Dry Eye Syndrome

Clinical study investigates treatment for dry eye disease.

Everybody sheds tears, and not just when they’re sad. Healthy eyes produce tears constantly, and when a person blinks, tears spread across the surface of the eye, lubricating it. Tears also clear the eyes of debris and protect them from infection. But there are factors that can interfere with this natural process, and these factors can lead to a distressing condition called dry eye disease.

“Dry eye is a very common disease, sometimes referred to as an ocular surface disease,” notes Lee Shettle, DO, a board-certified ophthalmologist at Shettle Eye Research who conducts clinical research in partnership with ophthalmic pharmaceutical companies. “It’s a condition in which people do not produce enough quality tears to effectively lubricate their eyes.”

Dr. Shettle’s research aims at assisting ophthalmic pharmaceutical companies in developing new medical eye drops to treat various eye conditions such as glaucoma and ocular inflammation. He is currently enrolling patients in a clinical study testing treatments for dry eye disease.

“Many people don’t even know they have dry eye disease, but they experience some of its symptoms,” observes Dr. Shettle, who has been practicing general ophthalmology in Largo since 1994. “It’s not until they’re examined by an eye doctor that they realize many of their symptoms are actually related to dry eye.

“Dry eye is a very common disease, sometimes referred to as an ocular surface disease. It’s a condition in which people do not produce enough quality tears to effectively lubricate their eyes.” – Dr. Shettle

”The most common symptoms are decreased vision or intermittent blurred vision, a dry sensation and a foreign body sensation. Some people experience eye fatigue, redness, double vision and glare, and some actually have tearing. If the eyes feel tired, they are dry.”

Dry eye disease is often a result of the glands around the eyes not making an adequate amount of tears. Some people with dry eye disease simply produce poor-quality tears that don’t adequately lubricate, protect and nourish the eyes.

In the latter case, the oil component of the tears is insufficient for them to properly lubricate the eyes. This is most often the result of blocked meibomian glands, which supply meibum, the oily substance that prevents evaporation of the tear film.

Several factors can lead to this disease.

“The common causes of dry eye disease include age, hormonal changes, autoimmune diseases, systemic medications, long-term contact lens wear, a history of LASIK® surgery, decreased blinking during computer use and blepharitis, which is an inflammation of the eyelid,”
Dr. Shettle reports.

“In addition, dry climates and exposure to wind, smoke and other environmental conditions can also contribute to the development of dry eye disease. Due to the effect of hormonal changes, it affects women more often than men.”

Maintaining Comfort

Dry eye disease rarely leads to blindness, but it is a threat to clear, comfortable vision. Fortunately, there are a number of effective solutions for relieving the disease’s distressing, uncomfortable symptoms. Treatment for dry eye disease is typically done in stages, beginning with lifestyle changes aimed at improving the physical conditions surrounding the eyes.

“When patients visit their eye doctor with mild to moderate symptoms of dry eye disease, the doctor generally begins by suggesting the most conservative measures to help maintain a moist surface on the eye,” Dr. Shettle confirms.

“These measures begin with simple but important lifestyle changes such as smoking cessation and the regular use of sunglasses or other protection from the elements. Patients who wear contact lenses may have to consider other options for correcting their vision, because the irritation of the corneas caused by the contact lenses can trigger dry eye disease.”

In addition, those who work at a computer for long hours may have to take breaks to interrupt their concentration on the screen or make a more conscious effort to blink often enough to properly lubricate the eyes. A humidifier may help counteract the dry air that accompanies air conditioning.

“When conservative measures fall short, there are different ways to treat dry eye disease,” Dr. Shettle offers. “The first thing is use of regular artificial tears. There are many types available, but some have the preservative benzalkonium chloride in them, and that tends to irritate the eyes. If people’s eyes are sensitive, I recommend preservative-free tears.

“If the dry eye symptoms don’t improve with tears alone, doctors generally use collagen and silicone plugs, called punctal plugs, as the next treatment. They place these plugs in the eye ducts to block the drainage system. The fluid will stay on the surface of the eye, which maintains lubrication during the day.”

Punctal plugs are typically placed during an outpatient procedure performed in the ophthalmologist’s office under a microscope using a local anesthetic. It’s a simple procedure that takes the doctor about five minutes to perform.

“There’s a very low risk of infection with the plugs, and the collagen in them dissolves,” Dr. Shettle informs. “The silicone plugs are also reversible. If there are any problems, they can simply be washed out.

“Sometimes, eye doctors also teach patients to massage their eyelids with their fingertips, right where their eyelashes come out. Doctors instruct the patients to push on the eyelids and express the wax blocking the oil glands so oil can get back into the tears. After doing that, the tear film stays stable for about two hours.”

Another treatment option for dry eye disease is prescription eye drops such as RESTASIS® or Xiidra®. These drops contain immune system-suppressing medications, or corticosteroids, that reduce inflammation and prevent damage to the eye’s surface. It’s important to note that these medications are only used when necessary. They are not first-line treatments.

“Most eye drops on the market work by replacing the oil component to help tears function appropriately, essentially creating a better quality of tear,” Dr. Shettle explains. “The eye drops also calm the inflammation around the eyes to keep the tears from evaporating off the eye’s surface.

Terrible Twosome

Dry eye disease is often associated with another eye disorder called blepharitis. They generally occur simultaneously and, if left untreated, can lead to permanent eyelid and tear gland dysfunction, as well as corneal damage. Dry eye disease and blepharitis are a terrible twosome affecting clear, comfortable vision.

Blepharitis is an infection of the eyelids and eyelashes. It is most commonly caused by an overgrowth of bacteria that live along the margins of the eyelids and at the base of the lashes. Not only do these bacteria cause the symptoms of blepharitis, they also produce substances that inflame the meibomian glands. “Symptoms of blepharitis are similar to those of dry eye,” Dr. Shettle reports. “They include itching, burning, tearing and a gritty foreign body sensation.”


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    • Shettle Eye Research, Inc.

      Dr. Shettle sees all of his patients himself to establish a more personal relationship. He is dedicated and committed to taking the time to help each and every patient understand their unique visual, medical or surgical co... Read More

    • Lee Shettle, DO

      Lee Shettle, DO, is board certified by the American Osteopathic Board of Ophthalmology and Otorhinolaryngology. He received his Bachelor’s degree in Biology from Northeast Missouri State University in Kirksville, then earned his Doctor of Osteo... Read More