Dry Eye Therapy
Conveniently located to serve Honolulu and Hawaii
I have been seeing Dr. Tantisira for several years now. Initially I went to see her for the fractional CO2 laser. Not even fully understanding it’s true benefits. Of course I was so happy with the way I “looked”. I looked so much younger! Then I went in for some Botox and fillers. Again I was thrilled with my results. A couple years have gone by and 50 is around the corner. Reality is setting in. I was diagnosed with basal cell skin cancer. And I have severe dry eye. She is an amazing eye doctor along with her other talents of skin care. I ended up needing my tear ducts cauterized. She performed this procedure and my quality of life has changed.
Come to find out the laser that I had done previously made a complete difference in the prevention of the basal cell on my face. I never even knew this could be helpful. I’m getting ready to have this procedure done again. Many talents and prevention’s are happening in this office. I wish I could spread the word to more people. I love the fact that I can look young and beautiful and help prevent things that can make me sick down the road. For more information please contact the staff. This office is so helpful and the staff is so incredible and amazing. I will definitely continue to go here for years to come.
By Susan B, Waimea, Hawaii
Dry eye is a chronic condition that affects many in their daily lives, causing both discomfort and blurry vision. It is a common problem, ranging from 5 to 50% of the population, depending on the age and sex of the population. It is much more common among those who work on a computer or other electronic device in air-conditioned environments for most of their day. Dry eye can interfere with driving, watching TV or especially working on the computer.
Symptoms may include:
- Gritty feeling
- Blurry vision
- Light sensitivity
- Excessive tearing, which is a compensatory response to the dryness
- Changing hormones
- Antihistamines or other medications
- Autoimmune disorders, including Sjogrens Syndrome
- Decreased production of liquid tears
- Disrupted lipid production that usually contributes to smooth tear film
It is important to see your ophthalmologist for an evaluation if you are suffering from any of these symptoms. He or she can diagnose the cause of your problem and contributing factors, then design a treatment plan to make your eyes more comfortable and to stay healthy in the long run.
Lacking a protective layer of water or oil in their tears, dry eye sufferers may try to compensate through excessive use of artificial tear eye drops, which may make the situation worse!
The thorough evaluation of dry eye at True Vision Center in Honolulu includes a thorough history with careful listening to each patient’s individual symptoms, then an examination with the slit lamp, which is a microscope that magnifies the eye 10 to 16 times. Any necessary testing is done after the exam. Once all of the diagnostic evaluation is done, the doctor, together with the patient, designs a treatment plan that is most suitable.
There are many treatments for dry eye:
- Artificial tears, which most patients try first.
- Restasis, a prescription drop that helps the eye produce more of its own tears by decreasing iflammation. Now available as a generic, cyclosporine 0.05% drop.
- Xiidra, a prescription drop that also interrupts the inflammation caused by dry eye disease.
- Cequa, a stronger and more effective cyclosporine drop, that is often used instead of Restasis.
- Tyrvaya, a new medication that is sprayed inside of each nostril to stimulate a nerve to produce more tears.
- Eysuvis drops for relief of short-term flare ups of dry eye symptoms.
- Punctal/canalicular plugs. These partially block the eye’s drainage system. This allows the eye to hold onto its own tears, supplemental artificial tears, and medications longer.
- Lacriserts, a tiny insert that is placed inside the lower eyelid once a day that slowly melts and changes the composition of tears so they evaporate more slowly. (This is temporarily off the market due to manufacturer’s difficulties.)
- Autologous Serum Eye Drops, eye drops made from your own blood that is sterilely blended with preservative-free artificial tears. These drops contain healing factors that nourish the eye differently from any other drops.
- Lipid modulating therapies such as azithromycin drops, doxycycline pills, or in office procedures to remove the meibomian gland lipids from the clogged glands.
- Artificial tear ointment, a very thick preparation of mineral oil and other lubricants may be indicated to protect the eyes from drying out while sleeping or if they do not close completely.
- Surgical options include punctal cautery, which seals the tear drainage holes more tightly than punctal plugs, and amniotic membrane graft, which provides stem cells to improve tear production.
Any of these treatments may be used alone or in combination with each other to achieve the best result for each unique patient. Treating dry eye appropriately is important not only for the patient’s comfort, but also for long term health of the eyes. Untreated dry eye disease leaves the eyes prone to surface damage and severe infection. If treated appropriately, the risk of chronic pain, blinding infection, and scarring is greatly decreased.
To use an analogy, it’s like trying to partially fill a dry empty sink. You can either turn up the water flow higher (Restasis, Xiidra, or Cequa drops and Tyrvaya) or partially close the drain (plugs or punctal cautery). In addition, if the eyes are inflamed due to the dry eyes, drops such as Eysuvis help settle the inflammation down.
Patients often have associated diseases that cause tear film instability. This very often includes meibomian gland dysfunction where the oil glands of the eyelids become clogged. The oil backs up into the eyelids. The eyelids get inflamed and cause burning of the eyes. Lack of oil in the tear film creates conditions where the tears dry out faster, especially in wind, dry heat or air conditioning. This may cause acute burning sensation.
Patients with meibomian gland dysfunction are treated with warm compresses to melt the thickened oil, doxycycline to change the composition of the oil, and Azasite drops which are both anti-inflammatory and change the composition of the oils. There are also procedures which may melt and milk the oils out of the glands that can be of at least temporary benefit.
In addition to local associated diseases, patients may have systemic diseases associated with dry eyes. These include:
- Sjogren’s Syndrome
- Rheumatoid Arthritis
- Systemic Lupus
- Diabetes Mellitus
It is extremely important to diagnose and treat all of these associated conditions as early as possible to prevent permanent damage to many organ systems. Dr. Tantisira will ask screening questions about these systemic diseases to see if you are at risk for having them. She also diagnoses and cares for all types of eye problems.
Dr. Tantisira has a lot of experience in treating dry eye disease. If you are suffering from any of these symptoms or have any of the diseases listed above, be sure to contact her! Contact Dr.Tantisira at (808)591-9111 to see how she can help you care for your dry irritated eyes.