Your eyes need constant moisture in order to help keep them healthy. If your eyes aren't producing enough tears or moisture, you could suffer from chronic dry eye which its symptoms include burning, stinging, itchy eyes, excessive mucous, sensitivity to smoke and wind, difficulty wearing contacts, and excessive tearing.
Unfortunately even though lasik surgery can help correct eyes with poor eye sight, after the surgery it can cause your eyes to become dry and irritable.
What treatment options are available?
Learn more from Dr. Jeffrey Golen, a UVA ophthalmologist who specializes in treating cataracts.
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What You Need to Know About Dry Eye and Lasik Surgery
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Learn more about Dr. Jeffrey Golen
Learn more about UVA Ophthalmology
Jeffrey R. Golen, MD
Dr. Jeffrey Golen is a fellowship-trained ophthalmologist whose specialties include cataracts and cataract removal.Learn more about Dr. Jeffrey Golen
Learn more about UVA Ophthalmology
Transcription:
What You Need to Know About Dry Eye and Lasik Surgery
Melanie Cole (Host): Your eyes are so precious but when your vision is compromised or you suffer from dry eye, you realize how important it is to get the best care. My guest today is Dr. Jeffrey Golen. He is a fellowship trained Ophthalmologist at UVA Health System. Welcome to the show, Dr. Golen. Tell us a little bit about dry eye. People have heard this term and they don’t even really know what it means.
Dr. Jeffrey Golen (Guest): Hi. Thank you for having me. There are actually two different types of dry eye. There’s a dry eye where you don’t produce enough tears. Then, there is another type of dry eye where we do produce enough tears but our tears are really not adequate to keep our eyes lubricated. They don’t have the right components and there are some inflammatory problems with the tears.
Melanie: What are some of the complications? We all need to keep moist eyes and be able to make tears. What can happen if you can’t?
Dr. Golen: I think a lot of people get confused about dry eye. They try to compare it to dry skin, I think. For a lot of men who might have dry skin, they don’t really get too worked up about it. But, the problem with dry eye is that it will not only lead to discomfort but will actually cause issues with vision. It can cause blurred vision or issues with glare. It actually does affect our vision.
Melanie: What do you do? How do you even know, first of all, that you have it? Will your eyes be itchy? Will they feel that dryness? Like you say, like dry skin, but will it feel itchy and like you just need something in there? What does it feel like? What are some symptoms?
Dr. Golen: It really does depend on the patient but oftentimes the patient will complain of eyes that feel dry or irritated or, sometimes in severe cases, it will actually feel like something is in the eye.
Melanie: If they’ve got any of these, they get to an ophthalmologist pretty quickly because you don’t want to mess around with your eyes. What do you do for them? How do you find out this is what is going on?
Dr. Golen: First we check their vision and examine the patient. There are a number of different tests we can do to check to see how dry one’s eyes are or if they are having issues with dry eye. After we do these tests and properly make the diagnosis, then we move forward to the treatment. There are a number of different modalities we use to treat this. We typically start with artificial tears, actually. It’s usually the most simple way to start. It’s not always adequate for every patient but artificial tears are available over the counter. I think one of the most common problems that patients make is that, instead of buying artificial tears, they will actually buy eye drops that are designed to get the red out. In fact these drops, while they do a good job of getting the red out, are not designed for long term use. What will happen is, the patients will be on these drops and their eyes will be perfectly white but they will not be adequately lubricated.
Melanie: If they are using those products, which are not the right product for this situation, do you put them on a product that they then have to be on long term, Dr. Golen? Is this something that maybe comes and goes?
Dr. Golen: It can come and go depending on the environment. It’s typically worse in the winter because there is less humidity in the air. I talk to patients about modifying their environment so that it’s the best possible environment for their dry eye. For example, recommending staying away from fans at night time, using a humidifier if possible in their house--things such as this. For the artificial tears, we typically start as an as needed basis. If the patients are doing fairly well with environmental modification, just as needed. But, if the patients are still having issues with dry eye, then we are going to go up on the artificial tears and use them more frequently.
Melanie: People have also heard about LASIK surgery, Dr. Golen. They hear it on commercials and late night television. There are people all over the country that talk about this now. What is the connection between LASIK surgery and dry eye?
