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Q: I have worn soft lenses for 20 years, taking them out at night. Things are fine, except that after long flights (10 hours plus) I sometimes experience uncontrollable burning in my eyes. It is excruciating.
This sometimes happens while I am wearing the contact lenses, and sometimes after I have been wearing my glasses on the flight for some hours, and put my lenses back in before landing. The only solution is to take my lenses out as soon as possible. I can't find references to this problem online. — M.
A: As a very frequent flyer I can attest to how eye-unfriendly aircraft cabins are. Although it's better in newer planes, recirculated air and very low humidity can wreak havoc on the tear film and eye surface.
Most people do okay, even on long flights, but add in contact lenses — which can help evaporate tears more quickly — and what I suspect is borderline evaporative dry eye, and you can end up with significant disturbance to the cornea. Pain, burning, tearing and light sensitivity are all symptoms of concern, as they suggest damage or irritation to the eyes' surface.
Without examining you, I can't be sure, but I suspect the root cause is meibomian gland dysfunction (MGD) causing evaporative dry eye. Wearing a conventional lens will worsen this, and if the problem is significant enough to occur without lenses, putting them in apparently pushes you over the edge.
Here is some advice:
Get a thorough dry eye work-up and make sure you share your experience on the plane with the doctor.
If you sleep on these flights (and with 10 hours in the air, I hope you do), have a flying companion check to see if you sleep with your eyes slightly cracked open. Exposure, especially in low-humidity environments, could explain your sudden and intense pain.
Try to avoid wearing your lenses on the plane, especially for long flights.
Use a dry eye drop with a lipid base, like Systane Balance or Refresh Optive Advanced Formula, at least once an hour during the flight. Note this isn't recommended while wearing contact lenses.
If you must wear lenses in the air, you might consider trying a single-use daily disposable. From a dryness perspective, Alcon's Dailies Total One is the class leader.
The bad news is that many forms of dry eye are progressive and will worsen without proper treatment. If it is MGD, the problem should be treated sooner, rather than later. It would be wise to seek professional advice, even though your problems are currently confined to airplanes. Safe travels. — Dr. Arthur Epstein
Q: What are the causes of dry eyes? How does eye twitching relate to dry eyes? — E.
A: There are so many causes for dry eye that even a brief answer is well beyond the limitations of this forum. I urge you to read the section on dry eye on this website and the other questions and answers on this page to get a better understanding of the condition.
Twitching eyes are typically associated with stress, not with dry eye. — Dr. Arthur Epstein
Q: Last summer my eyes began randomly burning, stinging and watering at times, from the inner corners. I went to an eye doctor, who said I had dry eyes. I tried all kinds of drops and also taking krill oil supplements, but nothing helped.
When it became winter, my symptoms completely vanished. I had no more eye problems at all. Now that it is beginning to warm up again though, they are starting to cause me trouble. What's more, I noticed when I opened the oven to check on a cake tonight, the heat from it stung my eyes and I couldn't keep them open.
This is a huge issue that is seriously affecting my life, as when it was summer, I literally had to pull over while driving almost every day because my eyes would tear up so bad. — L.
A: I know how frustrating this can be. Your symptoms sound like dry eye, but they are a bit unusual, and without examining you, it's hard to say for sure.
In most places, dry eye usually gets better in the summer as humidity increases and worsens in the winter as indoor heating dries the air. Allergens usually increase in the summer and fall way off in the winter, but itching is usually the most frequent sign of allergy.
Your experience with the oven suggests evaporative dry eye, which is usually caused by meibomian gland dysfunction.
You might try either Systane Balance by Alcon or Refresh Optive Advanced by Allergan, as both are designed to help with this issue. If that doesn't help, I suggest you consult with an eye care provider who is expert in managing dry eye to get to the bottom of this. — Dr. Arthur Epstein
Q: Why are my eyes so dry after being in the pool? Is there any inexpensive in-home remedy? I am seeing double, and it is really irritating. — L.
