Saturday, March 26, 2022

Best Omega 3 Fish Oil for Dry Eyes

I am here to bring the latest information on eye health and medicine. I also have a master's degree in nutrition. So today's topic is very dear to me.

In today's article, you'll learn why you should take omega-3 fish oil supplements for dry eyes. How to pick the best omega-3 oil you? and also my top three recommended oil supplements for treating dry eyes.

Why you should take Omega-3 Fish oil supplements if you have Dry Eyes

The tears on the surface of our eyes have 3 different layers. The lipid layer, the aqueous layer, and the mucin layer. The lipid layer of the tear film is the outermost layer and its function is to prevent the liquid portion of the tears from evaporating too fast.

It contains mainly meibum oil which is produced by the oil glands in our eyelids called meibomian glands. Therefore if the meibomian glands are not working properly due to inflammation or clogging or if the meibum oil is too thick or has abnormal composition, the lipid layer of the tear film may either contain too little oil or poor quality of the oil, and it will not function properly.

This results in your eyes getting dry due to rapid evaporation of the tears. This condition is called meibomian glands dysfunction, and it is one of the most common causes of dry eye disease.

Numerous studies have shown that omega-3 oil supplements can decrease inflammation of the meibomian glands, improving meibum oil flow into the tear film as well as improving the quality of meibum oil. That is why omega-3 oil supplements are commonly recommended by eye doctors for treating dry eye disease.

How do you Pick the Best Omega-3 Fish Oil Supplement for you?

When we go to a pharmacy or even a grocery store, the number of choices for omega-3 fish oil supplements available over-the-counter can be overwhelming. So how do you pick the best omega-3 fish oil supplement for you?

Omega-3 oil supplements, just like other dietary supplements, are not regulated by the FDA. So the quality and composition can vary greatly among different products. Let's talk about some key things to look for in good quality omega-3 fish oil supplements.


Most of the key information you are looking for to differentiate different types of omega-3 fish oil supplements is listed on the supplement facts label, which is typically located at the back of the package.

The first thing you should look at is the types of fatty acids contained in the supplements. You are looking for the amount of omega-3 fatty acids, and specifically, the amount of EPA and DHA contained in the product.

Omega-3 fatty acids are a group of polyunsaturated fatty acids. There are three primary omega-3 fatty acids in our diet, ALA, EPA, and DHA. Among these three types of omega-3 fatty acids, EPA and DHA have significantly more anti-inflammatory properties than ALA.

While ALA can be converted into EPA and DHA in our body, only 5 to 10% of dietary ALA is converted into EPA and DHA. You want to pay attention to the amount of EPA and DHA contained in each serving of the product.

Studies have shown that daily supplementation of 2000 mg of combined EPA and DHA is effective in treating dry eye disease. However, the amount of omega-3 fatty acids needed to treat dry eye disease can not simply be obtained by just eating fish due to the number of toxins contained in fish such as mercury and lead.

The amount of fish that you would need to consume daily to treat dry eye disease could pose a significant risk of mercury poisoning.

The second thing you are looking for is the form of EPA and DHA that the product contains. Significantly, you are looking for the triglyceride form of EPA and DHA and not the ethyl ester form.

Studies have shown that the triglyceride form of omega-3 oil can have up to 70% better absorption than the ethyl ester form. For example, in this type of fish oil supplement, you can easily get it from a big-box store.

Omega-3 fatty acids contained in this product are in ethyl ester form. omega-3 fatty acids in natural unprocessed fish oil are in the triglyceride form in order to remove toxins such as mercury and lead from the raw fish oil.

It is often processed with ethyl alcohol which converts the omega-3 fatty acids into the ethyl ester form. But it needs to be converted back into the natural triglyceride form to improve the absorption in our body. So in summary, it is important to pick omega-3 oil supplements that contain adequate amounts of EPA and DHA that are in the triglyceride form.

The third thing to look out for is the source of the fish oil used in your omega-3 supplement. Both farm-raised and wild-caught fish can be used to make omega-3 fish oil. But oil from wild-caught fish typically contains a higher concentration of the desired omega-3 fatty acids EPA and DHA.

Fish oil sourced from farm-raised fish is typically much cheaper. So why can't you just take more servings of the cheaper supplements to get the same amount of omega-3 fatty acids?

Fish that are farm-raised and fed with grain typically contain a higher concentration of omega 6 and other fatty acids which may be harmful or pro-inflammatory. Let's say supplement A contains 2400mg of fish oil, 600mg of which are EPA and DHA.

You would need to take almost 3.5 servings of supplement A to get the recommended 2000mg of EPA and DHA along with 6300mg of the less healthy and possibly harmful other oils and the calories from those oils.

In addition, the fish oil obtained from fish that are farm-raised and fed with grain may possibly contain pollutants and chemicals that may not be found in wild-caught fish. Not all manufacturers will specify the type of fish they used to source their fish oil on the package.