Dr. Golen: That’s a great question. There, actually, are quite a few connections. First off, people who have dry eye oftentimes do worse in contact lenses. Our patients who have issues with contact lenses are usually the first patients who want to get LASIK. Unfortunately, they are not always the best candidates because it is a fact that LASIK, or its cousin procedure PRK, will make the eye, actually, more dry. This is definitely something to keep in mind for someone who does have dry eye.
Melanie: It sounds like a vicious circle, if you have dry eye and you want to use contacts but you can’t because you have dry eye. You’re the person who wants to have LASIK but it can make the situation worse. What do you tell people--that they are just going to have to stick with glasses and use the artificial tears and go from there? What can they do?
Dr. Golen: They can be evaluated by an ophthalmologist to determine how bad their dry eye is. If it’s mild dry eye, typically, we can proceed with a procedure such as LASIK. As long as the patient is educated that afterward they will need to lubricate their eyes more aggressively, then it’s fine. If they have more severe dry eye, then we might think twice about doing the procedure. It really depends on the scale of the dry eye – the actual problem.
Melanie: Are there certain people who are more at risk for dry eye?
Dr. Golen: Yes, the elderly are more likely to have dry eye. In addition, women tend to have dry eye worse than men.
Melanie: Wow. Why is that? Do we know?
Dr. Golen: We don’t know exactly. We think it’s related to hormones, though.
Melanie: Doesn’t everything just seem to be related to hormones? What else can you tell the listener about LASIK surgery and how to find somebody if you are somebody who maybe doesn’t suffer from dry eye and you’re somebody who really wants to consider LASIK surgery, how do you find somebody who is really good at it and that you can trust?
Dr. Golen: You want to find a doctor who is willing to have the discussion about whether or not you are an ideal candidate for the procedure. Ideally, you should be a patient who has had a very stable refraction, meaning your glasses prescription hasn’t changed recently. You can’t be pregnant and you can’t have any history of eye trauma to the eye, ideally. We don’t want anyone with corneal scarring. There are a few different things that make a patient a non-candidate for LASIK. There are other tests that we do in addition to rule out a patient for the LASIK procedure. Things that we are looking for are thin corneas, or corneas that have an abnormal shape. You wouldn’t really know this unless you saw an ophthalmologist and had the appropriate tests taken but we do this for safety. Patients who get LASIK, typically, have otherwise healthy eyes and they see quite well with glasses. They are perfectly healthy. They just need the glasses. As a result, we don’t want to operate on eyes that are anything less than perfectly healthy.
Melanie: What do you tell people when they ask you, “Is this a permanent condition now? Am I going to be able to get LASIK surgery and be able to see perfectly and not have to do this again or never have to wear glasses – I can throw them away?” What do you tell people as a realistic outlook from this?
Dr. Golen: That’s a great question. It really depends on the patient’s current situation but I never promise that it’s permanent because it’s almost never permanent. The reason why is what we do is, we reshape the cornea so that the patient, at any given time of surgery, can see very well ideally at distance. If the patient is over the age of 45, they will probably need some form of reading glasses to see up close, especially, if we set them for distance. In addition, if we’re dealing with patients who are a little bit older they, perhaps, might develop cataracts in the future which would be another issue. With your typical LASIK patient who might be in their 20’s or 30’s, they’ll, typically, have at least 10 years of good vision without glasses in the best case scenario but it is almost never a permanent situation like that.
Melanie: Dr. Golen, in just the last few minutes, give listeners your very best advice about LASIK, about dry eye, and why they should come to UVA Ophthalmology for their care.
Dr. Golen: If you do have dry eye and you are considering LASIK, you should get evaluated for dry eye first, in my opinion, because the LASIK procedure can actually worsen the dry eye. One of the first things that any ophthalmologist will tell you is start with an eye drop such as artificial tears. I, typically, prefer preservative free artificial tears because preservatives can sometimes irritate the surface of the eye. After we lubricate the eyes adequately, we can go from there but there might be other procedures that are needed. For example, if people have severely dry eyes we can actually put little plugs in their eye lids and that can help hold in more natural tears.
