Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
Please consider supporting Speaking of Women's Health with a monetary donation to help us continue to provide free women's health content. Thank you!
Speaking of Women's Health
Managing Dry Eyes: Treatments and Lifestyle Tips
Unlock the secrets to managing dry eye syndrome more effectively with our latest podcast episode hosted by Dr. Holly Thacker. We promise you'll gain invaluable insights into cutting-edge treatments, including treatment for tackling Demodex mites that often go unnoticed and can be a main cause of dry eyes.
Explore the crucial role omega-3 fatty acids play in alleviating dry eyes and learn how to incorporate these essential nutrients into your diet for better eye health.
Subscribe to our podcast to continue receiving valuable updates on women's health topics.
Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...
Listen on: Apple Podcasts Spotify
Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Becker, the Executive Director of National Speaking of Women's Health, and I'm back in the Sunflower House for somewhat of a new episode. Our faithful listeners may recall that in Season one I did a very important podcast called Dry Eye Symptoms, causes and how to Get Relief. Dry eyes is such a common problem, especially amongst midlife women and there's at least 20 million people in the United States women and there's at least 20 million people in the United States and it seems to be frequently notoriously underdiagnosed and undertreated. And since that original episode played and now that we're into season three, there have been several updates in the medical and ophthalmic world on dry eyes and potential treatments. So we're going to first talk about mites, demodex mites. Recently, the FDA approved a treatment called Exdemvi and if you follow our news releases and highlights on speakinginwomenshealthcom or follow us on social media, like on Facebook or Instagram, you may have seen this release and it's the first and only FDA approved treatment. It directly targets demodex mites, which is the root cause of demodex blepharitis, and demodex blepharitis impacts one in every 12 adults and it's common, but it's often misdiagnosed or it's underdiagnosed as an eyelid disease that's caused by an infestation of demodex mites and this is the most common ectoparasite that is found on human skin. And these demodex mites are nocturnal. They come out at night to eat and mate and lay their eggs and I know this sounds so gross, but it's true Expel their waste products on your eyelids and also in the glands of your eyelids, which are called the mebobian glands, which are called the mebobian glands. This, combined with the debris of their bodies once they die, causes significant inflammation and mechanical damage. So it's not necessarily a problem to have an occasional demodex mite on your skin or in your eyelash follicles, because in small numbers they're common and benign and they generally don't cause harm. I mean, we live with multiple bacteria and fungi in our skin, our mouth, our gut, and so it's not surprising that there are some mites that are along for the ride. But if you have an overgrowth and a significant amount of these mites, they can either cause or make worse, exacerbate dry eyes, styes, calasians, blepharitis, mebobian gland dysfunction, ocular rosaceaa and rosacea of the face. That's thought to be one of the causes of rosacea of the face and we've done a podcast on rosacea now. An infestation of these demodex mites unfortunately can cause irreparable damage to your eyelashes, eyelids and mebobian glands if not treated, and that's why we want to reprise this episode about dry eyes with the exciting news of new treatment for a relatively common cause of dry eyes, and why you need to be empowered to be strong, be healthy and be in charge when you're seeing your eye physician, be that your ophthalmologist, who's usually a MD, or a doctor of osteopathy or an optometrist and if you're seeing someone in urgent care or primary care, they may or may not feel comfortable evaluating and treating this.
Speaker 1:I also want to talk about omega-3s. I've done columns on omega-3 fats. Basically, the guidelines are it's much better to get it in food than just taking supplements, but not everyone can get enough omega-3 in their diet. We have a great list on speakingwomenshealthcom of omega-3 rich foods like pound or ounce for ounce. Mackerel is one of the highest ones. Salmon is an excellent source of omega-3s, which isn't particularly high in purines if you tend to run higher uric acids or gout, many different types of fatty fishes, sardines, herring, anchovies, caviar, but even non-fish eating people or vegetarians. There are plant-based sources of omega-3s, particularly walnuts and flaxseed and chia seeds. There's some vegetables like spinach and Brussels sprouts. Seaweed is another rich source and there are some studies it's somewhat inconsistent that omega-3 supplements may help dry eyes and so high triglycerides and dry eyes or other inflammatory conditions that are worse in patients that have low levels of omega-3, I think is potentially reason enough to consider supplementation if you can't clean up your diet and you want to get other heart healthy fats in your diet, like avocado and olive oil diet, like avocado and olive oil and meats that are like grass fed or pasture raised chickens that lay eggs that can have omega-3s.