So you may need to do a little bit of research on your own to find out the source of the fish used in a given product.

Best 3 Omega-3 oil Supplements that I recommend for my Patients

1. Nordic Natural Ultimate Omega

Number one nordic naturals ultimate omega liquid form. I recommend this product because each serving contains 1460 mg of EPA, 1010 mg of DHA, both are in the triglyceride form.

The fish source is wild-caught deep-sea fish from sustainable sources according to the company. And the toxins levels in this product are significantly below the maximum allowance set by the different regulatory agencies.

I usually prefer liquid omega-3 oil supplements over capsules, because various materials can be used to manufacture the capsular shell, and some can decrease the absorption of omega-3 fatty acids in our body such as methacrylic acid copolymer.

2. PRN Dry Eye Omega Benefits

Number two PRN dry eye omega benefits liquid form. This is actually the supplement that I personally take. I would have listed this product as number one if weren't for the slightly higher price with the PRN products.

For a 10 oz bottle, this one typically costs about $108, and the nordic natural product costs about $72 for an 8-ounce bottle. So it's about $1.80 per oz difference. I really like the PRN dry eye omega benefits because each serving contains 1680 mg of a triglyceride form of EPA and 560 mg of a triglyceride form of DHA.

Also, PRN has stated that they are committed to using sustainable sources for their fish oil. And that they maintain strict testing criteria for purity and toxins.

3. PRN Omega-V Benefits

Number three PRN omega-v benefits. This is one for my vegetarian and vegan readers or those with dietary restrictions. This is a vegan product that still contains a high concentration of triglyceride form of EPA and DHA.

The source of omega-3 fatty acids in this product is algae, which is the main food source for many fish. Each serving contains 330 mg EPA and 670 mg of DHA.

There are limited choices in high-quality omega-3 oil supplements for vegetarians and vegans, or people who limit their consumption of fish or fish products, and this supplement can provide them with a good amount of high-quality omega-3 fatty acids.

Oil from algae is thought to be significantly better than flaxseed oil as a source of omega-3 fatty acids. The main form of omega-3 fatty acids contained in flaxseed oil is ALA.

As I mentioned before the conversation of ALA to the effective forms of omega-3 fatty acids EPA and DHA are less than 5 to 10% in our body. This makes flaxseed oil a much less effective source of omega-3 fatty acids.

Please remember to always consult with your doctor before taking any high dose of omega-3 oil supplements, to make sure that they are safe and right for you. 

Tuesday, March 22, 2022

What Eye Drops should I avoid for Dry Eye Disease?

In this piece of article, I'll show you three different over-the-counter eye drops that I would not use to treat dry eye disease. I will tell you about one lesser know eye drop you may also want to look out for.

4 Eye Drops Not Recommended

1. Soothe lubricant eye drops

soothe maximum hydration lubricant eye drops by Bausch & Lomb. The main reason I do not recommend this eye drop is the preservative they use in it. The preservative contained in this eye drop is benzalkonium chloride or BAK.


There are three different types of preservatives that are commonly used in drops. Detergent type, Oxidative type, and Ionic buffering systems.

The detergent type of preservative is the most toxic type to the surface of the eye, and BAK is the most toxic of the detergent type preservatives. BAK is also commonly used in many different types of medication eye drops such as antibiotic eye drops. Where its toxicity can actually be an advantage for short-term use.

BAK can interfere with the connections between the cells on the surface of the eye and reduce the number of cells on the outer layer of the eye called epithelial cells.

Therefore it can be quite harmful to the eye surface when used frequently or over a long period of time. If you really like the family of soothing eye drops, you would be better off using the soothe XP lubricant eye drops from the same company as they contain polyquad as the preservative.

Although polyquad is also a detergent type of preservative. It is less toxic than BAK. Because the cells on the surface of the eye tend to repel polyquad making it less toxic to the eye surface. Even better among the soothe family of the eye drops are the preservative-free eye drops.

2. Clear Eyes Drops

Clear eyes natural tears eye drops by prestige consumer healthcare. There are two reasons that I do not recommend using clear eyes natural tears for treating dry eyes.

The first is that this eye drop also uses benzalkonium chloride or BAK as its preservative and there is no preservative-free version of this eye drop.

The second reason is that this eye drop contains polyvinyl alcohol or PVA which is a demulcent that lowers the viscosity or thickness of the eye drop. PVA is found in many older types of artificial tear eye drops.

There are more effective newer compounds that are available as a demulcent in eye drops such as propylene glycol and polyethylene glycol which are used in some newer artificial tears eye drops.

3. Visine Eye Drops

Visine dry eye relief, Visine red-eye hydrating comfort, and Visine red-eye total comfort by Johnson & Johnson. Visine red-eye hydrating comfort and Visine red-eye total comfort contain tetrahydrozoline to reduce eye redness.

