Ask the Dry Eye Doctor

Do you have a question about dry eyes? Use the form below to send it to Dr. William Trattler, who will respond to you via email.

Dr. Trattler has performed research on dry eye and oil gland problems of the eye and has also lectured widely about these subjects. Each week Dr. Trattler will choose the best questions about dry eye to answer. Please remember that some questions can't be answered unless an eye doctor sees your eyes in person.

We are publishing the best Q&As below, so please check there to see if your question has already been asked and answered. (Note: Following each question we use only initials, not full names, to protect your privacy. Read our privacy policy.)

To find the Q&As most helpful to you, please click on one of these subjects:

• Dry Eye Causes and Risk Factors
• Allergies and Dry Eye
• Cataract Surgery and Dry Eyes
• Computers and Dry Eyes
• Contact Lenses and Dry Eye
• Dry Eyes Upon Awakening
• Dry Eyes in Cold or Windy Weather
• Eye Bumps, Eyelid Bumps, and Dry Eye
• Eye Infections and Dry Eye
• Eye Irritation, Pain, and Dry Eye
• Eye Redness and Dry Eye
• Eyelid Surgery and Dry Eye
• LASIK and Dry Eyes
• Nutrition and Dry Eyes
• Other Diseases and Dry Eye
• Permanent Cures for Dry Eyes?
• Punctal Cautery
• Punctal Plugs
• Vision Problems Related to Dry Eyes
   

Q: I have glaucoma and use the prescribed eye drops, Xalatan. Apparently these eye drops work in bringing the eye pressure down. But unfortunately, they make the rims of my eyes very itchy and seem to give me blurry vision. Do you know of any alternative treatment? — J.J.

A: Glaucoma medications such as Xalatan do a wonderful job of lowering eye pressure to control the eye disease. But they do have side effects such as ocular irritation caused by preservatives present in certain eye drops. The irritation can lead to symptoms such as itching, eye pain, and blurry vision.

There are a variety of treatments, including a common prescription dry eye medication known as Restasis (cyclosporine eye drops). The first approach may be to treat the irritation by lubricating the eye with preservative-free artificial tears. This can help reduce the overall irritation of the eye from these medications. Other treatments to increase tear production may include use of punctal plugs alone or with prescription dry eye medication.

Another approach to consider is glaucoma laser treatment. This straightforward procedure lasting four or five minutes helps lower eye pressure and can sometimes get a patient off of glaucoma drops for an average of two or three years. You should discuss these options with your eye doctor. — Dr. Trattler
 

Q: My husband has just been diagnosed with "extreme" dry eye. He also has just begun using a CPAP (Continuous Positive Airway Pressure) machine within the last couple of months. Is is possible that this is the cause of his condition? As I observe him during the night, I find that his breathing is very shallow at times. A lot of noise accompanies his breathing. He has a chin strap with the contraption, and often it seems that it isn't completely connected to him as there is a lot of "ssssss" noise.

As you can imagine, he is a male and is pretty much reluctant to pursue this. The noise is driving me a little crazy. But most of all, I am concerned that this CPAP is the cause of his dry eye. Possible? — N.N.

A: CPAP stands for Continuous Positive Airway Pressure and is a device used for patients who have difficulty breathing at nighttime. The device provides air that flows into a person's airway. But commonly there is extra flow of air around the face. This extra air flows over the eyes as well and causes evaporation of tears.

As you suspected, CPAP is therefore a well known cause of dry eye. If left untreated, CPAP can potentially lead to worsening dry eye over time.

The first step your husband should take is to see his eye doctor to figure out a treatment plan for dry eye. Some patients need to wear moisture goggles to lock in the tears and protect the eye from the constant flow of air. Another effective intervention is a thick, lubricating ointment to protect the ocular surface from damage.

Some patients benefit from punctal plugs, which raise the quantity of tears, as well as Restasis, which is a prescription medication that increases tear production.

Again, the first step needs to be for your husband to see his eye doctor. — Dr. Trattler

Q: What condition of the eye, besides dry eye, would cause extreme redness, dull to sharp constant pain, no discharge, a scratchy feeling, and movement from one eye to the other eye with the first eye becoming almost well? — L.J.B.

A: I can provide general comments on various conditions that could cause the constellation of symptoms you are describing. But my first and more important suggestion is for you to see your eye care provider for an examination to determine the exact cause of your red eye.

The most common causes of red eye are dry eye and ocular allergy. Other common causes include infection, pink eye (viral conjunctivitis), and inflammation of the conjunctiva or eye surface (episcleritis or scleritis).

Treatments of these conditions are all different. This is why it is important for you to get an eye exam to determine an exact cause of your symptoms. Clearly, episodes of redness and dull to sharp pain are abnormal. — Dr. Trattler

Q: Before I went on active duty service in Iraq, my eyesight was 20/20. Now, two years later, my eyesight is 20/40 and I have been experiencing constant dry eyes. I also have been diagnosed with hypertension (high blood pressure). Could my hypertension medication be causing my dry eye syndrome? — G.S.

A: Thank you for your question, and I personally want to thank you for your service in Iraq.

Dry eyes can cause a reduction in vision, and treatment of your dry eye may result in improved vision. Please see your eye care professional, who can prescribe various treatments for your dry eye.

Although some medications for hypertension can affect dry eye, many do not. I would focus more on the possibility of treating your dry eye with available options such as artificial tears, topical cyclosporine, and punctal plugs. — Dr. Trattler

Q: My eyes were bothering me, becoming blurry and sensitive to light. I went to my family physician, who said it was dry eye. I'm now on drops, and my physician took me off a medication that can cause dryness (Nortryptline). However, another reason for my visit is a gray mass that appears behind my pupil when I look to the left. It stays there temporarily until I blink a number of times. Can you advise? — J.S.

A: I am happy to hear that your dry eye condition is being addressed. As for determining what is causing the sensation of a gray mass, you should go back to your doctor and request a dilated eye exam. The gray mass could be a floater or a retinal problem. — Dr. Trattler

Q: I am 42 years old and have noticed for the first time that my eyes are very dry. I have been diagnosed with rheumatoid arthritis and diabetes, and also have had conjunctivitis twice in the past few years. For the dry eye, how long should I wait to see my doctor? What kind of doctor should I see? — D.D.

A: You have a number of well known medical risk factors for dry eye, including rheumatoid arthritis and diabetes. As well, females are also more likely to experience dry eye. With these risk factors, it is common for patients to develop dry eye symptoms.

You should plan on seeing an eye care professional for your consultation. Your doctor should perform a complete eye exam including tests for dry eye. These tests might include measurement of tear production (Schirmer's test), examination of the health of the cornea with fluorescein dye, and determination of the level of tears in your tear film. Your doctor may also measure the stability of the tear film (called tear breakup time) and the quality of the secretions from the oil glands.

If you are diagnosed with dry eye, then the treatment recommended by your doctor will depend on the severity of your symptoms and the examination results. Because you have a number of risk factors for dry eye, including rheumatoid arthritis, many experts would consider the use of prescription eye drops (topical cyclosporine). Other treatment options will depend on the findings of your eye exam, and may include preservative-free lubricating drops and gels, oral omega 3 fatty acids, and/or punctual plugs — Dr. Trattler

Q: Can night shift work adversely affect eye health, including causing dry eyes? — J.B.

A: No, night work does not affect the eye or cause dry eyes. — Dr. Trattler

Q: My eyes run all the time. The last doctor I saw said my tear ducts were full, and nothing was wrong with me. But my eyes are sore and red all the time. — D.Y.

A: Dry eye is one common cause of tearing. It sounds like your doctor ruled out clogged tear ducts, which is another cause of tearing. Besides tearing, eye redness also can be a sign of dry eyes.

You should return to your doctor and ask for some dry eye tests, such as a measurement of tear production (called a Schirmer's test) and evaluation of the oil glands of the eyelids.

If you do have dry eyes, there are a variety of treatments that your doctor can recommend. — Dr. Trattler

Q: I have 20/20 eyesight but sometimes have blurry vision affecting one or both eyes. Sometimes I'm not able to clear this up. My ophthalmologist said this may be due to dry eyes. Artificial tears don't make a difference. I do take allergy medications, which I know can be drying agents. — S.W.

A: Dry eye is a common condition, and you have described a few common signs of dry eye. Clearly, your eye doctor needs to confirm that dry eyes are the source of your difficulties.