A: Pool water usually contains chemicals that are quite harsh.
These additives reduce growth of a variety of organisms but are often irritating to the sensitive tissues of the eye.
Waterproof swim goggles should help, and I would advise that you find a well-fitting, comfortable pair that will shield your eyes from pool chemicals. — Dr. Arthur Epstein
Q: I was in a car accident a number of years ago, with some fairly serious head injuries (like permanent blindness in one eye). It also left me with constantly dry eyes. But my eyes now will drip tears whenever I am sweating! Is this a known condition?
Is there any treatment for the dryness? (The tears don't bother me.) — S.F.
A: Sorry to hear of your accident. Losing sight in one eye is terrible. Over the years I've dealt with many patients who have, and with some additional care they usually do fine.
Going forward, you need to be extra careful to protect the remaining seeing eye — that includes regular eye exams.
Tearing is common in patients with dry eye, but from your description, I suspect you sustained nerve damage from the accident. That can contribute to dry eye, but in your case, as your nerves healed, some of the connections got crossed, and now what causes you to sweat also causes tearing. Although it may sound weird, it isn't as uncommon as it sounds. The body will do whatever it can to heal, even if it means using existing "wiring" to repair damage.
This should be evaluated, but if it is, as I suspect, due to aberrant regeneration of nerves and you are not disturbed by the tearing, no treatment is needed.
You may also have dry eye that should be treated. In any case, have someone take a look to be sure. — Dr. Arthur Epstein
Q: I have severe dry eyes. Currently I live in a very dry climate, where it could get as low as 9 percent humidity with over 100-degree temperatures during the summer. My doctor told me that the film of tears that covers my eyes is very thin and evaporates quickly. I also keep getting blepharitis.
I'm a retiree, so moving to another place is not a problem. I'm thinking of moving to a small town by the Gulf, if that would cure my dry eyes. It has low pollution, high humidity, very low elevation and fairly moderate temperatures during the winter. Would that help my situation?
Also, which eye drops would be best for me? My doctor suggested Restasis, but it is extremely expensive. — A.J.
A: I live in Phoenix, so I know exactly the kind of environment you now live in. In the hot, dry desert environment, tear evaporation is a major problem. You are fortunate to be able to move so easily. Most folks can't.
The good news is that a move to an area with higher ambient humidity, lower elevation and low pollution should be helpful, but it may not completely alleviate your problems. How much it does depends on the health of your ocular surface and especially the health and function of the meibomian glands. These glands produce a complex oil with every blink that prevents evaporation and helps stabilize the tears.
The best treatment for meibomian gland dysfunction (which from your description I assume you have) is LipiFlow, a procedure developed by TearScience, which clears and restores function to the glands.
Regarding drops, the best contain oils that mimic meibomian gland secretions. These include Alcon's Systane Balance and Allergan's Refresh Optive Advanced Formula. FreshKote is an Rx product that may also be helpful.
I might also suggest that an extended visit to your intended new home would help you decide if the move would make enough difference to justify uprooting yourself from your current home. — Dr. Arthur Epstein
SEE ALSO: How To Apply Eye Drops — Without Getting Them All Over Your Face! >
Q: I have had dry eyes for more than two months now. Out of those two months there was one week where my eyes were better but not normal. This happens often, and more during the winter months, but I feel that because they are dry for so long, there is a bigger problem than just temporary dry eyes. Could there be something seriously wrong with my eyes? — T.D.
A: Dry eye is often a result of one or more protective systems that keep the eyes moist failing to work properly. Seasonal dryness seen during winter heating season or summer air-conditioning season, arid environments typical of the U.S. Southwest, or high altitudes as in Denver, are among the things that can stress ocular surface and tear systems, causing worsened dry eye symptoms.
I suspect your "temporary" dry eye isn't really temporary, but just symptoms of dry eye breaking through. It's likely things will get worse over time, and your symptoms will become more frequent.