Tetrahydrozoline is a chemical that temporarily constricts the blood vessels on the eye surface to reduce the appearance of eye redness. Frequent and long-term use of tetrahydrozoline can cause rebound dilation of the blood vessels on the eye surface when the eye drop is discontinued.

This means the eye will appear red if the eye drop is discontinued. Now unlike Visine red-eye total comfort, some other Visine eye drops like Visine dry eye relief do not contain tetrahydrozoline.

However, all three Visine eye drops I mentioned use BAK as their preservative, and as always, I recommend avoiding long-term use of any over-the-counter eye drops that contain BAK due to its toxicity to the surface of the eye.

If you really would like to choose an eye drop from the Visine family to treat dry eyes. You would be better off choosing Visine dry relief tired eye lubricant eye drops or Visine dry eye relief all-day comfort, as the preservative used in those two drops is polyquad which is less toxic than BAK.

4. Rohto Cooling Eye Drops

It is less well known than the other over-the-counter eye drops. Rohto cooling Digi eye contains both tetrahydrozoline and BAK which as we already talked about can be toxic to your eyes.

Saturday, March 5, 2022

Best Active Ingredients of Eye Drops for Dry Eyes

In today's article, I would like to talk to you about the science behind the ingredients in artificial tears. These are the over-the-counter eye drops for treating dry eye disease. This post will help you to understand the differences between different dry eye drop ingredients and will help you choose the artificial tears that work best for you.


Without further ado, let's talk about the ingredients in artificial tears. The ingredients of artificial tears can be categorized into three groups:
  • Active Ingredients
  • Inactive Ingredients
  • Preservatives

1. Active Ingredients

The active ingredients are the agents that have been approved by the FDA to be used in artificial tears to provide lubrication to the eye. There are three main categories of active ingredients in artificial tears.
  • Astringent
  • Demulcent
  • Emollient


The most commonly used ophthalmic astringent is zinc sulfate. Two common brands of dry eye drops that contain zinc sulfate are Clear eyes drop made by prestige consumer healthcare and Visine made by johnson & johnson.

Zinc sulfate can help reduce the burning and itching sensation from exposure to the pollutants in the air by reducing the mucus on the surface of the eye. So it can help reduce some allergy symptoms but zinc sulfate is not very effective in lubricating the eye compared to other active ingredients. So it is not a top active ingredient in artificial tears that I recommend for my patients to treat their dry eye disease.


The second group of active ingredients is called demulcent. This is the main ingredient in artificial tears which determines the consistency and thickness of the drop. Demulcents are typically mucoprotective agents. They reduce inflammation and irritation of the mucus membrane of the eyes and hold moisture to lubricate the surface of the eye.

They act on both the aqueous and the mucin layers of the tear film. There are a few common demulcents used by different brands of artificial tears. Carboxymethyl cellulose sodium (CMC) is the main demulcent used in the Refresh brand artificial tears made by Allergan. Systane brand of artificial tears made by Alcon typically contains polyethylene glycol or propylene glycol as their demulcent.

The other commonly used demulcent agent is hydroxypropyl methylcellulose (HPMC). It is the demulcent used in GenTeal brand artificial tears made by Alcon. Variation in the concentration of the demulcent such as CMC affects the consistency and the viscosity of the artificial tears.

For example, Refresh Optive gel drop contains 1.0% CMC which is double the concentration of CMC in the regular refresh optive eye drop. This allows the gel drop to provide a longer-lasting lubricating effect.

However, the higher concentration of the demulcent used increases the thickness of the artificial tears. This will require more blinking action by the eyelid to spread the demulcent polymer over the surface of the eye. Therefore if you use a gel eye drop you may notice it takes a little bit longer and more blinks to clear your vision after you put in the eye drop.


The third category of active ingredients is emollient. An emollient is usually fat or oil providing a long-lasting lubricating effect, and the eye drop which contains emollients tend to be thicker and take longer to clear up. So the liquid formulations of artificial tears typically do not contain a large number of emollients.

For example, mineral oil is a commonly used emollient and is intended to replace and thicken the lipid layer of the tear film in order to improve the stability of the tears and slow down the evaporation of the tears.

More commonly emollients are found in ointment formulations of artificial tears such as Refresh PM and Systane Nightime eye ointments. These formulations are more frequently used before bedtime and reserved for moderate to severe dry eye disease.

Some newer liquid formulations of artificial tears target all three layers of the tear film including the lipid layer, which often contain a small amount of emollient to provide a longer-lasting lubricating effect to the eye.

Artificial tears which contain emollients are a little bit thicker. So after you put in the drop make sure you blink a few times to spread out the eye drop across the surface of the eye. You may notice the vision is a little bit blurry and it may take a few blinks to clear up your vision. If you want to know what eye drops should not use for dry eyes. Click here

Monday, January 31, 2022

RLE Surgery - A Permanent Solution to Reading Glasses

So you want to get rid of reading glasses forever? that's the topic of today's article. I am here to bring you the latest information on eye health and medicine. The worsening of reading vision as we age is called presbyopia.

