Taking Care of Dry Eyes

November 6, 2013 Updated: December 13, 2013

As temperatures drop, heaters are turned up and humidity levels indoors are much lower, leaving people with increasingly dry and irritated eyes.

There are actually a variety of causes for dry eye and a variety of types, some of which can become a serious problem, said Dr. Steven Stetson, owner and medical director of seven Diamond Vision clinics which offer a the gamut of eye-care and vision correction surgeries in the Tri-State Area.

“More and more of my patients are coming to me complaining [they] can’t wear their contacts anymore, [they’re] rubbing their eyes constantly,” Dr. Stetson said. “And there’s so many little nuances that patients don’t realize they’re doing—that they’re making it worse for themselves in situations we can help them.”

Dr. Stetson is most well-known for his track record in refractive laser eye surgeries (LASIK, PRK), especially while serving as the medical director of the Air Force Academy’s Laser Eye Clinic.

Since taking over Diamond Vision in 2006, he has focused on using specialized technology to provide patients with a wide array of eye-care solutions.

Eye Mechanics

The top of the cornea is coated with a protective layer of fluid called the tear film. The tear film has three layers—oil on top, water, then mucus holding the tear film to your eye.

“So many patients have really limited oil glands, for a couple of reasons,” Dr. Stetson says. The biggest reason is that so many people are wearing contact lenses for prolonged periods.

Studies have shown that with contact lenses pushing against the eyelids, the oil glands are weakened. Even breathable contact lenses cause a level of oxygen deprivation to the eye. For those who never wear contact lenses, these oil glands also get naturally plugged up over time.

“It’s really important to have a good, smooth, uniform oil layer,” Dr. Stetson said. “If you don’t have it, the tears evaporate very quickly off your eye.”

Last year, Dr. Stetson invested over $100,000 on dry eye technology, and is one of the only centers in the Northeast with the technology to determine which type of dry eye a patient has.

“If you don’t determine the right dry eye, you’re not treating the right dry eye,” he said.

The device Dr. Stetson uses is a monitoring system that analyzes the thickness of the top oil layer of the tear film.

The machine, a device by TearScience called LipiView, allows doctors to determine whether it’s an oil gland deficiency, mucus deficiency, whether the patient isn’t producing enough tears, or if it’s something else.

The same company manufactures a device called Lipiflow, which can warm up the eyelids safely from the inside to stimulate the oil glands.

“You’ve heard of people using hot compresses—that’s to try to increase temperature in the eyelid, to try to let this gland liquefy,” Dr. Stetson said. “It doesn’t work well though, because there’s a lot of insulation the eyelid has, so the best way is to heat it from the inside.”

Another prevalent cause of dry eye is lowered blink rate. Many of Dr. Stetson’s patients stare at computer screens all day, which has been proven to lower blink rate by as much one third of the normal rate.

“I’d say more than half of the patients that come in here are computer workers suffering from evaporative dry eye,” Dr. Stetson said. “And they don’t have a proper oil layer to keep and seal the tears that they are making.”

Value of Vision Surgery

The majority of Dr. Stetson’s surgery patients are contact lens wearers who no longer want to rely on contacts. However, he also has a significant number of patients who come to him for problems such as monovision, glaucoma, and cataracts—which Diamond Vision is able to diagnose and treat, using their specialized equipment.

Dr. Stetson’s air force training re-enforced the importance of clear vision.

“It’s not just a luxury to see, it can be very valuable,” he said. “From my training …[in] the US Air Force it absolutely became very apparent when we would take patients and put them in frontline situations.”

The hurricanes Katrina and Sandy reminded Dr. Stetson that correcting your vision can be life saving.

He recounted how one of his patients was able to evacuate with her children during hurricane last year. In the midst of an emergency evacuation, the patient realized that if she had needed to go back downstairs for her glasses, she would not have had the time.

Even if you’re not on the front lines or disaster zones, correcting your vision can change the quality of your life.

“People talk about the freedom, about being able to get up and not having to worry about contacts or glasses—I get that all the time,” Dr. Stetson said.

Patients have told him that little things really make a difference, like being able to snorkel and see the fish underwater, or coming out of a building into the cold without their glasses being fogged up.

“Patients would say to me, ‘I didn’t really get it until I had it done,’” he said.

Diamond Vision Manhattan Location:
15 West 44th Street (Between 5th and 6th Avenue)
9th Floor
New York, NY 10036
Tel: 212-838-2020

Don’t Rub Your Eyes!

Dry eyes often come hand in hand with rubbing your eyes—something Dr. Stetson warns his patients never to do.

“I don’t think people are aware that rubbing their eyes, especially on a regular basis, is a bad thing to do,” he said. “Allergy sufferers—I really worry about them because they go in and they’re just rubbing all day long, as are the contact lens users.”

Why Shouldn’t I Rub My Eyes?

1. It weakens the corneas.

Corneas are woven with cross-linked collagen fibers, and rubbing your eyes can stretch out the fibers and weaken the cornea long-term—which will worsen your vision.

2. It causes inflammation

Again, this is very common for contact lens wearers, Stetson said. With a piece of glass or plastic sitting on your cornea for hours on end, oxygen can’t get into the cornea tissue. In response to the lack of oxygen, your eyes send signals to inflammatory cells to build new blood vessels under the cornea tissue.
“So people get really red eyes,” Dr. Stetson said.

3. It can worsen astigmatism
And because rubbing your eye can move surface cells around, if someone already has astigmatism, too much rubbing will only worsen it.

4. It releases histamine
Unfortunately, usually when you rub your eyes it’s caused by a need to stimulate oxygen flow, Dr. Stetson says, but further rubbing will irritate the inflammation, causing more irritation, more rubbing, and more inflammation.

“Once you’ve released histamine you’ve started cascading inflammation, which continues in a cycle,” Dr. Stetson said.