Speaker 1:You can read the labels when you're buying eggs. I always try to look for the omega-3 eggs. So because some studies and individually some patients and some ophthalmologists have found that in some people omega-3s, by reducing inflammation and restoring kind of a heart healthy fat balance, can improve dry eyes. Now, part of the problem with people not having enough omega-3 is having too much inflammatory omega-6. Some of these industrially altered so-called seed oils, like corn oil and safflower oil and sunflower and palm and rapeseed cottonseed these oils are chemically altered and increase inflammation and I think trying to get these things out of your diet.
Speaker 1:I have so many patients tell me oh, I don't ingest those. And then you ask them? Are you using regular mayonnaise, regular salad dressings? Do you go out to eat? Because very few restaurants are committed not to using seed oils.
Speaker 1:If you're eating a lot of pre-processed foods, things that have long shelf half-lives, if you read label you'll see that I mean olive oil and coconut oil and avocado oil tend to be more expensive and don't quite have the same shelf half-life, and so you don't see that as often my granddaughter Artemis loves popcorn and we don't always have time to make it and so much of the pre-made popcorn you know has extra sugar and artificial colors and seed oils. So I found a brand that doesn't have any of that and they used coconut oil. I was so kind of curious to taste it and it tastes just absolutely delicious. I was so kind of curious to taste it and it tastes just absolutely delicious. It is more expensive and certainly many times getting better quality foods is unfortunately more expensive, but with planning and organization you can many times do this for yourself and your family.
Speaker 1:So for my patients, if they have dry eyes and particularly if there's other reasons to consider omega-3 supplements, I tell them that the researchers say that the risks are limited, but there can be an increased risk of bleeding linked to very high doses of omega-3. So usually we don't go more than three grams a day and anytime you swallow something to do something to make yourself feel better, there is a strong brain effect and placebo effect and researchers have pointed out that patients have to usually take like several, like at least three large capsules a day to get the recommended doses. And this also includes having calories. So if you're doing intermittent fasting, which I recommend for so many of my patients, you take these capsules when you are not fasting and a lot of people don't like to burp fish oil. That can be unpleasant. Some of them have some lemon or lime added to kind of take that fish down.
Speaker 1:Some of the most practical ways to deal with dry eyes are artificial tear lubricants. So for a 30 day supply, depending on usage you're talking about, you know, at least $10. Warm compresses, environmental changes, like having a good humidifier, particularly in the winter, um, if you're planning on trying to take omega-3s for dry eyes and you've already been evaluated and it isn't might causing your dry eyes, then I think you should talk to your clinician about doing this. Other tear care if you have very extremely dry eyes and known Mabobian gland dysfunction, which is caused by dysfunction of some of these really tiny glands that make up the oil layer of tears, and this layer is one of three that keeps the eye surface from drying out too quick quickly, which is critical, and if your mebobian glands get clogged, you have less oil naturally reaching the eye surface and tears dry out too quickly. There is an FDA tear care, which is a procedure has to be done in three months and it doesn't negate the need for drops or other medication, so that is something that you might want to look into.
Speaker 1:There is some evidence that lack of androgens the more masculinizing hormones that males and females have women just have much less. If you're low in that because of age, ovary removal, sometimes higher doses of oral estrogen can drop down the androgen levels, then you don't make quite as much natural oils, and that can make dry eyes worse. That's why, certainly, hormonal therapy in general helps skin dryness, vaginal dryness and skin elasticity. But some women notice when they go on oral hormone therapy that they may have more dry eyes, and so sometimes I readjust things or I check the adrenal hormones and testosterone. None of this, you know. Supplementation with androgens is FDA approved, though for dry eyes, but I do mention it Now.