Artificial tears can be helpful for mild dry eyes. But if the dry eye condition is more advanced, then you may need a therapy such as prescription medication (cyclosporine). You also might be helped by punctal plugs, which close the drainage ducts so that more natural tears are preserved.

It is important to be aware that there are major differences in artificial tears. Preservative-free tears are better for people with more advanced dry eye. As well, there are a few brands with disappearing preservatives that are better than the standard eye drops. — Dr. Trattler

Q: I noticed that the area around my eyes is continually moist. Yet, when I wipe the area, it's not moist at all. I do wear glasses all the time. I was given drops for dry eye, but it is no better. My eyes do not look irritated. Is this dry eye, or could it be blocked tear ducts? — R.B.

A: It is impossible to know whether dry eyes or a blocked tear duct is the cause of your eye feeling moist. Both conditions can cause the symptom. You should see your eye doctor, who can perform tests to determine the cause. Best of luck. — Dr. Trattler

Q: I have been diagnosed with dry eyes. The eye that had surgery is far worse, with both shooting pains and increased loss of vision. (I had a torn retina about eight months ago that required surgery.) The eye doctor put in temporary plugs. But after three days, the pains came back, and maybe are even more severe. Should I get the permanent plugs, or is there a better treatment? — S.K.L.

A: Your dry eye condition is treatable. Permanent plugs, along with Restasis, artificial tears, and oral omega-3 fatty acids, can all work together to improve your condition. Your doctor may also want to consider brief treatment with a low-dose topical steroid. With treatment, your signs and symptoms of dry eye can improve. — Dr. Trattler

Q: What eye drop can I use on my eyes after I have looked at a welding arc? My eyes are red, and it feels like I have sand inside them. The light also bothers my eyes. — H.

A: It is, of course, very important for you to wear protective goggles when working with a welding arc. As well, the heat from the welding arc can cause dryness leading to ocular irritation. You should talk with your doctor about possible treatments to prevent dryness from the heat, which could include lubricating drops or gels. — Dr. Trattler

Q: In addition to having chronic watery eyes, I also have a mucous drainage coming from the inside corner of my right eye. When I examine my tear duct, I can see that this is the source of this drainage. Though my ophthalmologist believes I have allergies, I am getting good results for this drainage using over-the-counter treatments for dry eyes. However, I find I must use eye drops quite a few times a day. I have two questions: Can the mucous drainage in my right eye be related to chronic dry eye? Would I be better served by some prescription eye drops? The eye drops prescribed for allergies have had virtually no effect on either the watery eye problem or the mucous drainage. I have had these problems with my eyes for over a year, but they have become worse since my glaucoma and cataract surgery last December. — C.V.

A: Surgeries on the eye can exacerbate dry eye. Because you have glaucoma, you may be on glaucoma medications that can further exacerbate dry eye. The mucous discharge you are experiencing may be related to ocular allergies. Because there is a lower volume of tears with dry eyes, allergens that cause your allergies achieve a higher concentration. This results in chronic eye allergy symptoms.

Thankfully, various treatment options are available. The first treatment to consider is cyclosporine, a prescription dry eye medication. This medication will improve your tear film quality, and provide better lubrication of your eye. The second effective treatment involves placement of punctal plugs, which will raise the tear volume and dilute the allergens that end up reaching your eye.

An additional treatment that can be very helpful is a topical ocular allergy medication called Elestat, available only by prescription. Recent research has found that this medication, which treats the ocular allergy component, is least likely to cause dry eye (antihistamines, both oral and topical, can potentially exacerbate dry eye).

I hope these initial suggestions help you understand that there are available treatments. But, obviously, you need to discuss your condition with your own doctor. — Dr. Trattler

Q: My eyes are constantly getting red and itchy. The skin around my eye area gets chapped and red. When I apply something, my eyes swell up and get puffy and red. I'm also very allergic to dogs, cats, dust, and mold. I take Claritin as an allergy medication, and it does not help me at all. — L.

A: You have asked a very important question, which actually affects a very large number of patients. Ocular allergies result in symptoms of itchy eyes, eye redness, and swelling of the eyelids. Patients with ocular allergies often have allergies to animals, dust, and mold (called perennial allergies) or allergies to dust and pollens (seasonal allergies). Both of these situations can lead to ocular allergy symptoms.

It is critical to understand that dry eyes exacerbate allergies. When allergens contact the eye, they are washed away with our tears. If you have dry eye, then the eye has longer contact time with allergens before they are washed away. So one way to treat ocular allergies, especially for patients with dry eyes, is to use lubricating eye drops. If lubricating drops are not enough, then you can see your eye care professional and ask about a topical anti-allergy medication that is a combination antihistamine, mast cell stabilizer. This medication does a wonderful job at treating ocular allergy.

Of course, if underlying dry eye is an issue, your doctor may also recommend topical cyclosporine eye drops that can increase tear production and improve the quality of the tear film. This helps the eye handle exposure to allergens, as the allergens are more effectively "washed away" with our own natural tears.

Also consider that certain oral anti-allergy medications are very drying to the eye. They therefore can exacerbate ocular allergy symptoms rather than treating them. You may want to ask your allergist or regular medical doctor to see whether there are more local therapies for your allergic symptoms. For example, if your symptoms are primarily nasal and ocular, your doctor can prescribe a nasal spray and eye drops to target both areas. This way, you can avoid using a systemic medication that may be very drying to your eyes. I hope this helps. Please discuss this information in detail with your own doctor. — Dr. Trattler

[Read more about eye allergies.]

Q: I want to thank you so much for this page. A lot of people might find comfort knowing they are not alone with dry eye problems.

I suffer from allergies and dry eye. I know which day it will rain, because my eyes get very itchy some hours before it rains. I am from Costa Rica, and it rains a lot here!

I wake up with red, tired eyes. Frequently (every 20 minutes or so), I have to wipe away mucus that forms in my eyes. This is very annoying, because it affects my social life.

Also, some years ago I used contact lenses, and I stopped using them because I saw a lot of new blood vessels in my eyes. So now, every time my eyes are tired or itchy, the vessels look very conspicuous.

In my country, I have seen many ophthalmologists. They have given me eye drops like Refresh Tears, Tears Naturale, Patanol, Zaditen, etc., and antihistamines like Zyrtec and Flurinol. But honestly, I just experience a temporary relief. I have also tried homeopathy (still trying it), and it helped to a certain extent.

Could you please tell me if I should continue using eye drops like Refresh Tears for my condition? Also, what can I do in order to reduce the formation of mucus in my eyes? — A.V.

A: Dry eye and ocular allergies go hand-in-hand, because dry eye makes ocular allergies worse. Of course, this means that treating dry eye can help reduce the severity of ocular allergies.

You have tried a lot of treatments, all of which can be helpful. I have found one treatment that works best for the itching, redness, and swelling of ocular allergies is topical Epinastine, because it causes less drying than some of the other anti-allergy medications.

As well, you can consider continuing the use of artificial tears that help reduce dry eye and dilute ocular allergens that make it into the tear film. If you feel your eyes are dry despite the artificial tears, you can ask your doctor about punctal plugs or a short course of low-dose topical steroids.

I hope this general information is helpful. — Dr. Trattler

Q: Since moving from the Far East to a European country for three years now, I have been experiencing tearing, red eye, and dry eye problems for quite some time. Initially, these problems started during the summer months only, and now it is a daily affair. What puzzles me is that it happens to my left eye only. I am a contact lens wearer. But even when I wear glasses and put in eye drops, I am not helped much. On most days, I get a lot of mucous discharge. Especially in the morning, my eyes have a lot of dry, waxy stuff that causes my eyelids to get glued together. — J.V.

A: You are describing a combination of ocular allergies and dry eye, which is being exacerbated by your contact lenses. You should discuss a variety of treatment options with your doctor, including treatment of your ocular allergies with topical anti-allergy medications. As well, punctal plugs can increase the tear film and make your eyes less sensitive with contacts. Finally, you can consider low-dose topical cyclosporine, which can be very helpful in increasing contact lens tolerance. Please see your doctor to confirm what your e-mail suggests and to develop a treatment plan. — Dr. Trattler

Q: I've been diagnosed with cataracts and dry eye syndrome. I'm being treated for dry eye, and my symptoms have gone on for over one year. How long will my cataracts have to develop before they can be surgically removed? Is there anything else I can do to improve my ability to drive my car until that time? I still need to work and need my car for my job. — F.G.