With the recent FDA approval of the vuity eye drop which is a temporary treatment for presbyopia. A lot of my patients have been asking me about ways to eliminate reading glasses permanently.

Refractive Lens Exchange Surgery (RLE)

In today's article, I will discuss a surgical option that can treat presbyopia permanently. This type of presbyopia eye surgery is known as refractive lens exchange surgery or RLE.


I will go over how RLE works? Who are candidates for RLE surgery? What to expect before and on the day of refractive lens exchange surgery? what is the recovery process and what are the risks of this type of surgery? Make sure you read the entire article to learn about both the benefits and risks of RLE surgery?

How Does Refractive Lens Exchange Surgery Work?

So how does RLE surgery work? RLE surgery corrects presbyopia by replacing the stiff and aging natural lens in our eyes with an advanced intraocular lens implant or IOL.

When we are young we are able to see objects at different distances due to the flexibility of our natural lens. Our natural lens becomes more curved when the eye muscles contract called "Ciliary body muscles" and our eyes become more nearsighted.

This enables us to see objects that are close to us clearly. In our early 40s, our lenses gradually lose their flexibility and no longer change shape as our eye muscles contract causing presbyopia. Although there is no currently available treatment to restore the elasticity of our natural lens.

Refractive lens exchange surgery treats presbyopia by removing the rigid lens and replacing it with an advanced IOL to give us a clearer range of vision including distance, intermediate, and near vision.

Who is a Good Candidate for RLE Surgery?

So how do you know if you are a good candidate for RLE surgery? In general, people who are over the age of 40 and have developed significant presbyopia or difficulty reading, may want to be evaluated by an eye surgeon for RLE surgery.

In order to be a candidate for RLE surgery, you need to have a healthy eye, free of significant eye diseases. For example, people who have glaucoma, macular degeneration, significant diabetic eye disease, a history of retinal detachment, eye inflammation, or any significant disease of the cornea, are not good candidates for RLE surgery.

People who are extremely nearsighted or farsighted with an abnormal length of the eye are also typically not good candidates for RLE surgery.

For example, in people who are extremely nearsighted with a glasses prescription over minus 15 diopters, the length of the eyeball is extremely long and this increases the risk of developing retinal detachment including RLE surgery.

What to Expect before RLE Surgery?

Retinal detachment with any kind of intraocular surgery including RLE surgery. So what can you expect during your evaluation for RLE?

In order to determine if you are a candidate for RLE surgery, you will need to have a full eye exam by your eye surgeon and complete extensive testing and measurements of your eyes.

Typically a full RLE surgery evaluation will involve measuring the curvature and length of the eye, a full eye exam with pupil dilation, examining the health of the optic nerve and retina inside of the eye. Also, the strength of the glasses prescription for both distance and near vision is recorded during the exam.

After the examination and testing, if you are a candidate for RLE surgery, your eye surgeon and you will pick the best advanced intraocular lens implant for your eyes. There are two main types of advanced IOLs that are currently available in the US for presbyopia correction.
  • Multifocal IOL (MFIOL)
  • Extended depth of focus (EDOF) IOL
The choice of IOL for each candidate is made based on that individual's functional vision needs as well as any vision requirements for their profession and lifestyle.

What to expect on surgery day and vision recovery after surgery?

What should you expect on the day of RLE surgery and how do you care for your eyes after surgery?

RLE surgery is typically done for both eyes either separately or occasionally at the same. It is an outpatient procedure that takes about 15 minutes for each eye and you will go home the same day.

During the surgery, patients are typically not under general anesthesia. They will receive IV or local sedatives to stay conscious but in a very relaxed state. The surgery itself is painless and patients will be using different types of eye drops with a tapered schedule in the weeks of the following surgery.

Strenuous activities should be avoided during the first week after surgery. In general, your vision will be blurry on the day of surgery. With a successful RLE surgery, your vision should be much clearer the day after surgery and you should be able to resume most of your vision tasks the day after surgery such as:
  • Watching television
  • Driving
  • Reading or light reading
You may feel very mild irritation or foreign body sensation in your eyes and may have some light sensitivity for about a week after surgery.

The majority of vision recovery occurs during the first week after surgery. But it is not unusual for you to experience small fluctuations in your vision during the first month after surgery.

Although mild irritation and vision fluctuation are expected shortly after surgery, significant eye pain and sudden significant vision change are unusual and can be signs of potentially serious complications. If you experience those or any other concerning symptoms, you should contact your eye surgeon right away.

For RLE patients, their vision stabilizes about one month after surgery. However, a small percentage of patients may take a few months to fully recover their vision after RLE surgery. Usually, patients will be following up with their eye surgeon or eye doctor a few times during the postoperative period.

