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People of all ages experience irritation of their eyes.
Common symptoms include blurred vision, burning, stinging, excess tearing and the feeling there is a piece of grit on your eye or behind your eyelids.
Most episodes of eye irritation can be managed by doing the following:
-Artificial tears 1 drop to both eyes 4x/day
-Warm Compresses 2x/day (take a washcloth, soak it in warm tap water and apply it to your closed eyelids for one minute)
After a one to two week period you may continue the warm compresses daily and use the teardrops as needed. At the very least keep these two tricks in your “bag of tricks” for the day, maybe even far down the road, when you have problems like this again.
If you would like more information on the factors that contribute to eye irritation, and special circumstances, then read on.
The most common factors that play into irritation of the eye surface are dryness and inflammation.
Symptoms become more common:
-as we age (most especially after 40 and in females more so than males),
-when we use our eyes most intensively (computers, reading, handheld devices, etc.),
-when we are exposed to the elements (wind, dust, pollution, etc.),
-when we are sick, dehydrated or sleep-deprived.
Many medications taken by mouth make eyes more irritated, either by drying out the body in general, the eyes in particular, or because the medicine is secreted into the tear film. Almost all medicated eye drops can irritate the eyes, both through their active ingredient and from the preservatives added to keep microbes from growing in the bottle.
A useful oversimplification as to why we get dry eyes is that the eyes produce less moisture as we age both due to inflammation of the surface of the eyes and the tear glands wearing out.
Many people with dry eyes have excess tearing. Don't fool yourself into thinking the problem is your eyes are too wet. If you don't produce enough tears to lubricate your eyes regularly, your eyes will reflexively overproduce tears from time to time, especially when they are challenged by situations such as gusts of air, reading, using a computer or while driving.
Some people with dry eyes have no discomfort at all, only blurring of vision. This is the most common cause of blurry vision that comes and goes.
The treatment for people with excess tearing and blurred vision related dry eyes is the same as for those who experience irritation.
Treatments for Dry Eyes
Artificial tears are over the counter, no prescription is needed. There are many brands, feel free to experiment and find the brand you like most. Readily available brands include Systane, Theratears, and Refresh. Most people can use these artificial tears four or more times a day without problems. People who are sensitive to the preservatives in these should instead use Preservative Free Artificial Tears.
Preservative Free Artificial Tears
These are over the counter. They come in single-use vials, and as a result, don't have in them preservatives which are chemicals to keep microbes out. Preservatives can be harsh to the surface of the eye in people who are sensitive to them or need to use tears many times a day. You can use these as often as you want.
Restasis and Xiidra
These are medicines used twice a day for dry eyes. They work well in the majority of people that use them, but not everyone responds to them. They are also medicine and require a prescription, and can be expensive. Using them more than two times a day is not known to be more effective than twice a day and is certainly more expensive. We don't know if using them once a day, or skipping days will give you meaningful results. There is no reason to think you will continue to have a benefit from them after having stopped them, they must be used continuously.
This is a minor procedure done in the office. Soft plastic caps are put in the pores of the eyelid where tears naturally drain off the surface of the eyes. They are put into the tear drainage system, it does not block the gland that produces tears. It is a quick and simple procedure. The plugs can work for many months but sometimes come out early. Rarely they migrate down the tear drainage system and cause a permanent blockage or infection. If they cause problems they can be removed. Removal is usually easily done in the office.
Blepharitis is an inflammation of the eyelid margins. A simplified approach to blepharitis is to divide it into inflammation of the front of the eyelid (where the eyelashes are) and the back of the eyelid (where the oil glands are). Many people have inflammation of both the front and back of the eyelids. Because the eyelid margin is in contact with the tear film most people with blepharitis also have symptoms of dry eyes.
Anterior (Eyelash) Blepharitis can be treated by daily eyelid scrubs. This can be done with over the counter products such as Ocusoft and Lid Scrub. These are individually packaged squares of gauze soaked with a mild soap. Instead of buying a product, you can make your own; take 1 part of Baby Shampoo and mix it with 4 parts of water. Dip a Q-tip, cotton swab or washcloth in this and clean the bases of your lashes gently.
Whether you use a commercial product or one you make on your own, make sure you are concentrating on cleaning the skin where the lashes emerge.
Posterior (Oil-gland) Blepharitis can be treated with warm compresses. This should be done at least daily, but many find it useful to do this two or more times a day. Soak a folded over washcloth with hot tap water. Place this on your closed eyelids for a minute or so. How hot is too hot? If you can hold the washcloth in your bare hands or against your lips its safe for your eyelids.
Other remedies for Blepharitis:
-Some find benefit in taking daily Omega 3 Fatty acids (fish oil, flaxseed oil, etc) pills. This treatment can take several weeks to work. Though the perfect formulation or brand is not known, at this time I recommend at least 600mg total Omega 3 be used per day.