A: Visual degradation can occur from both cataracts and dry eye. Because both dry eye and cataracts can decrease quality of vision, it is important to differentiate the degree of vision loss from dry eye versus cataract.

One helpful way to determine underlying cause is to look at the degree of visual fluctuation. Because visual fluctuation is caused by dry eye, you can temporarily improve quality of vision with blinking. If the degree of dry eye can be improved further, then the visual fluctuation can be reduced and quality of vision improved.

Of course, cataracts also can reduce visual quality. Only your own doctor can determine the severity of your cataracts. Your doctor would be the one to advise you regarding the time it might take for your cataracts to progress to the point where surgery would be helpful. — Dr. Trattler

Q: Is there a link between cataract surgery and subsequent dry eyes? I had no problems with dry eyes previously. But after each cataract removal, the eye in question became and has remained uncomfortably dry, even though I use artificial tears. — P.N.

A: Cataract surgery generally is not known to cause or exacerbate dry eye. However, some patients can notice increased dry eye symptoms after cataract surgery, perhaps due to the use of the many medications during the postoperative period. The medications themselves do not actually cause dry eye, but the preservatives used in these medications can irritate the ocular surface, and this can result in dry eye.

If artificial tears are not relieving your dry eye symptoms, you may want to ask your eye doctor about a prescription dry eye medication known as cyclosporine, or ask about punctal plugs that can help retain moisture in the eye. — Dr. Trattler

Q: Before I had cataract surgery on both eyes two months ago, my eyes had no perceivable problems. A month after surgery, my left eye developed iritis. Now that eye has dry eye syndrome. Are the surgery and iritis responsible for the dry eye? Will the dry eye abate with treatment? What treatment would be best? Are oral supplements any good? — A.S.

A: Cataract surgery and post-cataract surgery inflammation (iritis) have not been shown to be a causal factor of dry eye. However, the use of a lot of medications can sometimes lead to ocular surface irritation, which can lead to dry eye-like symptoms. If someone has mild pre-existing dry eye, then they may be more susceptible to irritation from frequent use of medicated eye drops. Thankfully, the risk of this occurring is low.

Your doctor may have prescribed topical over-the-counter lubricating drops, which are a good first-line therapy. But if your symptoms do not improve sufficiently, you may want to consider prescription eye drops (cyclosporine). Oral supplementation with omega-3 fatty acids like fish oil and flaxseed oil can also be helpful. — Dr. Trattler

Q: I am suffering from dry eye. I use Refresh (artificial) tears every hour and have used Restasis (prescription dry eye medication) for five months now. I have had no major improvement. I also am suffering from severe eye strain and headaches while working on computers. Is this computer vision syndrome (CVS)? Can you suggest a cure for my problem? — A.K.

A: Treatment of dry eye can be challenging. Restasis is the only FDA-approved treatment and generally works very well. But for more advanced dry eye, Restasis is often just one of a few treatments required to keep dry eye under control.

For patients already on Restasis, I typically find that punctal plugs are an important first step because they increase the quantity of tears. As well, I find that the addition of a short course of topical steroids helps reduce inflammation and improve the quality of the tears. Oral omega-3 fatty acids can also help improve the quality of tears.

Of course, reducing the amount of time that one spends on the computer can help.

I would recommend that you see your eye doctor, who can help guide you through the additional treatment options that will enable you to improve your dry eye situation. — Dr. Trattler

[Read more about computer vision syndrome.]

Q: I have keratoconus, and I've been wearing Sofperm contacts for more than a year. The lenses feel very comfortable inside my eyes. But 90 percent of the time I have red eyes.

I have visited my doctor many times to see what I can do and to check the fit, etc. He says only that it is normal and I should just put eye drops or fake tears in my eyes three or four times daily. I do clean my contacts three times a week with Clear Care solution. And I take them out every night. In other words, I follow all the rules.

Is there anything else I can do or that you would recommend? — J.Y.

A: In general, it is not normal for patients to experience red eyes when wearing contact lenses. The cause of the red eyes is typically some form of ocular irritation, leading to release of factors that encourage the blood vessels in the white part of the eye to swell. As you mentioned, the fact that this occurs primarily with your contact lenses on tells you that this is an issue with the contact lenses affecting your eyes.

Various options are available to help your situation. These include punctal plugs to increase the quantity of tears so that your contact lenses float. As well, Restasis can increase tear film quantity and quality, which will help reduce ocular irritation and redness.

You may want to consider a second opinion. — Dr. Trattler

Q: I have been wearing soft contact lenses for several years now, but all of a sudden I am having eye irritations quite regularly. I went to the eye doctor, who told me that my contacts didn't fit properly and were irritating my eyes. I ordered brand new contacts, but the same thing is happening again. My eye doctor said he didn't see any sign of infection in my eyes. I have tried everything, but my eyes still flare up. They are uncomfortable. It sometimes feels like I have particles in my eyes, when there aren't any, and I sometimes get a red ring around my iris. I am tired of having bloodshot eyes, and I cannot stand to wear my glasses. Are there any alternatives? — J.S.

A: You are describing a case of contact lens intolerance that, in my experience, is commonly caused by dry eye. Your symptoms of discomfort and "red ring" are common symptoms and signs of dry eye.

Approximately 50 percent of contact lens wearers will experience dry eye symptoms and signs. There are new contact lenses designed specifically for dry eye, but patients can still experience dry eye symptoms with these contact lenses.

I have found that starting cyclosporine drops twice daily along with placement of punctal plugs together will improve the quality and volume of tears. Together, these treatments will improve tolerance to contact lenses and typically will allow you to return to wearing your contact lenses.

If these treatments alone do not eliminate your symptoms, there are additional options. These would include the use of preservative-free tears, oral omega-3 fatty acid supplements, and gels/ointments at bedtime. — Dr. Trattler

Q: I was recently told by a friend that contact lenses can make my vision problems worse. Is this true? — P.S.

A: One of the challenges is that contact lenses can cause some degree of dry eye symptoms. Patients who use contact lenses may report dry eye symptoms of pain, foreign body sensation, or ocular irritation. Contact lens wearers also may complain of blurring or fluctuating vision, both of which also are signs of dry eye.

Patients who wear contact lenses may therefore feel that the contact lenses are responsible for changes in their vision, or fluctuation of their vision. However, treatment with over-the-counter or prescription medication can also reverse these signs and symptoms, thus eliminating the sensation of blurry or fluctuating vision.

It is important to point out that many patients will have progression of their myopia, hyperopia, and astigmatism regardless of whether or not they wear contact lenses. — Dr. Trattler

Q: I am 42 years old and have noticed for the first time that my eyes are very dry. In both of my eyes, I am -10 diopters. I have worn contact lenses for about 25 years and this is the first time I have noticed dry eyes. What happened to my eyes? — C.L.

A: As we age, it is common for us to develop dry eyes. Your other risk factors include contact lens wear and being female. In one survey, for example, 50 percent of contact lens wearers reported dry eye symptoms versus just 7 percent of non-contact lens wearers. Thankfully, there are some great treatments for your condition including punctal plugs and prescription eye drops (cyclosporine). You should also talk with your contact lens specialist about switching to a contact lens that is designed for dry eyes, which could reduce your dry eye symptoms when wearing contact lenses. — Dr. Trattler

Q: I am 13 years old and wear Acuvue Oasys contact lenses. My doctor told me I could only wear them for eight hours a day. My friends who have the same brand and type can wear them all day. Should I change doctors? — B.L.

A: You may not have realized it, but your question actually has a lot to do with dry eye. We know that long-term use of contact lenses can lead to the development of dry eye. As well, if you wear contact lenses for an extended period of time, and especially if you sleep in contact lenses, you are at increased risk for infection.

Your doctor is providing good advice to delay any possible development of dry eye. Also, limiting your contact lens wear time will reduce your risk of infection. — Dr. Trattler

Q: After a week of performing all of the necessary cleaning and storing at night for a new pair of 30-day disposable lenses, my left eye begins to feel irritated like the edge of the lens has a flaw in it. I'm wondering if I'm storing the lenses correctly.

