Dry Eye Centre of Excellence

Armstrong & Small Eyecare Centre is proud to offer services to diagnosis and treat dry eye disease, also known as ocular surface disease. We have been at the forefront of the latest techniques and technology for over a decade.

Since there is no cure to dry eye, our goal is to find you a long-term strategy that will keep your eyes comfortable. Ideally, if you suffer from dry eye, we want to help you get through each day with less discomfort and less irritation.

Common symptoms of dry eye are burning, foreign body sensation (feels like something is in your eye), sandy, gritty, fluctuating or blurred vision, eye pain and/or soreness, sensitivity to light and excessive tearing.

Dry Eye can be exacerbated by many factors including aging, a prior history of cataract or refractive surgery, certain systemic medications, work environment (poor air quality), systemic disease like diabetes, auto-immune diseases like rheumatoid arthritis, smoking, allergies, contact lens wear, and poor nutrition. Particularly in Manitoba, we see a lot more dry eye symptoms during our cold, DRY winters.

Over the years, we have attempted to hone our treatment protocols ideally keeping it as simple as possible, for you, the patient, so that you can stick to a regimen that will provide you with long-term relief. Compliance, actually doing what your doctor has prescribed, is a huge issue when treating dry eye as most patients will feel better and then stop all of their prescribed treatments. Often, we see these patients back in our clinic 3-6 months later with the same
symptoms. Much like physiotherapy exercises or flossing your teeth, patients find it hard to stick to a daily routine.

The following instructional videos were designed to help our patients start with a basic daily regimen to begin to treat their symptoms. If you’ve been advised to start treatment or you are waiting to see one of our doctors for a dry eye assessment, these are, in our humble opinions, some of the basics that you should be doing a daily basis until we get your symptoms to subside and then we hope to find a maintenance program that will provide you with a long-term strategy. Most of our dry eye products are available on our online store ( https://armstrongandsmall.sightlyapps.com/dry-eye-products ) and can be shipped directly to you.

Introduction to Dry Eye:

Steps 1&2: Heat & Lid Massage

Step 3: Eyelid Wipes

Step 4: Drops

Step 5: Wait there’s a step 5? Omega-3’s

Advanced Treatment: In-office Treatments

What steps can I take to minimize my Dry Eye?

Other factors that can contribute to dry eye and how to avoid them

1. Blink! It may sound simple, but many people who regularly perform eye-straining tasks such as driving, reading or computer use get so absorbed in the activity at hand that they forget to rest their eyes. When you are on the computer for long periods of time, remember to look away from the computer for about 20 seconds every twenty minutes (a 20/20 break), letting your eyes blink freely. Periodically make a forceful blink by squeezing your eyes tightly. This will push out oil into your tear film and prevent your tears from evaporating.
2. Use lubricating drops even before you start an activity such as reading, watching TV, computer work. Make sure to take frequent breaks and use lubricating eye drops throughout these activities. If your eyes start tearing, this is likely reflexive tearing which indicates that you have been drying out during the activity. In which case, pause, blink and re-apply drops.
3. Adjust your TV or computer monitor to a lower height so that you are looking slightly downwards. This lowers your eyelids over your eyes and decreases tear film loss from evaporation.
4. Indoor humidity should be between 40 and 50 percent. Fill the humidifier with filtered water. “ Hard” tap water can cause an airborne mineral dust that can act as an eye irritant. It is a good idea to place a humidifier where you sleep and where you work.
5. When you are in a car, turn the air vents away from your face and eyes. Remember to actively blink while driving. Do a forceful blink at every stop.
6. Wear sunglasses outdoors to reduce sun, wind, and dust exposure. If your dry eye is severe you may benefit from specially designed moisture retaining goggles/glasses.
7. If you wear eye makeup make sure it is waterproof to avoid it leaking into the eye. When applying mascara, only apply it to the tips of the upper lashes. Moisture retention around your lower lids is more important for the overall comfort of your eye. If you can, try to avoid applying makeup to the lower eyelid and lashes.
8. Supplement your diet with foods that are rich in omega 3 fatty acids.
9. Stay well hydrated throughout the day by drinking eight to ten glasses of water per day. If your urine is concentrated or dark in color then you are likely not drinking enough water. Remember that dehydration worsens dry eye.
10. Research suggests that smoking, too, can increase your risk of dry eye syndrome. So if you smoke, here is more motivation to quit!
11. Allergies worsen dry eye as do some of the medications used to treat allergies. Minimize your exposure to allergens. Consult with your Winnipeg Optometrist before using allergy eye drops.
12. Post-menopausal women are at particular risk of dry eye. Estrogen supplementation, when used without progesterone, can worsen dry eye. Speak to your family physician as combining estrogen with progesterone may reduce your risk of dry eye.
13. Each lubricating eye drop is different. Find the brand that works best for you! If the drop comes in a large bottle it has preservatives and should not be used more than 6 times daily as it may irritate the eye further. If you require drops more than 6 times daily you should use preservative-free drops.
14. Do NOT use eye drops that are marketed for treating the red eye. Examples of these products include “Visine for the red eye” and “Clear Eyes - redness relief”. These preparations have active chemicals such as Naphazoline, Tetrahydrozoline, or Oxymetazoline which can cause irritation and rebound red eye.
15. Use a thicker lubricating eye ointment or gel at night before going to bed.
16. Contact lens wear tends to alter the tear film further and will exacerbate a dry eye.  Typically patients with dry eye have a hard time wearing contacts or have to minimize their wear.  Daily disposables can be a good option to reduce the risk of infection and don’t’ require any solution that may also make a dry eye worse.
17. Laser eye surgery (LASIK) can worsen dry eye. Your dry eye has to be well controlled prior to considering refractive surgery such as LASIK.

Why do my eyes tear?

Excessive tearing can be annoying and also impact your vision. Dry eye isn’t always the culprit, but more often than not, it is.

A few questions to ask:

• Do both eyes tear equally? If not, then there may be a blockage in the tear drainage system. Like the downspouts on your house, everything needs to be pointing in a certain direction to make sure they are flowing properly.
• Is the tearing triggered only in certain environmental conditions? Wind, cold air and bright sun can cause tearing and this sensitivity tends to worsen with age. If the tear film isn’t staying on the eye as well as it should, your brain will say “make more water”. The watery part of the tear film doesn’t stay on the eye very well by itself and then over-powers the system and starts to drip from the eye.
• A dry eye assessment with our Winnipeg optometrists will help to determine the root cause of your tearing and provide you with a treatment plan in hopes of reducing this annoying issue. Please see our entertaining videos below done by Dr. Lepage and Dr. L. Small regarding their thoughts on excessive tearing.