Why Do Dry Eyes Water?

JORDAN PYSZ / iFoundMyDoctor.com
Alan Killick

Alan Killick used the promotional concepts he learned as a marketing major to help establish a successful 40-year career in biotech pharmaceutical sales, first as a drug rep and later as a regional sales director.

“I started out in college selling over-the-counter medicines for Bristol Myers Squibb,” Alan recalls. “I sold Bayer®, Bufferin®, NoDoz® and other medicines as well as a product called Body on Tap, which was a shampoo that had beer in it.

“Then, I got the opportunity to go into prescription medications, mostly injectable and infusible medications that alter the immune system. I worked for a company called Biogen and focused on medications for autoimmune and rare diseases.

“I had a degree in marketing, and the pharmaceutical companies I worked with taught me the science. That enabled me to be a successful salesperson and got me promoted to sales management. I supervised a team of salespeople throughout the Southeast that promoted the company’s products for rare diseases.”

Alan, 62, retired in 2023. Because he’s no longer working, he can spend more time traveling and taking care of himself.

“I try to stay in shape and exercise,” Alan says. “My wife and I love to travel. We’ve been to some exotic places like Bora Bora. We’ve also been to the Pacific Rim — Asia, Australia and Japan. We’re going to travel even more now that I have more time, but we’re also raising three teenage kids, which is a big part of my life.”

For years, red, itchy, irritated eyes were a big part of Alan’s life, too. He visited several eye doctors who diagnosed his condition as dry eye disease, a common disorder that occurs when the tears can’t provide sufficient lubrication to keep the eyes moist. Alan was surprised by the diagnosis because his eyes produced an excess of tears.

“I thought dry eye was about not making enough tears, and your eyes are essentially dry,” Alan relates. “I had plenty of tears, so I assumed I didn’t have dry eye. But I had red, itchy, fatigued eyes, and when I blinked, it felt like there was sandpaper rubbing against my eyeballs. The wind, fans, the air conditioning in my car and even being on the computer for a long time made things worse.

“The eye doctors I went to inserted punctal plugs to block the channels that drain the tears to increase the amount of tears in my eyes, but that didn’t help at all. It just made my eyes more watery. I decided I needed to visit a dry eye specialist, so I searched online and found Dr. Ramsower.”

MGD: A Common Cause

Jenifer Ramsower, OD, is the founder of the Dry Eye Center of Florida, a practice dedicated to the diagnosis and treatment of dry eye disease.

“When Mr. Killick came to me, he presented with very red eyes and was actually producing a good amount of tears,” Dr. Ramsower reports. “That can occur when the eyes are irritated and inflamed from dry eye, and that’s why he wasn’t getting any relief from the six-month dissolvable plugs that he was treated with. So, I recommended a full work-up to determine the root cause of his problem.”

Dr. Ramsower’s evaluation included scans of Alan’s meibomian glands, which secrete oil from the eyelids into the tears during a blink. Alan also underwent lab tests to obtain an analysis of his tear film, which is a thin layer of fluid (oil, water and mucus) that covers the outer surface of the eye. The analysis measures the oil and water, which must be in balance to maintain a healthy tear film.

“A thin oil layer results when the meibomian glands become blocked and do not function properly,” the doctor explains. “This is called meibomian gland dysfunction, or MGD.”

More than 85 percent of dry eye cases are related to MGD, according to Dr. Ramsower, who warns that if the MGD is not treated, dry eye symptoms will persist.
-Dr. Ramsower

“Patients should know that if punctal plugs aren’t working and they have persistent dry eye symptoms, further evaluation is warranted because the problem may be MGD, which must be addressed to ease those symptoms,” she confirms.

“That’s what happened with Mr. Killick. His MGD stemmed from ocular rosacea, which is an inflammation at the lid margin that plugs up the oil glands and causes an unstable tear film. Calming down the ocular rosacea helps to improve the function of the meibomian glands.”

To calm Alan’s ocular rosacea and ease his MGD, Dr. Ramsower used a combination of two FDA-approved advanced treatments. One is the Johnson & Johnson® LipiFlow® Thermal Pulsation System, which clears obstructions in the meibomian glands and restores healthy function. The other is the Lumenis® Optima Intense Pulsed Light (IPL), which seals off the abnormal blood vessels that cause inflammation in the surrounding ocular tissue.

Dr. Ramsower also recommended a daily regimen to help keep Alan’s oil glands open and stave off symptoms. It includes performing lid hygiene, placing a heating pad on his eyes for 20 minutes and using anti-inflammatory eyedrops.

JORDAN PYSZ / iFoundMyDoctor.com
Alan tries to stay in shape and exercise. He’s been enjoying his workouts and life in general more since his meibomian gland dysfunction was treated.

“Normal” Eyes

The comprehensive treatment plan made a world of difference for Alan.

“Mr. Killick’s problem was never the amount of tears produced,” Dr. Ramsower affirms. “Instead, the oil layer in his tear film wasn’t sufficient because his glands were obstructed. Now that he has more natural oil being released into his tear film, his condition is stable and he no longer experiences dry eye symptoms.”

“My eyes feel normal now,” Alan enthuses. “They aren’t red anymore, and the excess tears went away. When Dr. Ramsower removed the punctal plugs, my eyes were able to drain properly. And when you add oil to the tears, they stay on your eyes longer.

“My eyes are not watery anymore because Dr. Ramsower fixed the problem with the oil in my tear film. My eyes don’t feel like they have to produce extra tears to get rid of the irritation from the dry eye.”

Alan says he was very impressed with by the dry eye specialist who restored his meibomian gland function and eased his aggravating symptoms.

“Dr. Ramsower is extremely knowledgeable, very compassionate and understanding,” he raves. “I’m so pleased, I referred my 88-year-old mother to her. I wouldn’t recommend her to family unless I was totally satisfied with her, and I am.”