If the lens container has low solution in it, is it possible that the lens could fold and thereby create a permanent indentation? Is that what I'm feeling? If so, can soaking a lens in solution for a long period of time cause it to regain its original form?

Another theory is that I may have the lens in backwards. This irritated feeling happens each time I open a new set of contact lenses. I just can't understand why the left lens feels so comfortable for about a week, and then it suddenly causes eye irritation. Any advice is appreciated. — M.B.

A: Dry eye occurs in 50 percent of contact lens wearers. It is possible that the ocular irritation you are experiencing is related to dry eye. Another thing to consider is that the contacts may somehow be building up a residue.

You should talk with your eye care professional about switching to a brand of contacts designed for dry eye. You can also consider the daily disposable contact lenses.

Finally, you can consider adding lubricating drops and, potentially, Restasis to help treat any underlying dry eye. Your doctor will help you determine whether or not Restasis would be beneficial. — Dr. Trattler

Q: I went to the optometrist because I really want to wear contact lenses. So the doctor did the tear level test and doesn't recommend contact lenses. If I stubbornly want to use them still, I have to use the daily disposable contacts and for no more than six hours. And if I don't listen, when I'm older I might have blurred vision, etc. I'm 31. What's your opinion? I'm currently trying out Focus Dailies. Can I use these contacts for at least 10 hours? — K.

A: Ask your doctor about punctal plugs, which will raise your level of tears. As well, Restasis has been shown to increase tear production. Your doctor can also provide one of the newest generations of contact lenses designed for dry eye. The key for now is to limit your total wear time of contact lenses until your dry eye is treated. — Dr. Trattler

Q: I know I have dry eyes, but I've successfully worn Surevue contact lenses for years without many issues. As you know, Surevue contact lens have been discontinued. Now I cannot seem to find anything else that works. I've tried several contacts specifically made for dry eyes with little to no success.

Based on the contents of this web site and my personal experiences, I know that this is simply a matter of finding a doctor or optometrist in Washington who is competent in dealing with lens fittings for dry eye or "hard to fit" people. Please recommend some doctors you know in Seattle who may be knowledgeable and helpful. — K.

A: Unfortunately, I do not know who to recommend. You may want to consider finding a doctor who specializes in the treatment of dry eye. You can get your dry eye treated with punctal plugs, Restasis, etc. Then from there, you can go back to contact lenses. — Dr. Trattler

Q: I used to wear glasses but changed to contact lenses four years ago. Contacts have never been a problem for me. I find that my sight is excellent, and my eyes are comfortable. But I recently found out I am pregnant. My eyes have suddenly started to itch. They are red and swollen and seem to get better only when my contacts are not in. I have no glasses, so I rely on contacts to do daily tasks. Does this reaction have anything to do with me being pregnant? — S.L.

A: Your first step should be to get a new pair of glasses. Although contacts in general are great, you cannot rely on them exclusively. When people develop ocular irritation while wearing contact lenses, for example, they should remove their contact lenses and switch to glasses. So the key really is for you to get glasses.

The second issue is pregnancy. It is possible to develop some mild dry eye during pregnancy, and that could explain your symptoms. You should see your eye doctor for a complete exam. Your doctor may prescribe treatment for dry eye or perhaps even ocular allergies. Good luck with your new eyeglasses. — Dr. Trattler

Q: I have been experiencing dry eye mostly in the right eye, and this has made wearing contacts difficult. (My eye doctor recommended GenTeal eye drops to ease the dryness.) In addition, I have noticed that this same eye is prone to having blood vessels burst, causing quite a scary-looking eye condition. This occurs in the same area of the right eye, from the inner corner of the eye running out to and around the contact lens. Any suggestions for helping this issue? — D.S.

A: For patients with dry eye related to contact lenses, artificial tears are often a good first start. But often, artificial tears alone are not enough. You should ask your doctor about Restasis drops as well as punctal plugs to help increase the tear film quantity and quality. As far as the subconjunctival hemorrhages, they are typically nothing to worry about. — Dr. Trattler

Q: My eyes seem to be tired even when I first get up in the morning. I am using over-the-counter eye drops. But my eyes still seem tired and puffy. — C.

A: There are a number of reasons for your eyes to feel tired when you first wake up in the morning. First, it is likely that you have dry eyes. A visit to your eye care professional is important in determining the degree of dry eye present.

As well, your examination results will help determine your best course of therapy, which can range from lubricating drops or gels, prescription topical cyclosporine eye drops, punctal plugs, oral omega 3 fatty acids, etc.

The second thing to consider is whether there are any situations you can alleviate in your home to reduce the dry eye symptoms you are experiencing upon awakening. A common cause for this complaint is the presence of a ceiling fan over your bed. The fan can cause increased circulation of air in your bedroom, which leads to evaporation of tears. A similar situation exists when an air conditioning vent is pointed at you while you are sleeping. Steps to take include turning off your fan and pointing the air conditioning vent away from your bed.

A final condition that must also be ruled out is ocular allergy. Patients with allergies who awaken with allergic symptoms of the eye (puffy eyes, for example) may have higher levels of allergens present when they are sleeping. This can be due to accumulation of allergens in a pillow or pillowcase, or even on your own hair (especially if it is long). You can consider washing the pillow cases at hot temperatures, using pillow coverings that trap dust mites (a common allergen), and washing your hair at night to remove any accumulated allergens.

I hope these suggestions are helpful. But clearly, your next step is a visit to your eye doctor. — Dr. Trattler

Q: Every morning when I get up, my left eye always seems to be red or pink. However, my whole eye is not pink. It is the veins beneath my eye that look inflamed. This causes no pain, itching, or anything. It feels normal but looks different. Do you have any idea what it could be? — M.M.

A: Various conditions, from ocular allergies to dry eye, can cause red eye without other symptoms when you awaken in the morning. In my experience, dry eye is the more common cause of this condition, especially if you sleep under a fan or have an air conditioning vent blowing on your eye. I recommend that you see your doctor, because the exact cause of your problems cannot be determined without an eye exam. Your doctor can determine the cause of your eye redness and prescribe the appropriate medicine. — Dr. Trattler

Q: I woke up this morning, and all of sudden, I can't tear up. I can't cry. What may be my problem? — J.M.

A: This is a complex question, and not easy to answer. I am not aware of any conditions where you can suddenly not make tears. You should see your eye doctor to determine the degree of lack of tears that you have actually developed. From there, your eye doctor can make recommendations to help. — Dr. Trattler

Q: My eyes water very much when I am out in cold weather or in the wind. Is there a remedy or drop that will control this? — R.D.

A: You are describing classic symptoms of dry eye. You should see your eye doctor to determine if, indeed, you have dry eye. Your doctor will discuss treatment options, which will often start with the use of lubricating eye drops. — Dr. Trattler

Q: I believe I have dry eyes because they are red and dry all day. Lubricant drops provide temporary relief. I wake up to red and irritated eyes even with sufficient sleep. Sometimes I see little white bumps on my upper lids. Can this be more than dry eyes? I am at a loss about what to do. — V.G.

A: You should not be at a loss. Your next step is very simple. You should see your eye care professional and undergo a complete eye exam, including testing for dry eye. Your doctor will be able to diagnose your degree of dry eye and make treatment recommendations.

Your symptoms are common for patients with dry eyes. Waking in the morning to red, irritated eyes even with sufficient sleep is a common complaint. Your symptoms of dry eye may be exacerbated by an overhead fan or an air conditioning vent pointed at you. You can consider stopping the use of your fan or repositioning the air conditioning vents, if these situations are present.

Since your symptoms do improve with the use of lubricant eye drops, your doctor may recommend topical cyclosporine eye drops that may be able to increase tear production.

Regarding the white bumps, it is important for you to see an eye doctor for an evaluation. Often these bumps are meibomian gland secretions at the opening of the oil glands of the eyelids. These secretions can harden, and appear as white bumps. This condition, called meibomian gland dysfunction, is often treated with warm compresses as well as prescription eye drops.

Of course, because I have not had the opportunity to examine you, I can only discuss your situation in a general way. You need to have an examination with your own eye doctor, who will be able to examine your eyes and make the appropriate treatment recommendations. — Dr. Trattler

Q: I have a white bump on my upper eyelid near where your upper and lower eyelids meet on the side of the eye closer to the ear. The bump looks similar to a pimple. My eye is very dry and it hurts to blink. Help? — A.G.