The surgical steps of RLE surgery are basically the same as cataract surgery, and it can be done with a conventional manual method or with assistance from a femtosecond laser.

What are the Risks of Refractive Lens Exchange (RLE) Surgery?

Please remember, there are risks with any surgery including RLE surgery. With RLE surgery there is a small chance of infection, bleeding, increased eye pressure, glares at night, and potentially other risks that you should discuss with your eye surgeon.

Most of the complications from RLE surgery are treatable with additional medications or procedures. Although it is rare, the risk of vision loss is not zero with RLE surgery or any intraocular surgery.

The goal of RLE surgery is to reduce the need for reading glasses and to help you eliminate reading glasses for most of your vision needs. Most RLE patients do not need reading glasses after surgery.

However, people who spend a lot of time doing prolonged close-up work. for example, threading needles or reading very small print up close for hours at a time may still want to wear reading glasses for those tasks in order to reduce eye strain.

Therefore it is important for you to have an individualized exam and consultation with your eye surgeon to determine if RLE surgery is the right treatment for you. 

Sunday, January 30, 2022

Are Floaters in Eyes Normal? - When they are Serious in Eyes

Hey guys! today we are going to be talking about floaters if you have had flutters before you know that they can be a little bit of a nuisance as they kind of float around your visual field. Sometimes they can be a sign of something more substantial like a retinal tear or a retinal detachment.

So we are going to talk about what floaters are? When they are normal and when do you need to worry about them? So I am Dr. Ruman from the website and today we will discuss floaters.

What are Eye Floaters?

Floaters are a super common symptom that probably most everybody will experience at some point in the course of their life. but what exactly are they? When you see floaters what do they look like?


Floaters are just a little kind of grayish or black strands or little floating almost kind of mosquito-looking objects that are floating in your visual field.

You have probably noticed that they are more commonly seen when you are looking at something that has not very much detail like a blue sky or a white. You know a piece of paper or white background on your computer and what those floaters actually are little condensations in the vitreous gel in the back of our eyes.


What is the Vitreous Gel?

So this is our handy eye model and this is a cross-section of the eyeball. So in the cross-section where the cornea exists, the front surface of the eye directly behind that is the iris the colored part of the eye the lens and then this entire space is a huge open cavity. That's occupied by this substance called the vitreous gel.

At what age does Vitreous Detachment Occur?

The vitreous gel is very formed when we are in our teens and 20s kind of early in life. It's really solid almost like jello and it barely moves at all. So that's why in those years we really don't see floaters because the vitreous is just very firm but as we start to age in our 30s and 40s and definitely 50s, 60s and beyond. All of those collagen bonds that make up the vitreous gel start to break down and the vitreous starts to liquefy you will get these little clumps that form in the vitreous little condensations.

That is going to be suspended you know intermittently throughout the vitreous and so what we actually see as floaters is a shadow cast on the retina. When the light comes through the eye hits, that little condensation and then casts a shadow on the retina.

We are not actually seeing the condensations ourselves because they are in the eye. They are too close to our retina for us to perceive them. we can see that shadow that's cast on the retina and that's why you notice them more when it's a white lighting setting.

Are Floaters in Eyes Normal?

If you are in a dark room, you know there is something else for your brain to look at. If you are looking at a complex image, you are not going to see those floaters as much as you will. If you are looking at that bright blue sky.  If you are having those kinds of occasional floaters that start in your 30s and 40s, they are usually not worrisome.

But occasionally as the vitreous gel starts to liquefy it will actually pull away from some of its attachments in the back of the eye. The vitreous is attached very firm to three different locations in the back of the eye. It's attached to the optic nerve which is right here and as the nerve comes into the back of the eye.

We can see that in the above cross-section a little circle, it's attached to the retinal blood vessels and it's attached to the very far periphery of the retina. Where the retinas kind of stretched out to their thinnest point and so as that vitreous is starting to pull away.

It can pull a little piece of tissue off the optic nerve and you actually see this little ring-shaped area of tissue we call a Weiss ring so this is called a posterior vitreous detachment. 

What is a posterior vitreous detachment?

A posterior vitreous detachment is a normal process of aging and it just means that vitreous gel is going to be pulling away from the back connections to the optic nerve and to the retina patients will typically say when they present with this.

You know I have had floaters for many years but all of a sudden I just had really a big floater and it was in the shape of a ring or some semblance of a ring. Because we can actually see that little piece of tissue that's been pulled off from the optic nerve.

What Causes a Posterior Vitreous Detachment?

So the reason that we make a big deal about this is that 10 to 15 percent of people who have a posterior detachment will have a retinal tear associated with that and the reason for that is as we are talking about earlier the retina is one of the things that the vitreous is very closely adherent to and so as the vitreous is pulling away from the retina.