Speaker 1:If you lose tears too quickly, it can make this chronic cycle of inflammation, friction in the eyes and actual damage to the ocular surface of the eye, and it can disrupt that very intricate balance among the many important layers of eye function. For some people it causes dryness, itching, stinging or like there's some foreign body in the eye, or infection. Studies have shown that Mebo, which is a prescription eye drop, directly targets the excessive tear evaporation instead of just tear formation, and for some people this can be highly effective. The solution in it is perfluorohexaloctane and it's a substance that's designed to mimic a key natural function where the mebobian glands produce a lipid-rich secretion that forms the tear layer and helps maintain a healthy ocular surface. Now another solution called Tyravivie is varanacillin solution, and this offers another option for patients whose eyes don't make enough tears, and it's a nasal spray that starts your own body to produce its own natural tears, and this solution works by activating the glands and cells connected to the nerves inside your nose, and it's part of a pathway for controlling tear film production and in some cases it can help relieve the symptoms for people who have not had success with other therapies. There's also sometimes different types of light stimulation therapies that have been used, and there are other things in investigation. Because this is such a chronic problem, it's very important to take care of your special senses, and once you're over 50, you really should be seeing an eye doctor and having an exam at least every one to two years, and certainly once you're over 60 to 65, yearly and so up.
Speaker 1:Next is the dry eye podcast from season one, with all these additions we've talked about today, and I hope that you enjoy listening to this episode, whether it's for the first time or the second time, and thank you so much for joining me in the sunflower house and I'll see you next time. Be strong, be healthy and be in charge. Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, and I'm glad to be back in the Sunflower House, and today's podcast is on dry eyes. In fact, I needed to put eye drops in my eyes. Just reading over the material was making my eyes dry.
Speaker 1:It's such a common problem, especially amongst midlife women's health, and a lot of what I'm going to be discussing is really nicely encapsulated by a terrific column on our website, the nonprofit speakingofwomenshealthcom, and it was authored by one of our graduated specialty women's health fellows who I hope to be able to recruit back to the Cleveland Clinic, dr Tiffany Cochran. She's just a fabulous woman. She's an internist and a women's health specialist and she is practicing internal medicine and specialty women's health and seeing patients right now at Port Royal Medical Center in Port Royal, south Carolina. She's originally from Alabama and she is such a well-mannered Southern lady and her patients just adored her. She got her Bachelor of Science from Valdosa State University and her Doctorate in Medicine from Morehouse School of Medicine and she also has a Master's of Arts in Healthcare Administration and I really hope to interview her live later in the month on women's health, hormones, blood clots, dvts. She authored an excellent chapter on this. She's also authored chapters in osteoporosis and menopause. So a couple of her columns I think we really need to highlight, and one includes dry eyes.
Speaker 1:Now, dry eye disease is a really common reason for needing to see an eye doctor, like an ophthalmologist or even an optometrist or even your general physician, because it can lead to eye discomfort, lower eyesight and a reduced quality of life, particularly for people over age 50. And dry eyes affect over 350 million people worldwide and over 50% of all, perimenopausal and menopausal women experience dry eyes, dry eyes, dry skin, dry mouth, dry vagina, and this disease can impact the quality of the tears, leading to overall poor eye health. And if you don't treat dry eyes, you can get a higher risk of eye infections, abrasions, inflammation of the eye structures, which can lead to damage to the cornea, the front surface of the eye, and this can result in eye pain, ulcers, even permanent vision problems. In fact, one of my girlfriends who has this cute Boston Terrier Napoleon Bonaparte is his name and he's got a big personality and he's a little dog he apparently was attacked by a pit bulldog and got a corneal ulcer and was in danger of losing his vision, and so they had to set an alarm clock around the clock every four hours to put eye drops and ointment to save the dog's vision, and luckily he's much better. So we all have to protect vision.
Speaker 1:Your eyes are very important. Any kind of trauma, infection, pain, drainage, foreign objects need to be taken care of right away. In fact, I remember my husband telling me oh, just go ahead and treat your two-year-old son Emerson, he's got another ear infection. No, let's not take him to the doctor, you already know what is and I'm like no, I'm not a pediatrician, I think we really should take him in and we all thought that he had an ear infection. He actually had a foreign body in his cornea that the pediatrician astutely picked up. So in children who aren't that verbal or you know, can't necessarily describe what's wrong with them also, including pets or elderly people or anybody with any communication skills you have to be alert to symptoms that actually might be from the eyes.