A: Please see your eye care professional. A bump on the eyelid is most commonly a stye, but it can be a benign or even a malignant form of cancer. Please see your eye doctor, who can help determine what the "bump" is as well as the best way to treat the bump. — Dr. Trattler

Q: I have a bump on the white part of my eye. It is a little red and irritating. Is that something serious? — J.J.

A: You are describing either a pingueculum or a conjunctival lesion. I cannot know whether this is a benign or serious condition. Please see your eye doctor to determine exactly what this "bump" is. Note that dry eye can irritate bumps on the eye. So lubricating drops are something to consider as well, once you have seen your doctor. — Dr. Trattler

Q: I have a dry eye condition. Why do I get eye infections often? — E.A.

A: Dry eye predisposes to ocular allergies and eye infections, because the tear film quantity is too low to effectively wash out allergens or infectious organisms. As well, a healthy tear film has a large number of antibodies present to fight infections. However, when dry eye is present, the tear film is often deficient in proteins and antibodies that help fight infection. — Dr. Trattler

Q: I have been diagnosed with dry eye symptoms but now am experiencing an involuntary closing of the eyelid (one more than the other). Do you think this is a "habit" created by eye irritation, or is something else going on? — J.H.

A: Dry eye is a chronic condition. With significant ocular irritation, patients may notice that they start to close or favor their eyes. And of course, the most irritated eye will tend to close more. However, it is very important to rule out other potential causes of a droopy eyelid, including nerve palsy or neurological conditions. As well, conditions like neuromuscular disease (myasthenia gravis), thyroid disease, and even eyelid cancers can cause drooping eyelids.

I hope this basic background provides enough information to convince you to see your own eye doctor to carefully evaluate your conditions. — Dr. Trattler

[Read more about droopy eyelids.]

Q: My eyes are in severe pain. I've been to many different eye specialists, and they've given me many different types of eye drops, which have all failed. I've been in pain since I was in my early teens, and I am now 27 years old. My eyes constantly have mucus. I wipe my eyes constantly. I can't wear makeup. My own tears burn. My eyes feel like someone wiped grease all over them. They burn severely, water constantly, and are so dry it feels like there is sand in my eyes. I can't wake up in the morning without first flipping my eyelids and then wiping my eyes constantly. I really need any help any doctor can give me. I really can't take the pain anymore. Please help me if you can. — K.O.

A: There is hope, because a lot can be done to help with dry eye. You obviously sound like you have severe dry eye. So your doctor may need to provide you with a number of treatments at once to reduce the severity of dry eye. This approach can be considered "breaking the cycle." Chronic dry eye causes ocular irritation, which leads to even more dry eye. So you need to treat and reduce your dry eye to reduce your overall level of ocular irritation. This will help to further reduce your degree of dry eye.

You should talk with your doctor about various treatment options, including punctal plugs, topical cyclosporine (Restasis), topical steroids, a new next-generation lubricating drop (called Optive), etc. As well, you should talk with your doctor about starting oral flaxseed oil or fish oil supplements. You may also require lubricating gels or ointments at bedtime until the condition improves.

I hope this overview helps. Dry eye treatment can be challenging, and your doctor is welcome to contact me with any questions. — Dr. Trattler

Q: My eye will itch and be dry for a few days. And then I will wake up one morning with it swollen and red. I have tried ice packs and over-the-counter eye drops. My doctor has prescribed steroids, but the symptoms keep returning. My eye is dry, itchy, red, swollen, and feels like it is slightly burning. Help! — T.S.

A: This can be a challenging condition. It sounds like you have a combination of ocular allergies and dry eyes. You will need to treat both conditions. I would recommend that you speak with your doctor about Elestat, an ocular allergy medication that is very effective and does not have the potential to exacerbate dry eye like some other topical ocular allergy medications.

As well, you should talk with your doctor about Restasis and punctal plugs, which can raise your tear film and potentially dilute any allergens that get into your tear film. Hopefully, you can work with your doctor for improvement of your situation. — Dr. Trattler

Q: Please help me! Every day, my eye is always dry, and it seems like my eye does not produce enough tears. My eye is constantly dry, burning, and red. I use eye drops to remove the redness, but that does not cure the problem. I think the dryness is what causes the redness every day, because I'm not sure what other cause it could be. This condition makes my life so miserable. — P.X.

A: You are describing dry eye syndrome, and clearly you need to see your eye care professional. Your first step is to stop the use of drops to remove redness. These drops, called vasoconstrictors, work only temporarily. Worse, extended use of these drops can lead to a rebound phenomenon where redness actually becomes worse.

Your eye care professional will probably discuss a variety of excellent treatment options, from punctal plugs to prescription therapy. These treatments can have a tremendous positive impact on your dry eye symptoms. — Dr. Trattler

Q: My left eye has been feeling itchy and red for the past two days. I put in some Visine eye drops to relieve the itching and redness. But my eye started burning even more and feels heavier than my right eye. I don't know if I should go to the emergency room, because I don't have health insurance, and I don't have a primary care doctor. What should I do? And do you think I have pink eye? Also, I was wondering if someone can get pink eye from hugging and kissing someone with pink eye? — A.

A: It is impossible to know if you have pink eye without an exam. Pink eye, or viral conjunctivitis, can be transmitted via contact. For example, you could shake the hand of a person who has pink eye and potentially be exposed. If you place your own exposed hand to your eye, then you could transmit pink eye.

As far as what to do, you will need to see a doctor to figure out if you have pink eye or another condition such as dry eye. Then you can receive appropriate treatment. Other common conditions that can be similar to pink eye are bacterial conjunctivitis or allergic conjunctivitis.

All of these conditions require separate types of treatment. Of course, dry eye also can cause a red and irritated eye. So you should see your doctor to figure out what is going on. — Dr. Trattler

Q: The inside corner of my right eye has been red for two days. Can pink eye infect only one side of an eye? Or is it something else? — C.C.

A: There are multiple causes of a red eye. Dry eye, of course, is a common cause. But viral conjunctivitis (pink eye) is another common cause. A third common cause is called epi-scleritis, which is an inflammatory condition and requires treatment. There is no way that someone on the Internet can know which condition you have. So your next step is to see your eye doctor. — Dr. Trattler

Q: I'm only 17, and I was wondering if I'm old enough to get laser surgery. My eyes are always red, but I don't have any other problems besides that. So can I get laser surgery or any kind of treatment for red eyes? — C.

A: First, you need to determine the cause of your red eyes. Dry eyes and ocular allergies are two of many potential causes. Once you figure out the cause, you can also work on treating your red eyes. We typically wait until age 18 for laser vision correction. Note that laser vision correction can worsen dry eyes. So, again, get checked first. — Dr. Trattler

Q: I have red eyes all day long and every morning when I wake up. I do not use any type of Visine products. I have been using artificial tears. My eyes sometimes water at night when I am asleep, too. What can I do? It is embarrassing to have constant red eyes. I saw an eye doctor, and he is the one who told me to use the artificial tears. — S.

A: Untreated or incompletely treated dry eye can cause chronic redness. There are other causes as well, including ocular allergies. Eyes that water at night also can be a symptom of dry eye. Artificial tears are only the first line of treatment. Talk with your doctor about Restasis, punctal plugs, lubricating gels, and oral omega-3 supplements. Keep us posted on your doctor's findings and suggestions. — Dr. Trattler

Q: I am five weeks post-op after upper and lower blepharoplasty (eyelid surgery). I have a severe case of dry eye due to incomplete lid closure, hopefully not permanent. I had plugs inserted one week ago and have been massaging lids after warm soaks three times daily. I have used different lubricating eye drops and 1,000 mg flaxseed oil with no improvement. How long before I see any improvement? Are there any medications that will speed up the healing process? Can you recommend the top dry eye specialist in the Dallas-Fort Worth area, or in the United States for that matter? — J.A.

A: Dry eye is a common occurrence after eyelid surgery. The good news is that, with time and therapy, the dry eye typically will improve. For patients who are experiencing severe dry eye after eyelid surgery, the first situation to investigate is making sure that the eye is closing properly, especially at nighttime. Sometimes the eyes do not close completely and the eye becomes dry at nighttime. Your eyes can also be further dried if you have a ceiling fan or an air conditioning vent blowing directly at your eyes.