If it pulls a little tear in the retina that can lead to a retinal detachment which of course you know we don't want to happen. So if that were to happen we could, of course, treat that but we want to get you in and get you seen as soon as possible.

If you are at risk for that the symptoms that people have if they are about to experience a retinal tear or they are experiencing a retina tear are that they will have these peripheral arc-like flashes of light and the flashes are typically split. Second a lot of times people wonder if they are even seeing if they feel like maybe a camera flash or you know something a reflection.

You know of off light or something was what they were seeing and they realized oh my God this is actually happening inside of my eye. The reason that we see that flash is that as the vitreous is tugging on the retina that traction on the retina is going to be perceived by us as a flash.

Most people will describe them out, in the temporal periphery but occasionally you can see them nasally as well. But they are almost always going to be in an arc shape split second and people describe them as kind of a white or silver flash.

The other thing that people frequently see with a retinal tear is a whole bunch of little tiny floaters. So I call them pepper dot floaters. Because people say it feels like somebody took a pepper shaker and just shook it in front of the eye and instead of a couple little you know big amoebas floating around.

When we have got hundreds of little tiny dots the reason that this is a symptom is that the retina is tearing. It will release the pigment from underneath the retina that pigment then scatters throughout the vitreous and we can see that. We will see all those little pepper dot floaters so our front desk knows that if somebody calls with flashes or pepper dot floaters.

Floaters are coming immediately but in general, we tell anybody who's having a new onset floater especially if it's large that they should come in because like I said you know 10 to 15 of people who have a posterior vitreous detachment are going to develop a tear.

So what will happen at your visit when you come in is we will get you in. we will get the eye dilated we are going to look all the way around the edges of that retina to make sure that there's not a tear.

If there is not a tear but I can see that somebody has developed a posterior vitreous detachment then I just give them those warnings that we were just talking about if you are having flashes of light.

If you are having pepper dot floaters come back and see me sooner and then I always follow up with them about two to three weeks after that initial visit. because this posterior vitreous pulling away from the retina is kind of a process in evolution.

So the highest risk for a tear is going to be in those first few weeks afterward we bring them back and check them all over again and make sure that the retina looks okay.

If there is a tear then the next step is to immediately get you to a retina specialist to treat that tear. So the tear itself can never be put back to place but what they can do is that the tear is way out here in the peripheral retina.


They will use a laser to spot weld around that tear so that the two layers the retina and the choroid kind of you know spot weld together. they shrink together so that no fluid is allowed to come up underneath that retina which causes a rental detachment. This procedure is an outpatient procedure.

The retina docks are wonderful. they do these all day long. It takes a couple of weeks for that laser to really settle in so they tell patients to kind of take it easy for about a week or two after the procedure but the wonderful thing about this treatment is that it does not affect the vision and people preserve you know it preserves their vision for folks which is excellent.

When Floaters are Serious in Eyes?

If there were actually a retinal detachment that's a little big procedure and we can certainly talk about that in a different article but we definitely want to make sure that anybody with flashes or pepper dot floaters comes in immediately okay.

So let's summarize floaters a lot of floaters are just a normal process of aging so if you have noticed that occasionally you see a little mosquito flying through your field of vision. that's okay and if that comes and goes we are really not worried about those.

What's not okay is that if all of a sudden you notice these peripheral flashes of light or you have a whole bunch of new floaters especially if they are hundreds of little black pepper dot floaters.

At what point should you Call the Doctor?

You know patients are always kind of confused or wondering like when should I call my ophthalmologist and I always tell them If you are worried you call. we only have two eyeballs and so we really want to make sure that if there is something that needs to be seen.

We get you to see up again if you have a posterior vitreous detachment. there is an 85 to 90 percent chance you are going to be fine and nothing is going to happen at all. But considering almost all of us are going to get a posterior vitreous detachment 10 to 15 percent of all comers and this is a pretty big number.

So we want to make sure that you are seeing so never feel bad about calling our front desk and just front desks in general can kind of help evaluate that and give you some guidance but in general, we only have two eyes so if you are worried about them please come into us. So guys on floaters I hope you found this article helpful.

Tuesday, January 25, 2022

How to Get Rid of Blepharitis? - Treatment and Home Remedies

Here in this piece of article, we are going to discuss one of the most common questions that I have been getting during my clinic time which is what do I do with my red and crusty eyelids and what can I do from home? So I don't have to go to the eye doctor.

So today we are going to briefly explain the topic regarding blepharitis which is the usual culprit and some really easy steps that you can do from home to get the eyes feeling a whole lot better. So let's talk about blepharitis. What is blepharitis?


Blepharitis is a very common eyelid condition that I see all the time caused by an overgrowth of the bacteria that live naturally on the skin. You know we all have bacteria living constantly on the skin and most of the time they are just living harmoniously.

They are not causing any trouble but occasionally they will get overpopulated and when that happens in the face that can give you acne and when that happens around the eyelids and eyelashes that's what we call blepharitis.