Melanie: Why should they come to UVA Ophthalmology? Tell us about your team a little bit.
Dr. Golen: We’ve got a very strong team here. We cover every discipline of ophthalmology and we have an optometrist who specializes in difficult to fit contact lenses. We really have everyone across the board in one department. We have excellent specialists, no matter whether you need an ocular plastic surgeon, a retina specialist or a cornea specialist. We’ve got everything covered. We communicate very well with each other.
Melanie: Thank you so much, Dr. Golen. What great information. So beautifully put. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
What You Need to Know About Dry Eye and Lasik Surgery
Melanie Cole (Host): Your eyes are so precious but when your vision is compromised or you suffer from dry eye, you realize how important it is to get the best care. My guest today is Dr. Jeffrey Golen. He is a fellowship trained Ophthalmologist at UVA Health System. Welcome to the show, Dr. Golen. Tell us a little bit about dry eye. People have heard this term and they don’t even really know what it means.
Dr. Jeffrey Golen (Guest): Hi. Thank you for having me. There are actually two different types of dry eye. There’s a dry eye where you don’t produce enough tears. Then, there is another type of dry eye where we do produce enough tears but our tears are really not adequate to keep our eyes lubricated. They don’t have the right components and there are some inflammatory problems with the tears.
Melanie: What are some of the complications? We all need to keep moist eyes and be able to make tears. What can happen if you can’t?
Dr. Golen: I think a lot of people get confused about dry eye. They try to compare it to dry skin, I think. For a lot of men who might have dry skin, they don’t really get too worked up about it. But, the problem with dry eye is that it will not only lead to discomfort but will actually cause issues with vision. It can cause blurred vision or issues with glare. It actually does affect our vision.
Melanie: What do you do? How do you even know, first of all, that you have it? Will your eyes be itchy? Will they feel that dryness? Like you say, like dry skin, but will it feel itchy and like you just need something in there? What does it feel like? What are some symptoms?
Dr. Golen: It really does depend on the patient but oftentimes the patient will complain of eyes that feel dry or irritated or, sometimes in severe cases, it will actually feel like something is in the eye.
Melanie: If they’ve got any of these, they get to an ophthalmologist pretty quickly because you don’t want to mess around with your eyes. What do you do for them? How do you find out this is what is going on?
Dr. Golen: First we check their vision and examine the patient. There are a number of different tests we can do to check to see how dry one’s eyes are or if they are having issues with dry eye. After we do these tests and properly make the diagnosis, then we move forward to the treatment. There are a number of different modalities we use to treat this. We typically start with artificial tears, actually. It’s usually the most simple way to start. It’s not always adequate for every patient but artificial tears are available over the counter. I think one of the most common problems that patients make is that, instead of buying artificial tears, they will actually buy eye drops that are designed to get the red out. In fact these drops, while they do a good job of getting the red out, are not designed for long term use. What will happen is, the patients will be on these drops and their eyes will be perfectly white but they will not be adequately lubricated.
Melanie: If they are using those products, which are not the right product for this situation, do you put them on a product that they then have to be on long term, Dr. Golen? Is this something that maybe comes and goes?
Dr. Golen: It can come and go depending on the environment. It’s typically worse in the winter because there is less humidity in the air. I talk to patients about modifying their environment so that it’s the best possible environment for their dry eye. For example, recommending staying away from fans at night time, using a humidifier if possible in their house--things such as this. For the artificial tears, we typically start as an as needed basis. If the patients are doing fairly well with environmental modification, just as needed. But, if the patients are still having issues with dry eye, then we are going to go up on the artificial tears and use them more frequently.
Melanie: People have also heard about LASIK surgery, Dr. Golen. They hear it on commercials and late night television. There are people all over the country that talk about this now. What is the connection between LASIK surgery and dry eye?
Dr. Golen: That’s a great question. There, actually, are quite a few connections. First off, people who have dry eye oftentimes do worse in contact lenses. Our patients who have issues with contact lenses are usually the first patients who want to get LASIK. Unfortunately, they are not always the best candidates because it is a fact that LASIK, or its cousin procedure PRK, will make the eye, actually, more dry. This is definitely something to keep in mind for someone who does have dry eye.