For that reason, I suggest you get a full dry eye workup so that therapy can be instituted sooner rather than later, when it may be more difficult to properly manage your dryness. — Dr. Arthur Epstein
Q: My eye care provider told me I have a bit of dryness in my eye, and the cause of it is that I spend about eight hours a day in front of a computer.
I've reduced the time I spend before the computer, and the grittiness is gone. But I still feel dryness, but only a little bit. I'm 16 years old, which is too soon for me to have serious dry eye, but I don't know whether it's chronic or not. Is it possible that I can permanently heal my dry eye? — N.
A: The tears and ocular surface work together to keep the eye moist and to insure crisp vision. Dryness usually worsens with age, but it can occur in younger individuals in some cases. Computer use decreases the frequency of blinking, and that promotes evaporation of the tears. That can be either the cause or a factor that contributes to your symptoms.
You might be helped by one of the newer lipid-based dry eye drops that are available at the pharmacy. Because dry eye tends to be both chronic and progressive, if your symptoms persist I would consult with an eye care provider for a full dry eye evaluation. — Dr. Arthur Epstein
Q: I traveled to South Africa this past May. My total flight times were 25 hours going and 30 hours coming back. When I came back to the United States I started experiencing extremely dry eyes.
A: As a fellow traveler who has spent many long hours on international flights, I understand just how eye-unfriendly aircraft cabins can be.
In addition to being pressurized — usually to equivalent altitudes of 6,000-8,000 feet above sea level — the cabins also have very low ambient humidity, typically in the low teens, which can make an otherwise asymptomatic person quite uncomfortable.
For most people, the effects of even a prolonged flight are transient and abate within an hour or two. In your case, I suspect you suffered from marginal dry eye to start with, which became apparent and symptomatic after the long flights.
Without examining you, it is difficult to pin down an exact cause, but my impression is that your primary problem is evaporative dry eye, a condition almost always associated with meibomian gland dysfunction (MGD).
Evaporative dry eye may be worsened by some brands of silicone hydrogel lenses, which can attract the lipid that normally serves as a moisture barrier. Lipid attracted to the surface of the lens can disrupt the moisture barrier and often results in worsening discomfort and reduced wearing time.
To properly address your problem, I suggest you consult an eye care professional for a dry eye workup — especially looking at meibomian gland function. Your provider can also rule out other possible issues that can cause dry eye that may have coincidentally developed (thyroid problems, for example).
If your issue is evaporative dry eye, treatment ranges from dry eye drops containing lipid supplements like Alcon's Systane Balance or Allergan's Refresh Optive Advanced, warm compresses and lid massage, to treatment of MGD with TearScience's LipiFlow system.
From a contact lens perspective, be sure you're wearing a modern, wettable lens material and ask your eye care professional about the proper lens care system to use with your lenses. In my experience, patients suffering from dry eye often do better with daily disposable contact lenses.
With proper diagnosis and treatment, comfort should return, as well as your ability to wear contact lenses. — Dr. Arthur Epstein
Q: Sometimes when I cry, tears won't come out of one of my eyes. Why does this happen? — S.
A: Sometimes a seemingly simple and straightforward question can be very difficult to answer. This is one of those times. An examiner would need to know your age, how recently this started, if there are any other symptoms or problems you've noticed, and if it always occurs in the same eye. Even with a careful history, proper diagnosis would require a thorough eye exam.
Because some of the causes can be potentially serious, especially if this is of recent onset, I advise that you consult your eye doctor immediately to rule out a serious eye or health disorder. — Dr. Arthur Epstein
Q: Why do my eyes well up in tears when I'm either reading a book or on the computer? — E.B.
A: There are lots of possible reasons that your eyes tear excessively when you do close work. Decreased blink rate as you concentrate can reduce tear flow throughout the tear drainage system, which can cause tears to well up. More likely, an unstable tear film and deceased blinking will cause reflex tearing.
Many patients who experience this have evaporative dry eye and would benefit from evaluation of their meibomian glands and treatment if appropriate. — Dr. Arthur Epstein
