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To submit a question
please email
askthedoctor@floridaeyecenter.com |
LASIK Surgery and Dry Eye Syndrome
Question:
I am
having Lasik eye surgery soon. The Doctor wants to
charge me an extra $200 to put in dissolving
punctal plugs after the surgery. Do you think that
necessary for the price?
Answer :
If you are considering LASIK, be aware that dry
eyes may disqualify you for the surgery, at least
until the problem is resolved. Dry eyes must be
taken seriously.
Dry
eyes increase your risk for poor healing after
LASIK, so most surgeons (
Meet Our LASIK
Surgeons )will
want to treat the dry eyes first, to ensure a good
LASIK outcome. This goes for other types of vision
correction surgery, as well.
LASIK Checklist (.pdf).
Plugs
may make the difference between success and poor
results.
Some
doctors at some discount laser companies have been
known to "sell" $200 plugs even when not needed. I
am not able to tell if you need them or not. Since
they are simple and safe and also successful at
preventing any possibility of dry eyes after lasik,
your lasik doctor may have your best interest in
mind.
READ
FURTHER ABOUT DRY EYES AND PLUGS !
One of the most common patient concerns following
LASIK is an increased awareness of eye dryness.
LASIK / Laser
Most patients experience relief by
frequent use of lubricating drops. Patients with
post-operative dry eyes usually find resolution
within six months. Healthy tear film production
prior to treatment reduces surgical inflammation
and sensitivity.
Over
ten million Americans suffer from dry eyes. It is
one of the most common problems treated by eye
physicians. The usual cause is a problem with the
quality of the tear film that lubricates the
eyes.
Symptoms
-
Itching
-
Burning
-
Redness
-
Irritation
-
Blurred vision that improves with blinking
-
Excessive tearing
-
Discomfort after reading, working on the
computer, or watching TV
Dry
eye syndrome has several causes. It occurs as a
part of the natural aging process, especially
during menopause; as a side effect of many
medications, such as antihistamines,
antidepressants, certain blood pressure medicines,
Parkinson's medications, and birth control pills;
or because you live in a dry, dusty or windy
climate. If your home or office has air
conditioning or a dry heating system, that too can
dry out your eyes. Another cause is insufficient
blinking, such as when you're staring at a
computer screen all day.
Dry
eyes are also a symptom of systemic diseases such
as lupus, rheumatoid arthritis, rosacea or
Sjogren's syndrome (a triad of dry eyes, dry
mouth, and rheumatoid arthritis or lupus).
Long-term contact lens wear is another cause; in
fact, dry eyes are the most common complaint among
contact lens wearers. Recent research indicates
that contact lens wear and dry eyes can be a
vicious cycle. Dry eye syndrome makes contact
lenses feel uncomfortable, and the rubbing of the
lenses against the conjunctiva seems to be a cause
of dry eyes.
Incomplete closure of the eyelids, eyelid disease
and a deficiency of the tear-producing glands are
other causes. Tears are composed of three layers:
the outer, oily, lipid layer; the middle, watery,
lacrimal layer; and the inner, mucous or mucin
layer. Each layer is produced by a different part
of the eye (the lacrimal gland produces the
lacrimal layer, for example), so a problem with
any of those sources can result in dry eyes.
Dry
eye syndrome is more common in women, possibly due
to hormone fluctuations. Recent research suggests
that smoking and taking multivitamins can increase
your risk of dry eye syndrome, and that eating a
lot of omega-3 fatty acids (found in cold-water
fish) may decrease your risk.
(1) Eyedrops
How to Insert Eye
Drops
-
Wash your hands
with soap and warm water. Dry them with a clean
towel.
-
If you are
putting in your own eye drop medicine, lie down
or use a mirror. Ask someone to check that you
are getting the eye drops in your eye.
-
Look up to the
ceiling with both eyes.
-
Pull the lower
lid of your eye down with one hand. Hold the eye
drops bottle or tube in your other hand (rest
part of your hand on your forehead if necessary
to keep it steady).
-
Place one eye
drop or a small amount of ointment inside your
lower lid. The tip of the medicine bottle or
tube should not touch your eye.
-
Blink and dab
away the excess eye drop fluid with a tissue.
-
If you are
prescribed both eye drops and eye ointment, use
the eye drops first.
-
If you have
more than one eye drop medicine to put in your
eyes, wait about 5 minutes after the first
medicine before putting in the second eye drop
medicine.
Dry
eye syndrome is an ongoing condition that may not
be cured (depends on the cause), but the
accompanying dryness, scratching and burning can
be managed. Your eyecare practitioner may
prescribe artificial tears, which are lubricating
eyedrops that may alleviate the dry, scratching
feeling.
Restasis eyedrops (cyclosporine in a castor oil
base) go one step further: they help your eyes to
increase tear production. Restasis treatment is
the first of its kind.
(2)
If the problem is environmental, you should always
wear sunglasses when outdoors, to reduce exposure
to sun, wind, and dust. Indoors, an air cleaner
can filter out dust and other particles from the
air, while a humidifier adds moisture to air
that's too dry because of air conditioning or
heating.
(3)
Temporary or permanent silicone plugs in the
lacrimal (tear) ducts keep tears in your eye from
draining away as quickly. Called lacrimal plugs or
punctal plugs, they can be inserted painlessly
while you're in the eye doctor's office and are
normally not felt once inserted.
A new
type of punctal plug made of acrylic is a small
rod that becomes a soft gel when exposed to your
body heat after insertion. It is designed to
accommodate to the size of any punctum canal.
Advantages of this type of plug are that one size
fits all so measurement is unnecessary, and
nothing protrudes from the tear duct that could
potentially cause irritation.
Punctal Occlusion
One way to alleviate dry eye is to help the
eyes to make better and longer use of the small
amount of lubricating tears they do produce. This
is accomplished by closing off the small
funnel-like drain hole found in the inner corner
of the upper and lower eyelids. These drain holes,
called punctums can be closed with tiny plugs
called punctal plugs. Both temporary dissolvable
collagen plugs or permanent silicone plugs are
available. The plugs can be placed in the two tear
ducts, top and bottom, in both eyes or in only the
lower ducts. The punctum can also be permanently
closed with a heat or laser procedure.
Punctal plugs can be temporary or permanent.
Temporary plugs dissolve a few days after
insertion. If your dry eye symptoms disappear when
the temporary plugs are inserted, your doctor may
consider permanent punctal occlusion.
Punctal occlusion is for those:
There are two
methods to close the lacrimal drainage system. The
doctors at Florida Eye Center perform these
procedures on a daily basis.
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