The most common treatments for dry eye issues after eyelid surgery are lubricating ointments at nighttime and pressure patching the eye. Further treatments would include lubricating gels during the day and punctual plugs. After punctual plugs first are used for plugging the lower ducts, your doctor may consider whether plugging the upper ducts would be helpful.

Oral medications (Evoxac and Salagen) that increase saliva and potentially lacrimation (tear production) are not very effective for dry eye in general, and typically would not be that useful in this type of situation.

Finally, there are many fantastic eye surgeons in the Dallas area. I trained under Jim McCulley at Southwestern Medical Center. AllAboutVision.com (this site) has a nice eye doctor directory, and that might be a good place to start as well. — Dr. Trattler

Q: I had LASIK surgery done about 10 days ago. Prior to the surgery, I had never been able to wear contacts comfortably because of dry eyes. Without contacts, the dryness wasn't too bad. The doctor did insert punctal plugs prior to the surgery to help with the dryness. Today, I have noticed an uncomfortable feeling in one particular spot in my eye. Upon drawing my eyelid back, I saw what looks like a red circle with white in the center, almost like a whitehead with a red ring around it. Is this something you think could be caused by the dryness? The spot is on the surface of my eye, not on the lid or lash line. — E.W.

A: This is a great question, because many patients are interested in LASIK because of the challenges involved in wearing contact lenses. As I am sure you are aware, LASIK results in dry eyes in many patients, and even more commonly in patients with pre-existing dry eyes. Punctal plugs are a helpful treatment for dry eyes, but they are just not enough. And from your description, dry eyes may be an issue for you even just 10 days out from the procedure.

Many experts recommend a prescription dry eye medication (Restasis) twice daily in addition to the punctal plugs. I also like low dose topical steroids in combination with Restasis to help further reduce the inflammatory cascade.

As far as your description regarding the spot on the surface of your eye, I cannot figure out your next step. I recommend that you see your own doctor to help you figure out exactly what is going on. — Dr. Trattler

Q: I need some advice about dry eyes after laser surgery. I have used several over-the-counter eye solutions, with no success. I had surgery six years ago and have had dry eyes since it was done. But lately it has gotten worse. When I use drops, my eyes seem to get worse. Is there anything that I can use that might help? This is very annoying. — D.L.

A: Because I have not examined you, I can provide only general advice. Dry eye can certainly occur following laser eye surgery. For many patients, the dry eye condition improves with time. For other patients, it can take a while for the dry eye condition to resolve. In your case, your dry eye has worsened.

The first step is to see your doctor for recommendations. Cyclosporine eye drops (Restasis) is an excellent medication to start with, as it has been shown to improve tear production. Additionally, your surgeon may recommend punctal plugs to increase the tear film. To supplement these treatments, your doctor will often recommend lubricating drops. It is important to understand that not all lubricating drops are the same. Preservative-free formulations or gel drops with disappearing preservatives are very effective.

Clearly, your next step is to see your own doctor for an eye examination to determine how to best improve your dry eye symptoms. — Dr. Trattler

Q: I have dry eyes. Should I have LASIK eye surgery? — A.K.

A: Studies have shown that LASIK can severely exacerbate dry eyes. The risk of developing significant dry eyes after LASIK is higher in patients who have pre-existing dry eyes.

Marguerite McDonald, MD, has recently reported that patients with significant dry eyes can have pre-treatment with topical cyclosporine eye drops (available only by prescription) and subsequently undergo LASIK. In her study, she pre-treated patients with topical cyclosporine for one month prior to surgery. She found that the group pre-treated with topical cyclosporine had fewer dry eye complaints after LASIK and better postoperative vision compared with a similar group of patients pre-treated with artificial tears.

Of course, if you have severe dry eyes, then LASIK still may not be an option. Instead, placement of a lens inside your eye (called a phakic intraocular lens) may be a more appropriate option. This procedure is not known to exacerbate dry eye, and the results have been very good. Obviously, the downside of a phakic intraocular lens is that surgery is performed inside the eye, so the risks may be slightly higher compared with LASIK.

Another surgical option to consider is surface ablation (often called PRK or LASEK). This procedure uses the same laser that is used with LASIK, but causes less dry eye because the laser is applied to the surface of the eye and a LASIK flap is not created. Again, if you are considering this option, pre-treatment with prescription eye drops can help by improving the quantity and quality of the tear film, which should allow for fewer dry eye symptoms after surgery.

Your own physician is your best resource when you consider which procedure might be the best for you, because only your surgeon has had the opportunity to examine your eyes and determine your degree of ocular dryness. As well, only your surgeon knows whether any of these surgeries are options for you, as only the surgeon has had the opportunity to perform the appropriate preoperative tests to make this determination. — Dr. Trattler

[Read more about LASIK, LASEK, and PRK. Also read more about phakic intraocular lenses.]

Q: I had LASIK surgery two weeks ago. The left eye had almost completely recovered within two days, and was seeing 20/20. The right eye was foggy after two days, with around 20/80 vision. The doctor who performed the surgery noticed a few very fine wrinkles on the right eye. Four days after the original surgery, the doctor re-lifted the flap and installed a contact lens for one day. When the lens was removed, the right eye was still 20/80 after one day.

Now over a week later when I first wake up in the morning, the right eye feels like it has sand in it and my vision is completely blurry. When I put a couple of "Refresh Plus" (artificial tears) drops in it, it begins to feel better. But the vision is still blurry. The vision then slowly begins to clear over the next four to eight hours, but never gets close to the clarity of the left eye. Then, the next morning, the same process begins again with no apparent improvement. Could this be a dry eye issue in the right eye since the flap was lifted twice? If so, is this something that should get better over time? My eyes were not dry prior to surgery. I couldn't wear contacts comfortably after about eight to ten hours. But without contacts, my eyes never felt dry. — R.J.

A: Based on your description, it sounds like you have more than just dry eye. Please see your surgeon. Since I have not examined your eyes, I cannot know for certain what is going on. But I am concerned that the wrinkles on the eye may still be present based on your description. If they are still present, then you should talk to your surgeon about further treatment such as flap suturing or relifting and stretching the flap. Dry eye is certainly common even in non-dry eye patients. So it is not uncommon for you to have some dry eye symptoms early on after surgery. Since dry eye may also be an issue, you should talk with your doctor about increasing your dry eye treatment. This treatment might include the placement of punctual plugs and/or prescription dry eye therapy (cyclosporine). — Dr. Trattler

Q: I had LASIK eight years ago and awoke to severe dry eye about a week after the surgery. I never improved after having four punctal plugs and spending $4 daily for eye drops and ointment at night. I still haven't returned to work and wonder if I can get disability for this. — R.K.

A: Post-LASIK dry eye can be a challenge to treat. But fortunately, there have been continued improvements in dry eye treatments over the last several years.

Three years ago, for example, I participated in a study of patients with severe dry eyes following LASIK. Patients enrolled in the study ended up with significant improvements in their dry eye. The study basically utilized three principles of dry eye treatment. The first was to increase the quantity of tears. This required occluding (blocking) the drainage ducts of the tears with punctal plugs or punctal cautery (permanent tear duct closure). For most patients in the study, all four ducts were closed. Following this treatment, patients were placed on topical anti-inflammatory eye drops to reduce the inflammation. After these first two interventions, dry eye symptoms improved significantly.

However, the biggest improvement occurred with the addition of special warm compresses applied twice daily for 10 minutes. The warm compresses applied to the (closed) eyelids resulted in improved secretion of oil into the tear film, which subsequently resulted in improved quality of tears. Patients noted an even further improvement in their dry eye signs and symptoms. After one month of treatment with warm compresses, patients experienced a prolonged improvement in the dry eye condition.

Besides the above treatments, we also have many additional treatments for chronic dry eye following LASIK, including Restasis, lubricating gels and ointments, omega-3 fatty acids, and moisture goggles.

Your next best step would be to see a specialist in dry eye who can help you with these therapies and answer any further questions you may have. — Dr. Trattler

Q: For as long as I can remember (I'm now 29), I never could produce tears in my left eye. Plus, I always have this discharge in my eye. What could this be? Can it be corrected through LASIK surgery? — N.