Common Symptoms of Blepharitis

So the most common symptoms of blepharitis are
  • Redness
  • Burning
  • Stinging the Sensation ( that something's always in the eye ) which we appropriately call foreign body sensation.
Then when you wake up in the morning you have got that little discharge in the corner of the eyes. All of these things are associated with blepharitis so two main things we see in eyelid anatomy with blepharitis.

So first normal healthy eyelids we have got lashes that are nice, clean, and directly behind those eyelashes. Most of us in each or lives. We have about 10 to 15 oil glands and the job of those oil glands is to secrete that oil onto the surface of the cornea.

So it keeps our tears film nice and stable, keeps the eye feeling comfortable, keeps the vision nice and sharp. When those oil glands get plugged as they often do in blepharitis. They cause a series of kind of a cascade of effects so this is what it looks like.

When they get plugged so instead of that nice clean margin you have got all of these little plugged oil glands. The skin around the oil glands gets kind of congested and angry and swollen. That's what causes that soreness and then without that oil freely flowing onto the surface of the cornea.

Our tears evaporate too quickly and evaporative dry eye starts to take effect and that's what gives you a lot of the stinging and burning.

So how do we treat Blepharitis?

1. Warm Compresses

If you imagine all of these oil glands are like a bunch of teeny tiny sticks of butter. We need to melt that butter and the easiest way to do that is with heat so a real, simple thing you can do without having to buy a thing is to take a wash cloth that you already have at home.

put it under the hot water wring it out and put it over the eyes for a few minutes and that works ok. The problem is as you would imagine after just a few seconds usually that washcloth is anticipating that heat you can't get the heat to stay for very long and so for that reason a lot of companies have come up with some great little microwavable masks.


You just throw this mask in the microwave for 10 to 15 seconds and make sure it's not too hot so you don't burn yourself. Then just put that over the surface of the closed eyes and hold it there for about 5 to 10 minutes. That's gonna melt all of the oil that butter and allow that oil to freely flow over the surface of the eye.

It feels really nice. So it's a nice easy trick to do at home so that's going to take care of what we call "posterior blepharitis" with just all of those plugged oil glands. But what about all these crusty guys on the front this is called anterior blepharitis and these little crusts are called color X and that's what gives you that sensation that's something in the eye.

2. Use Lid Scrubs

You are always just kind of itching and wanting to mess with the lids so to get rid of this we use a dental analogy. So of course all of us you know would never argue with our dentist that it's appropriate to brush your teeth morning and evening at the very least to make sure that the buildup of plaque and tartar is removed mechanically.

Every single day and similarly when this kind of buildup builds up around the lids and lashes. We can also kind of do some lid brushes lid scrubs. This is again one of many different kinds of lid scrubs.


How to use Lid Scrub?

The gist is it's a small little towelette that has soap that's safe to use around the eyes. It's really simple to use you just open the scrub. here's the little towelette. It's got a little bit of texture to it which is nice to really pull off all of this crust.

I like to kind of wrap it around my index finger and then with your eye closed. You are gonna start all the way up at your brow and go back and forth until you kind of feel that bony portion of your orbit so from the top all the way to the bottom of the eye. Then you will just flip it around and do the exact same thing on the other eye and then throw it away.

These are meant to be done just at the same time since you brush your teeth so morning and evening. what I typically recommend folks do this and if you can get into that habit of doing both lids scrubs and the warm compresses usually that takes care of blepharitis for most people in general.

I try to encourage patients to gain think about doing lid scrubs at the same time that they are brushing their teeth. So morning and evening you should be doing the lid scrubs the warm compresses which are best done at night time.

I recommend doing the warm compresses first for 5 to 10 minutes getting all that oil coming out and then finishing cleaning the lids with the lid scrub right before you go to bed. The reason I like to do the warm compresses at night time is that as that oil starts to open the glands, open the oil flows onto the front of the eye.

That can blur you a little bit so if you try to do that first thing in the morning. You might be a little frustrated with me but if you do that right before you are going to bed this will resolve your symptoms.

Sometimes blepharitis can be you know especially stubborn and patients will say you know I'm doing all of these things regularly and it's still not helping and that's when we need to call in you know some of the bigger treatments including medications either topical or oral antibiotics. Sometimes a little mild steroid drop or ointment.

There are several Clinical procedures that we have available for blepharitis as well if needed. Those can certainly be the topic for some other articles to come but for now, I just wanted to give you guys two simple home remedies for blepharitis and hopefully, that will have everyone feeling better really soon. My next post will be about eye floaters.

Friday, January 21, 2022

How to Get Rid of a Stye? Home Remedies and Treatments

Hey guys, today we will talk about red painful styes and their several treatments which will provide you better feelings in no time. So today we are gonna be talking about probably one of the most common phone calls we get in our clinic every day and that is I have a stye what can I do about it?


