, which corrects one eye for distance and the other for close-up vision.
Monovision is an alternative approach to manage presbyopia, a normal aging process resulting in difficulty with close-up tasks like reading small print.
Dr. Salinger also corrected Judy’s astigmatisms – imperfections in the curvatures of her corneas.
“I found the procedure fascinating. Both eyes are done during the same procedure. You can actually watch as the laser reshapes your eye,” describes Judy. “It’s very easy and painless.
“My vision cleared up almost immediately. For the first time in my life, I don’t need contacts or glasses. I don’t need a million pairs of reading glasses around.” Her dry eyes have improved, too, allowing her to manage her condition with occasional over-the-counter drops.
Judy recommends Dr. Salinger to others seeking help for dry eyes and other persistent vision challenges.
“He’s very competent and knowledgeable,” she asserts. “He’ll sit and answer your questions, which I find most important.”

*The patient’s name has been withheld to protect her privacy.
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