A: LASIK will not solve this problem! You need to have an eye exam to determine why you do not produce tears. Once the reason is determined, your doctor can provide artificial tears, topical cyclosporine, punctal plugs, etc. Note that eye discharge can be related to ocular allergies, which are exacerbated by dry eye. So treating your dry eye may be very helpful. Please see your doctor. — Dr. Trattler

Q: Is any nutritional supplement treatment for dry eye effective? — J.B.

A: Omega-3 fatty acids are nutritional supplements that are believed to help improve the quality of the tear film, and thus improve a patient's dry eye condition. Flaxseed oil and fish oil supplements both are high in omega-3 fatty acids. As well, there are a number of nutritional supplements designed specifically for dry eye. — Dr. Trattler

Q: I have had dry eyes since high school and have seen numerous optometrists and now an ophthalmologist. No one has even tried to figure out the underlying cause. They all write out a prescription for Restasis and say all will be okay. But I am only 26 and don't want to be on that drug for the rest of my life in order to have comfortable eyes.

I wondered what you thought of using a naturalist? What do you think about detoxifying your body and then taking omega-3 fatty acids, flaxseed, vitamin A, and all the other supplements he prescribes? I am desperate, because a couple of times a day I have to lie down with a wet washcloth over my eyes. I can't do a lot of activities with my kids outside, such as biking, because of the sun and wind. — B.J.K.

A: The first thing to understand is that many times we do not know "why" a person develops dry eye. Although dry eye is more common in the elderly and in females, we see it all the time in young patients. Thankfully, some treatments are available that can help. Restasis, which you are using, is a good option. Other options include oral omega-3 fatty acids and flaxseed oil supplements. Raising the quantity of tears with punctal plugs is also helpful.

One thing to consider is that certain oral medications (anti-allergy or antidepressants) can cause eye dryness, as can extended viewing of computers. — Dr. Trattler

Q: What other nutritional supplements besides omega-3 fatty acids can be taken for dry eyes? I have been trying to drink more water and take two flaxseed pills a day. How long does it take to notice improvement from taking flaxseed oil? — M.Z.

A: Omega-3 fatty acids are nutritional supplements with various health properties. Studies have found that oral omega-3 fatty acids help reduce dry eye symptoms. The theory is that omega-3 fatty acids improve the quality of oils present in glands of the eyelids. These oils are an important part of the tear film and provide improved quality of a person's tears. Some people do not have good oils in their oil glands, and therefore they produce a poor quality of tears.

For patients with dry eye, oral omega-3 fatty acids are often recommended as a dry eye treatment. In reality, omega-3s are helpful, because they can improve the quality of a person's tears, although they require a few months to really work. But for most patients, oral omega-3 supplements are not sufficient to eliminate dry eye symptoms.

Instead, we recommend oral omega-3s as part of a comprehensive treatment plan for dry eye. I am not aware of any other oral nutritional supplements that would improve dry eyes. Other important components of a comprehensive treatment plan include lubricating drops and topical cylcosporine eye drops (available by prescription). — Dr. Trattler

[Read more about flaxseed oil for dry eye.]

Q: I have tried everything for my dry eyes. I had the punctal plugs put in, but my doctor said they fell out. They didn't seem to help me anyway. I tried Restasis (prescription dry eye medication), but it just burned my eyes terribly. I had to stop using it. I have used every type of dry eye drop, preserved and not preserved, but get only sporadic relief.

My eyes are constantly full of mucus, which is horrible, and I spend all my time getting it out. If I don't, the mucus hardens in my eyes and feels like there are shards of glass in there. I am about ready to go crazy. I have had this condition since 2000 and have Sjogren's Syndrome with dry mouth, too. Evoxac (medication to help increase salivary gland secretions) helps my dry mouth, but nothing seems to help my eyes. Is there anything on the horizon that may give me some relief? — K.P.

A: Sjogren's Syndrome is an autoimmune condition associated with severe dry eyes and dry mouth. Your description of the challenges you have experienced treating your dry eye is not unique. Thankfully, there are additional treatments that can potentially help.

The first thing to find out from your rheumatologist (autoimmune disease specialist) is whether your underlying autoimmune condition is under control. Some patients require systemic (general) treatment of their autoimmune condition, and this can help reduce progression of the disease.

After you consult your rheumatologist, you should seek out a local dry eye expert who can hopefully tailor a comprehensive treatment regimen for your dry eye. I am sure your expert can help, but the steps for treatment would typically include:

• Closure of at least two and perhaps all four of your drainage ducts.
• Anti-inflammatory drops to help reduce inflammation of the ocular surface.
• Optive, which is one of the newest lubricating drops, to help lubricate the ocular surface.
• Lubricating gels or ointments at bedtime.
• Oral omega-3 fatty acids.

Other potential treatments include:

• Topical or oral doxycycline (antibiotic).
• Warm compresses to liberate oil (from your eyelid glands) and improve tear film quality.

Again, the key is for you to find a dry eye specialist who can help guide you in improving your ocular condition. — Dr. Trattler

Q: Are dry eyes, ocular hypertension, and headache related? My eye pressure is at 21, and I am experiencing pain around the left eye. I have a headache on the left side. — R.P.

A: Elevated eye pressure and dry eyes are not related. However, as we get older, we have an increased risk of both dry eyes and elevated eye pressure.

Interestingly, there is also no relationship between elevated eye pressure and headaches. You should see your medical doctor to determine the underlying reason for your headache, because there are many potential causes. Of course, if the pain is localized to the orbit (eye socket) or eye, your doctor will have to rule out a variety of conditions, including sinus disease.

So please see your doctors, and let us know the outcomes. — Dr. Trattler

Q: My eyes are extremely dry, and they hurt. I have had breast cancer and a bone marrow transplant, so there are lots of reasons for the dry eyes. I had my tear ducts closed. As well, I take fish oil capsules along with Restasis and Soothe. What else could I do? Should my eyes still bother me after a year of this treatment? — D.S.

A: You have a few risk factors for dry eye. First, you are female. This is a common risk factor for dry eye. Secondly, you have had a bone marrow transplant. Patients who have had this procedure are at a significantly higher risk of developing dry eye. In one article on bone marrow transplants from 1989, 43 percent of patients had symptoms of dry eye.

You mentioned that you have had punctal plugs, oral fish oil, Restasis (cyclosporine), and artificial tears. These are all great treatments for significant dry eye. But there are other additional therapies your doctor can consider, including low-dose topical steroids, warm compresses, moisture goggles, lubricating gels, etc. As well, your doctor can increase the frequency of topical cyclosporine use. — Dr. Trattler

[Ed note: The article mentioned by Dr. Trattler was published in November 1989 in the journal, Bone Marrow Transplant.]

Q: I am female, 22 years old, and have keratoconus. Can you tell me something about this? — E.S.

A: Keratoconus is a condition where the eye's clear front surface (cornea) is warped, resulting in reduced quality of vision. Patients often must wear contact lenses, because vision quality with glasses is poor.

Contact lens intolerance, often due to dry eye, is one of the big issues with keratoconus. I have found great success in treating my keratoconus patients with cyclosporine eye drops, a prescription medication that improves tear film quality as well as increases the quantity of tears. These improvements allow for improved ability to wear contact lenses and also help reduce the chance of becoming intolerant to contact lenses.

Depending on the severity of your condition, there are other treatments for keratoconus. These treatments range from implants known as Intacs to, in rare cases, a corneal transplant. — Dr. Trattler.

[Read more about Intacs for keratoconus.]

Q: My four-year-old son was just diagnosed with Thygeson's. We are seeing a pediatric corneal specialist who has him on FML (fluorometholone steroid drops) twice daily in the left eye and prednisolone (also a steroid) three times daily in the right eye. She says he will be on this treatment for months, and maybe even years. My question is: What are the long-term effects of these drops? Our doctor also mentioned Restasis as a possible treatment down the road. Have you ever heard of Restasis being used for Thygeson's? — A.T.

A: Cyclosporine eye drops (Restasis) are a potential treatment for Thygeson's, which is an inflammatory condition of the cornea. Many studies have looked at the use of cyclosporine for Thygeson's, with one example represented in a paper published in 1999 by Dr. T. Reinhard and Dr. R. Sundmacher in Graefe's Archive for Clinical and Experimental Ophthalmology journal. The study found that cyclosporine eye drops were effective in treating Thygeson's. Please show this information to your own doctor. Note that topical cyclosporine eye drops have a significantly lower rate of side effects than topical steroid eye drops. — Dr. Trattler

[Ed note: The abstract cited by Dr. Trattler notes that healing took place in about one-third of adults who underwent therapy with cyclosporine, without the side effects associated with conventional treatments that can include steroid eye drops. The study indicated that children possibly will not respond as well as adults to treatment.]