So we discuss today in this post specifically about the styes and what they look like? what are the symptoms? But more importantly, in-clinic treatments that we use to take care of them.

What causes styes in your eye?

I think almost everybody knows what they are. It is a red painful bump that you wake up with and you are just too embarrassed that you have to go to work with this giant bump on the eye.

Stye becomes due to the plugging of the oil glands and just as a little reminder this is a little healthy eyelid and we have about 10 to 15 oil glands that sit behind the eyelashes. When those get plugged up and blepharitis they look like this and all of these little oil glands are plugged and then bacteria can kind of find a nice warm spot that it likes and it forms a stye.

The stye can form either on the inside of the eye where you have to pull your lid down to see it or you have probably. If sometimes you see folks with that big red kind of looks like a pimple on the outside that's an external stye. It's basically the same thing it just depends on whether it opens on the inside or the outside of the eyelid.

Treatment and Home Remedies

1. Warm Compress and Massage

If you are at home and you know no access to a doctor then the first thing and most important thing to do is to use heat remembering that those oil glands are kind of like a bunch of little sticks of melted butter.


You want to open those oil glands and get everything to flow freely so these are microwavable warm compresses that you can buy over-the-counter or online. You throw them in the microwave for about 5 to 10 seconds get them nice and warm but not too hot that you can burn yourself and then you just place them over the eyes and hold them for about 5 to 10 minutes.

If you have an actual stye and what I usually instruct my patients to do is after. You can kind of massage over the area where you have this stye after the heat on there for a while through the warm compress.

You want to try to break up all of that inflammation and pus and allow that freely flows from the eyelid and it's coming out that's a really good sign okay.

2. Topical ointment or Eye drops

So if you have tried that already and you have been warm compressing till you can warm compress no more and the stye is still there then a lot of times we have to use topical medications most of the time you don't need oral antibiotics for this.

I see that prescribed a lot but it is usually not necessary to look favorite combinations usually include an antibiotic and steroid and that can come either a drop or an ointment that you apply topically three or four times a day about a week or two.

3. Steroid Injections

Most of the time that's going to clear everything up but occasionally the stye will come back in a couple or three weeks and if that's the case then one of the next lines of treatment what's called the intralesional Kenalog and this is just a tiny little bit of steroid that we inject directly into the sty that since there is like a little depot.

It will sit around in the lid for three or four weeks and it works as anti-inflammatory magic and a lot of times this stye goes away.

4. Incision and Drainage

If we have done the catalog and the stye persists then the last resort is to do something called an incision and drainage. We try to avoid this if we can this is not the most fun procedure for patients but it is the definitive treatment to get rid of the long-standing stye and secondly we will gonna take you back to our minor and go through some of the instrumentation so what I use to do this procedure, let's talk a little bit more about it okay.

A surgical cut is made with a 30g needle Which is literally the smallest needle that you can get. This procedure is known as an incision. We are easy on the eyelids because it's such thin skin and once I draw that up usually less than you know point 1cc is really tiny. I am gonna that directly into the stye most of the time.

We will do that injection on the external part of the lid just so that it's not as uncomfortable on the internal part and it will get all the way through and then patients I always warn them that there will be a tiny little white area where that steroid injection was deposited that will slowly absorb over the next three to four weeks.

Typically I will do a follow-up with them. you know a month or so later and see if it's all resolved most of the time it is if it's not resolved then the next step is something called an incision and drainage and so for that what we are going to do is actually take the lid and revert.

It so that I actually have access to this little area through a small clamp that I will use to finish the inflammation with the sty. It's actually going to go over the surface of the lid it will allow me to tighten it and then invert the lid and then I will have a little view of the inside of the lid.

Where I can remove the stye so this is all of course after the eye is numbed up with some alighted cane try to get the patient as comfortable as possible with the clamp on evert the lid and then use a blade to sort of pen the area and then we can kind of just gently dissect out to the stye as you know all of the little usually.

There is a lot of scar tissue associated with it at this point. If it's been there for several weeks to several months sometimes you will get to know a good gush of fluid and you sort of know it's gonna resolve quickly other times.

It's been there for a while and you have to really dissect out some of that scar tissue once you clean up the lid get some hemostasis to get the bleeding to kind of settle down when we just put the lid right back kind of hold pressure for a little while and I will usually put a pressure patch over the eye for about three or four hours as the patient goes home.

Just so it kind of keeps everything nice and stable and then they use the same point means that they were typically before which is a combination antibiotic steroid for about a week or so by that time. the patients come back for their follow-up, the inside of the lid has already healed because it heals so quickly and fast.

So there are just some of the little treatments that we use for styes and hopefully, you won't ever have to have that done but if you do you know what you are gonna be looking at okay. Thank you so much for reading this article about styes hopefully you found it helpful so please share this post as much as you can.