Melanie: It sounds like a vicious circle, if you have dry eye and you want to use contacts but you can’t because you have dry eye. You’re the person who wants to have LASIK but it can make the situation worse. What do you tell people--that they are just going to have to stick with glasses and use the artificial tears and go from there? What can they do?
Dr. Golen: They can be evaluated by an ophthalmologist to determine how bad their dry eye is. If it’s mild dry eye, typically, we can proceed with a procedure such as LASIK. As long as the patient is educated that afterward they will need to lubricate their eyes more aggressively, then it’s fine. If they have more severe dry eye, then we might think twice about doing the procedure. It really depends on the scale of the dry eye – the actual problem.
Melanie: Are there certain people who are more at risk for dry eye?
Dr. Golen: Yes, the elderly are more likely to have dry eye. In addition, women tend to have dry eye worse than men.
Melanie: Wow. Why is that? Do we know?
Dr. Golen: We don’t know exactly. We think it’s related to hormones, though.
Melanie: Doesn’t everything just seem to be related to hormones? What else can you tell the listener about LASIK surgery and how to find somebody if you are somebody who maybe doesn’t suffer from dry eye and you’re somebody who really wants to consider LASIK surgery, how do you find somebody who is really good at it and that you can trust?
Dr. Golen: You want to find a doctor who is willing to have the discussion about whether or not you are an ideal candidate for the procedure. Ideally, you should be a patient who has had a very stable refraction, meaning your glasses prescription hasn’t changed recently. You can’t be pregnant and you can’t have any history of eye trauma to the eye, ideally. We don’t want anyone with corneal scarring. There are a few different things that make a patient a non-candidate for LASIK. There are other tests that we do in addition to rule out a patient for the LASIK procedure. Things that we are looking for are thin corneas, or corneas that have an abnormal shape. You wouldn’t really know this unless you saw an ophthalmologist and had the appropriate tests taken but we do this for safety. Patients who get LASIK, typically, have otherwise healthy eyes and they see quite well with glasses. They are perfectly healthy. They just need the glasses. As a result, we don’t want to operate on eyes that are anything less than perfectly healthy.
Melanie: What do you tell people when they ask you, “Is this a permanent condition now? Am I going to be able to get LASIK surgery and be able to see perfectly and not have to do this again or never have to wear glasses – I can throw them away?” What do you tell people as a realistic outlook from this?
Dr. Golen: That’s a great question. It really depends on the patient’s current situation but I never promise that it’s permanent because it’s almost never permanent. The reason why is what we do is, we reshape the cornea so that the patient, at any given time of surgery, can see very well ideally at distance. If the patient is over the age of 45, they will probably need some form of reading glasses to see up close, especially, if we set them for distance. In addition, if we’re dealing with patients who are a little bit older they, perhaps, might develop cataracts in the future which would be another issue. With your typical LASIK patient who might be in their 20’s or 30’s, they’ll, typically, have at least 10 years of good vision without glasses in the best case scenario but it is almost never a permanent situation like that.
Melanie: Dr. Golen, in just the last few minutes, give listeners your very best advice about LASIK, about dry eye, and why they should come to UVA Ophthalmology for their care.
Dr. Golen: If you do have dry eye and you are considering LASIK, you should get evaluated for dry eye first, in my opinion, because the LASIK procedure can actually worsen the dry eye. One of the first things that any ophthalmologist will tell you is start with an eye drop such as artificial tears. I, typically, prefer preservative free artificial tears because preservatives can sometimes irritate the surface of the eye. After we lubricate the eyes adequately, we can go from there but there might be other procedures that are needed. For example, if people have severely dry eyes we can actually put little plugs in their eye lids and that can help hold in more natural tears.
Melanie: Why should they come to UVA Ophthalmology? Tell us about your team a little bit.
Dr. Golen: We’ve got a very strong team here. We cover every discipline of ophthalmology and we have an optometrist who specializes in difficult to fit contact lenses. We really have everyone across the board in one department. We have excellent specialists, no matter whether you need an ocular plastic surgeon, a retina specialist or a cornea specialist. We’ve got everything covered. We communicate very well with each other.
Melanie: Thank you so much, Dr. Golen. What great information. So beautifully put. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.