-Cliridex (tea tree oil) scrubs of the lashes is useful for blepharitis caused by a common mite called Demodex. It is not clear whether this mite is truly a pathogen (that is it may not cause the inflammation,) as it can be found in individuals without problems. It may be a normal part of the complement of microbes that normally live on your body. This is available for purchase online.
-If antibiotic drops or ointments are prescribed it will only be for a short while. Longer usage just selects for bacteria that are resistant to the medicine.
-Doxycycline is an antibiotic pill commonly used to treat certain skin conditions, like Rosacea and acne. It is useful in some individuals for Posterior Blepharitis. This is typically used for several months and in some individuals indefinitely. It works by thinning out the oils of your eyelid, more than decreasing the number of bacteria, so bacteria becoming resistant is not a problem.
Allergies and your eyes
Allergic conjunctivitis is very common; up to 20% of people may suffer from allergies of the surface of their eyes at some time in their lives. However, it is just as often that people will attribute their eye irritation to allergies despite the fact blepharitis and dry eyes are more common. Everyone knows the word allergies and “If all you have is a hammer, everything is a nail.”
If you have itching of your eyes it might be worth your while to try an antihistamine drop:
-Zaditor (ketotifen): Is effective, inexpensive, over the counter and available as a generic.
-Pataday and Lastacaft are modestly more effective than Zaditor and last longer. They are available with a prescription.
Antihistamine pills (Benadryl, Claritin, Zyrtec, Xyzal, etc.) are effective for allergies, including the eyes. They all to one extent or the other dry the eyes out, because of this, it is possible the pill you are taking for your eye irritation is making it worse, not better.
Most people get some degree of dry eyes as they age, even those that have allergies. So if you have irritation despite your antihistamine drop or pills, you should experiment with artificial tears.
Eye irritation in contact lens wearers
If you are a contact lens wearer and you are experiencing eye irritation, the odds are pretty good that your contact lens wear is contributing to your eye irritation. Contact lenses: make your eyes dryer, they decrease the amount of oxygen coming into contact with your corneas, and slow down the departure of metabolic wastes from the surface of your eyes. People can also be allergic or intolerant to the solutions they are using with their contacts. Contact lenses are also are like sponges holding irritants and allergens from the environment or your eyelids against your eye.
If you are a contact lens wearer and your eyes are irritated, you should remove them and not put them back in until you are back to normal. Ideally, wait until 2-3 days after you are back to normal.
If your eyes continue to worsen after removing the lenses, or are not showing signs of improvement after 24hours, call us.
Sleeping in Contact Lenses
“Extended Wear Contact Lenses” are designed and FDA approved for sleeping in. Some are even approved for up to 30 days of continuous wear. Having said that, sleeping in your contacts is considerably riskier than removing them before bed. Several studies have shown a 10-20 fold increase in problems in those that sleep in their contacts. These problems can include sight-threatening infections.
I discourage all of my patients from ever sleeping in their contact lenses. If you do insist on sleeping in your contact lenses they must be the FDA approved Extended Wear Lenses.
Waking up with irritated eyes
People commonly describe waking with eye irritation.
Blepharitis is a common contributor to this, so if you have this problem be sure to use warm compresses and do eyelid scrubs as described above.
Some people expose their eyes while sleeping, that is they sleep with their eyes “cracked open.”
Fans and vents blowing into your eyes can contribute to the irritation.
Coating your eyes with an ointment such as Refresh Lacrilube or a gel such as Genteal gel before bedtime is useful. Most teardrops or “gel drops” won't last all night long. Sleep masks or goggles are other strategies to improve your morning comfort.
Environmental and lifestyle modifications
Some tricks that many find useful are:
-Ensuring fans and vents don't blow in your eyes whether at work, in the car or while sleeping.
-Side-shields or wrap around glasses when outdoors.
-Avoiding smoke and dust
-Using sleep masks or moisture shields when sleeping
-Minimizing time in contact lenses
-Consciously blinking more when reading, using a computer or a hand-held device
-Drinking more water
-Getting more and better sleep
How long can eye irritation last?
The duration of eye irritation is highly variable. In some it can be a bad day, in many, it is a life-long problem. A useful rule of thumb is, that the older you are, the more likely it is a persistent problem. Another useful rule of thumb is, that if it has been a long-lasting problem, it will continue to be one. Simply put, the most common factors in eye irritation (Chronic Blepharitis and Dry Eyes) are not curable, and require a lifelong approach.
If I have directed you to this page, I have already examined you and did not find any serious eye conditions. If you worsen despite these treatments, let us know so we can see if another approach works.
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