Speaker 1:So, getting back to dry eyes, what are some of the causes? Well, there's a lot of different factors that have been elucidated. Certainly, autoimmune diseases are right up there and women suffer from more autoimmune conditions than men, and some common autoimmune conditions that can cause dry eyes are Sjogren's syndrome, rheumatoid arthritis, systemic lupus erythematosus, which is inflammation of the blood vessels from an overactive immune response. Systemic sclerosis, also known as scleroderma, and also people that have primary biliary cirrhosis, which is autoimmune, can also cause dry eyes. Lots of medicines can cause dry eyes Antihistamine, beta blockers, diuretics, antispasmodics like baclofen and flexerol, used for muscle cramps or muscle disorders, bentil, used for irritable bowel syndrome.
Speaker 1:All of these can lead to drier eyes. Certainly, different antidepressants, especially some of the older ones, the NSRIs, like amitriptyline and nortriptyline are notorious for dry eyes. Vitamin deficiencies can also trigger dry eyes, as well as contact lenses, seasonal allergies, lower humidity, high windy areas, certain types of outdoor job exposures and, of course, aging. We kind of get drier as we get older and have less fluids. Now there's other reasons that one can have dry eyes. If there's something wrong with the mebobian glands, and anytime that the blink rate is lowered, there can be drier eyes, because when you blink you actually stimulate some movement of tears, and it's thought that perimenopausal and menopausal women produce less androgens, which we know that they do just with age, and women have much less androgens than men, and that can cause fewer secretions from mebobian oil glands as well as lacrimal tear glands in the eyes. The mebobian glands produce essential oils for tears, and if you have less oil in your eyes, you just have less tears. Now estrogen plays a critical role and women can experience dry eye symptoms at certain times of their monthly cycle. Dry eyes can be a side effect of certain hormonal contraceptives, especially if they lower the androgen levels.
Speaker 1:Now rosacea is a common condition and we'll do another podcast on rosacea and other skin disorders that are so common in women, but rosacea is a skin inflammatory disease that can affect not just the face, the nose, but also the eye anatomy, and serious eye problems can develop, even if the rosacea on the skin is pretty mild. So ocular rosacea is a relapsing inflammatory condition of the eyes and its structures and it often requires continued treatment. Now, remember this is not medical advice. We are just empowering you to be strong, be healthy and be in charge and understand common conditions that might affect you or your family members or your friends. And rosacea is a frustrating skin condition and particularly when it affects the mebobian glands and if there's scarring of the opening of these gland orifices sometimes there's also telangiectasias or dilation of the blood vessels the eyes can become very irritated and dry. And unfortunately, sometimes ocular rosacea is overlooked because people think the eye symptoms are simply allergies or problems from contact lenses or contact lens solution. So 50% of all people with rosacea will develop symptoms in their eyes and when I see someone with rosacea who doesn't have eye symptoms, I just remind them of that. And really anyone over the age of 50 should see an eye doctor every year.
Speaker 1:So what are dry eye risk factors? Well, we told you, female gender is certainly one, being over the age of 50, having any kind of connective tissue disease like Sjogren's or rheumatoid arthritis. Use of contact lenses, which are very popular. Medications, including the diuretics, the antihistamines, the antidepressants, as well as Accutane isotretinoin, which is used to many times, give acne cures dramatically reduces oil gland secretion. People who've undergone bone marrow transplant, any person with lower testosterone levels, as well as, of course, perimenopause and menopause. Lower testosterone levels, as well as, of course, perimenopause and menopause. I get a lot of calls from patients saying oh, their eye doctor said that you know their hormone regimen is causing their dry eyes and I think sometimes it's a little bit misinterpreted. Certainly, being low in hormones or having a hormone imbalance may make that predisposition or condition worse.
Speaker 1:So what are some of the signs and the symptoms? Well, swollen red eyes are common. There can be bloodshot eyes and I think using things like Visine, which just cause vasoconstriction, aren't really a good idea. If there's pink eye, it can be a sign of a viral or bacterial infection and you need to seek medical attention. There can be crusty eyelids or eyelashes. In fact, my cat, my cute elderly, almost 19 year old ragdoll kitty cat, she, every morning I would clean out her crusty eyes and once I got my air filtration and duct system cleaned in my house, my air filtration and duct system cleaned in my house. She has no more crusty eyes, so really good quality air that's also humidified, and she likes to come into my bedroom and put her little face and whiskers right in front of the humidifier. But, come to think of it, she really doesn't do that behavior now that we've cleaned out the air ducts.