Q: I have developed severe dry eye after completing months of chemotherapy. I am told I have no moisture at all in my eyes. Different prescriptions of tears and gels have not helped. The pain in one eye has become debilitating, but none of the doctors I have seen are familiar with this pain. — W.R.

A: Severe dry eye can be a challenge to treat. Reducing any inflammation that may be present typically is the first step. For this purpose, your doctor may prescribe topical steroids along with topical cyclosporine. After inflammation is reduced or perhaps even during treatment, your doctor will consider occluding (blocking) all of your tear drainage ducts. This procedure can be performed with punctal plugs or punctal cautery. [See Q&As below on punctal cautery and punctal plugs.]

These two approaches — closing the eye's drainage system and decreasing inflammation — should help reduce the severity of dry eye.

Of course, your doctor may also need to provide additional treatments that can include topical lubricating drops during the day and ointment at bedtime. Oral omega-3 fatty acids, like fish oil or flaxseed oil, may also be beneficial.

I hope you see your eye care doctor in the near future, and that he or she can help you treat your severe dry eye condition. There is hope! — Dr. Trattler

Q: I am a 38-year-old pharmacist from Taiwan. I suffer from a dry eye problem. When I went to the eye clinic, doctors prescribed artificial tears and a corticosteroid. I happened to see that there are new eye drops, called Restasis. This medicine in our country is fairly new (approved in 2006). Does Restasis really work for dry eyes? How long should I use it, and when can I stop? Are there any side effects? — S.

A: Dry eyes are often caused by underlying inflammation. Topical steroids work nicely to reduce inflammation and treat dry eyes. However, topical steroids have side effects if used for prolonged periods of time.

Restasis is a mild, anti-inflammatory drop that works on the ocular surface to reduce the underlying cause of dry eye. Yet these drops do not cause long-term problems. Patients have been using this medication for a number of years in the United States.

Inflammation causing dry eye is a chronic process. Restasis suppresses the inflammation, but is not a cure. This approach is similar to the treatment of high cholesterol or elevated blood pressure. As long as you are on the medication, the condition is suppressed but not cured. — Dr. Trattler

Q: Is there any permanent cure for dry eyes without using eye drops? I also would like to know the cause and long-term adverse results of dry eyes. Does the condition damage the cornea of the eye? Does it reduce vision? I have tried everything, but I'm not getting any relief. — V.S.

A: Dry eye is a chronic condition that requires treatment with various types of drops. Oral omega-3 fatty acids are a nutritional supplement that may be all that is needed for mild dry eye treatment. Otherwise, treatments for dry eye are typically in drop form. So it would be difficult to avoid the use of drops for treating dry eye.

As far as what happens if dry eye is not adequately treated, chronic dry eye over time can be progressive and can lead to fluctuating vision and loss of quality of vision. For severe chronic dry eye, treatment is important to avoid visual problems down the road. So please see your doctor to figure out your next steps for treating your condition. — Dr. Trattler

Q: I am a 19-year-old male. I have a dry eye condition. However, I was wondering whether the dry eye condition can pass with time. If you have dry eye, will it stay with you forever? Also, could it be a hormonal issue? — R.T.

A: Dry eye can develop even in teenagers, especially if they spend a lot of time in front of the computer. As well, certain medications such as for allergies can also cause dry eye. An eye doctor can perform a complete evaluation and determine the source of your dry eye, as well as recommend treatment.

Recent studies have shown that Restasis can not only provide relief but also cure dry eye in a small percentage of patients. This was a small cohort, and the followup was only for a year or so. But it does provide hope that, at least for a small percentage of patients, dry eye can be treated and "cured."

However, for most patients, dry eye treatment is long-term. Hormones may play a role in dry eye, but this possibility is still being investigated. — Dr. Trattler

Q: I have dry eyes. Yesterday, my doctor inserted a trial plug in my right eye. I go back in two weeks to have the permanent plugs done. He said they would be cauterizing those into my eyelids. I am scared and about to back out. Won't this be very painful even with drops in my eyes to try to help with the pain? Also, can this procedure be reversed if it does not work or if I am uncomfortable and want them out? — J.D.

A: Punctal cautery is an effective method of closing up the lacrimal (tear) drainage system, but it is considered a permanent procedure. The procedure typically is not painful, because it's relatively easy to anesthetize the area.

If you have severe dry eyes, then punctal cautery is an option. On the other hand, if you have mild to moderate dry eyes, you can consider permanent punctal plugs because these are easy to reverse. — Dr. Trattler

Q: I am considering getting punctal plugs for my dry eyes. I did have them for a short period and I thought they were a bit uncomfortable. Which option is best? Getting the plugs again or taking a supplement in pill form? I am a 68-year-old female in very good health except for the dry eyes and mild osteoporosis. My ophthalmologist said my corneas were in terrible shape. I will be taking artificial tears four times a day. I don't have any redness and my eyes don't bother me except I am sensitive to sunlight. — M.B.

A: Some patients find that punctal plugs are uncomfortable. But for many patients, the discomfort will improve with time. If the discomfort does not resolve, one option is to consider replacing the punctal plug with a design called an "internal" punctal plug. The internal punctal plugs are inserted in the puncti (openings that allow drainage) and do not have an external portion. Although some forms of internal punctal plugs led to occasional problems in the past, the newer generation internal plugs seem to be relatively safe. I use them quite a bit for patients in my own practice. Besides considering punctal plugs, you should also talk with your doctor to see whether prescription dry eye medication would be an option for you. — Dr. Trattler

Q: I suffer from puffiness under my eyes and always have. I also have slight dryness of the eye. Can the tear duct plug surgery actually help puffiness? — J.S.

A: Tear duct surgery, which involves closing the ducts that drain the tears from the eye to the nose, works great for patients with dry eyes. However, the surgery typically will not solve the problem of puffiness under the eyelids. Please see your eye doctor to determine the cause of the puffiness under your eyelids, so that the appropriate treatment plan can be developed. — Dr. Trattler

Q: I tried Refresh tears for dry eyes without relief. My eye doctor wants to use punctal plugs, but I was reluctant. He also prescribed Restasis and Alrex drops. I haven't started them either, because I'm concerned about long-term use and side effects. What would be your next step? — M.B.S.

A: Dry eyes are a common problem. Artificial tears often are not able to resolve the signs and symptoms of dry eye. The second step for treatment includes topical Restasis and low-dose topical steroids, which include Alrex. These medications are considered safe. Restasis is extremely safe. Alrex is also safe to use, though eye pressure must be monitored every one to two months.

Punctal plugs are also effective at helping with dry eye, though topical steroids and Restasis help improve the effectiveness of punctal plugs. My suggestion would be for you to speak with your own doctor about all of your concerns so that you can obtain dry eye treatment. — Dr. Trattler

Q: Can erratic double vision in one eye be a symptom of dry eye syndrome? Also, is a humidifier a good appliance to help prevent dry, burning eyes? — J.H.

A: Dry eye cannot cause double vision. You should see your eye doctor ASAP to figure out the cause of your intermittent double vision. Humidifiers can be very helpful for dry eye. But you may also need to consider lubricating drops and gels to treat your dry eye symptoms. — Dr. Trattler

Q: Can dry eye cause vision problems over time? I have Sjogren's Syndrome, and I am having some changes in in my eyesight when I drive at night. Although problems are mild, they are noticeable.— M.S.

A: If left untreated, moderate to severe dry eye can lead to visual problems over time. Specifically, chronic irritation of dry eye can damage the ocular surface. This can lead to poor quality of vision.

As well, dry eye is a cycle. Dry eye leads to poor quality of tears and ocular surface irritation, which results in further dry eye.

The key point is that dry eye is treatable. Patients with Sjogren's Syndrome should see their eye doctor to determine their degree of dry eye. From there, their doctor will make treatment recommendations to keep the dry eye that occurs with Sjogren's Syndrome from progressing. — Dr. Trattler

[Also see Q&A above on Other Diseases and Dry Eye, in which treatment options for Sjogren's Syndrome are discussed.]