Speaker 1:Getting back to symptoms, there can be burning, itching, sensitivity to light, blurry eyes or feeling like there's a gritty sensation or foreign body in the eye. Anytime there's any recurrent eyelid infections, you need to worry about these mebobian glands and the tear ducts. So certainly, if you have these symptoms, talk to your primary care physician. You might need to see a dermatologist or an ophthalmologist. So what are some of the treatments? Well, the main goal of treatment for dry eyes focuses on restoring the tear production, and so you might need to approach it from multiple different ways.
Speaker 1:Eye hygiene is very important. Using a very soft like baby washcloth with maybe some baby shampoo and warm water gently washing around the eyes, warm compresses can help improve oil and tear production. Keeping your eyelids clean and applying a warm cloth or pad several times a day may be recommended to keep the debris away and the gland ducts open. Be careful not to over exfoliate, though, because that can really irritate the skin, and if you're in front of a screen like many of us are in front of phones and computers and electronic devices take some breaks. Blink frequently, because we do know when people are on the screen they don't blink as much, and blinking does improve tear production. Protect your eyes. Wear sunglasses with UVA blocking to block harmful sunlight. Also, really dry, windy conditions can be hard on the eyes and avoid triggers like pollen. Listen to one of our prior podcasts on allergies and pollens and physical things you can do to your home. Try to avoid smoke.
Speaker 1:Bad air quality In fact, I am recording this at the end of June of 2023, where many areas of the country have had dangerous air conditions because of all the Canadian fires. In fact, you know, on a beautiful day like today, the kids in the summer camps were inside because of the air quality in the summer camps were inside because of the air quality. Alcohol causes dehydration and makes a lot of things worse Heat, dry air, certain cosmetics you know the eye doctors usually recommend changing your eye cosmetics anytime there's any eye irritation or infection and just regularly getting new eye makeup Again. Considering that humidifier to moisten the air around you I use one year round Exercise, light aerobic exercise might actually improve tear production.
Speaker 1:Many of my patients say they don't have any dry eyes during the day, when they're moving around, but they get it at night. Certainly you should eat healthy foods, mediterranean type diet rich in omega-3s, and avoid processed foods, sugary foods and getting enough vitamin A, which is a real vitamin, as opposed to vitamin D, which is a pro-sterile hormone. You can become toxic on vitamin A, so you need to avoid anything more than twice the upper recommended daily allowance, especially pregnant women. But vitamin A is good for the eyes, so it's in foods like carrots and pumpkins and squash, yellow and orange foods and omega-3 foods, which we'll have an upcoming podcast on omega-3,. They also help with tear production and some women find that higher doses of omega-3 really do help their dry eyes. Now it's extra calories. It can sometimes cause breast cysts and breast tenderness, so I think you really should get a physician's advice before doing that.
Speaker 1:Now there are many over-the-counter lubricating eye drops and ointments. Artificial tears in the form of drops or even thicker ointments can provide some relief for dry eyes. They can maintain the moisture in the eyes, but in general they can make ocular rosacea worse. So again, you need to see your physician. Generally, drops should not be used more than four to six times per day because if you're exposed to a lot of the preservatives it can damage the eye surface and lead to conjunctivitis. Preservative-free artificial tears are less irritating to the eye surface and can be used more frequently, and because they don't have preservatives, they're usually like in single application. Autologous serum tears or platelet-rich plasma can be a treatment option because it contains both anti-inflammatory factors and growth factors that can help in treating dry eye disease and support healing of the eye surface.
Speaker 1:Now tetrahydrolizine, which I had mentioned earlier, the vasoconstrictor that narrows the blood vessels, can lead to rebound redness with chronic use, so in general I don't recommend it. Now there are some emulsion formulated eye drops that replace oil to tear production, which can help reduce the evaporation of just the liquid H2O water, and so these emulsion formulated eye drops might be a great choice for people who have the blurry vision, and sometimes it actually improves people blinking. There are lubricating eye gels and ointments. Generally they're used at night because they can cause blurry vision.
Speaker 1:Steroid eye drops. Corticosteroid eyedrops sometimes are prescribed but they're only prescribed generally by ophthalmologists because they can cause drug-induced glaucoma, which is an increased pressure of the eye. They can increase cataract formation, especially if they're used for more than four weeks, so it should be restricted and generally not routinely used. Hormonal related dry eye treatments it's a little bit debatable about using systemic hormone therapy because we don't really have consistent results. I think it's kind of individual. Certainly there is some studies in using androgen formulations in patients showing some improvement, so I think that's something for us to watch in the literature.
Speaker 1:Some medications can reduce eyelid inflammation, including antibiotics. So sometimes antibiotics are used not to treat bacterial infection but to actually reduce inflammation, and a common one is doxycycline, which is a tetracycline-based antibiotics and it can be used daily for up to six weeks. If someone is tetracycline allergic, occasionally erythromycin or azithromycin are used. Certainly these antibiotics, especially doxycycline or any tetracycline, cannot be used in a pregnant woman because it can affect the developing baby's teeth.
Speaker 1:There are other anti-inflammatory prescription treatments. One of the first ones was Restasis, which is topical cyclosporine and that acts to increase tear production due to eye inflammation because it inhibits the activity of certain inflammatory immune cells in the lacrimal tear ducts and glands. Topical ivermectin, which is an anti-parasitic medicine and cream, can be applied to rosacea, face and eyelids and dramatically reduces inflammation. Zydra is the brand name for the generic Lifidagrast, which is an ophthalmic lymphocyte function associated antigen one antagonist, an LFA1 antagonist, and it's an eye drop that reduces inflammatory cell binding, meaning less eye inflammation. Some of my patients say it really burns when they put it in their eyes and so they refrigerate it to make it cooler. That can be more soothing. I've had some patients prescribe these expensive eye drops who find that just by doing humidification, getting their hormone balance in order, doing the appropriate eye hygiene and using the preservative-free eye drops, they're able to not need prescription medicine. In terms of devices, there are scleral contact lenses that are large, rigid lenses that sometimes give a temporary reserve for tears, or ophthalmic medications that sometimes eye doctors might prescribe.
Speaker 1:There are procedures occasionally that might be recommended. Surgery might be recommended for people that have abnormal eyelid anatomy or function, people who can't totally close their eyes to protect the cornea, like people who have seventh cranial nerve palsy, bell's palsy. Corneal transplants or grafts are possible for severe dry eye disease, but again, that's not something that we normally do. Occasionally a plug is placed in the lower lacrimal gland it's either silicon or collagen to block the tear ducts, because the tears that are made stay in the eye and it reduces the drainage of tears to the back of the nose. Now my oldest son, stetson when he was born he had blockage of his corneal ducts and actually had to have surgery because they were hard like cardboard and he always looked like he was crying. And his daughter, artemis, my granddaughter had the same condition, but massage opened hers up and she didn't, thankfully, need surgery. So we sometimes do the reverse for older people who otherwise are not responsive.
Speaker 1:There's another therapy called intense pulse light therapy that might be considered as a treatment for dry eyes caused by ocular rosacea, and this treatment requires direct application of light in various wavelengths to the skin. But this is pretty new. We don't have a lot of long-term research on the effectiveness and safety of therapy and certainly we do like to have long-term data, but it's very irritating for people with dry eyes. I think you need to stay on top of it. You need to talk to your regular doctor, perhaps even a dermatologist, or your ophthalmologist, if you're suffering from any symptoms of dry eyes, because we want eyes that are comfortable and attractive and appropriately moisturized with good vision, because that's part of us being strong, being healthy and being in charge.
Speaker 1:So thanks so much for joining me in the Sunflower House. I'm your host, dr Holly Thacker, the Executive Director of National Speaking of Women's Health. Please subscribe to our podcast if you don't already. Anywhere you get podcasts, there's podcast apps on your phone or computer. It's free. Hit the subscribe button, give us a five star rating and we'll see you back in the sunflower house.
