Best Treatment for Baby Pink Eye - Conjunctivitis

In this post, I am sharing details about conjunctivitis or pink eye in babies. Conjunctivitis is very common in July or august especially and typically it spreads very easily in this season. I hope a lot of parents might be looking for this information to treat their baby's eyes.

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So firstly I have to tell you that conjunctivitis is very common it's not something about that you have a panic about it's not something that you have to get extremely worried about it. If you take the right treatment at the right time then you don't have to be worried at all. So I start to tell you about the symptoms of conjunctivitis.

4 Common Symptoms of the Conjunctivitis

So the typical symptoms of pink eyes that you will see:

1. Red or Pink Eye

So the white area in the eye or the lower eyelid will turn pink or reddish. It may start with one eye or it may start with both the eyes together. The symptoms will vary from one child to another or one person to another. It is very common in elders also but in children, it spreads easily.

2. Rubbing Eyes

You will see your child is rubbing his eyes or touching his eyes. The extremely rubbing or touching on the eye's skin creates harmful bacteria that become a cause of itchiness in the eyes of a baby.

3. Watery Eyes

In normal activities, if your child is not watching tv or is not expose to light or anything normally playing but the eyes are getting watery again and again it can cause pink eyes in the child.

4. Green or Yellow Discharge

Green or yellow discharge that leads to sticky eyes. Some of the children while sleeping and when they woke up, could not open their eyes due to the eyes discharge and often the result of a blocked tear duct. These are the four symptoms that you will see for conjunctivitis.

But one disclaimer that I would like to give here is especially in babies less than 6 months that is another condition of the eye that you have to be very careful is blocked tear duct. So never confuse a blocked tear duct with conjunctivitis because the treatment of both is separate. So these were the symptoms now talk about the causes of pink eyes.

Top 3 Causes of Conjunctivitis

There are three main causes of conjunctivitis or pink eyes and the first one is;

 1. Viral Conjunctivitis

Viral conjunctivitis is a condition in which a highly acute conjunctival infection is usually caused by any virus. Normally viral conjunctivitis belongs to a company with a cold or after a cold in babies.

2. Bacterial Conjunctivitis

It is an infection of the eye's mucous membrane caused by bacteria, the conjunctiva that extends from the back surface of the eyelids into the fornices and onto the globe until it fuses with the cornea at the limbus.

3. Allergan Conjunctivitis

Typically it occurs due to pollution, dust or smoke, or any irritants like chlorine in the water when you put your baby in that water his eyes can get an Allergan conjunctivitis. So this virus of bacteria can spread only through by touch or rub not by just looking into the eye.

Treatment for Pink Eyes in Children

1. Consult Your Doctor

When a baby has pink eyes the first thing is you should call your eye doctor because I strongly believe that no matter how many home remedies you are aware of, I think when it comes to a kid it is so sensitive matter that a doctor can solve effectively.

2. Recommended Medication

The medication recommended for kids usually is two eye drops, the one drop is an irritant eye drop that removes irritation and keeps your eyes cool with the antibiotic eye drop that removes the harmful bacteria from the eyes. 

3. Clean eyes with Saline

Take some sterile cotton and dip it into the saline then gently clean the baby's eyes with it. It helps to protect the eyes from bacteria.

4. Give Warm Compress

Take a baby's towel and put it into the light warm water then give warm compress to the eyes of a baby. It will minimize itching and stickiness on the eyes' skin.

Contact Lenses vs LASIK Eye Surgery - Which one is safer?

In today's post, I would like to answer a question I often get from my patients. Is it safer to wear contact lenses or have LASIK surgery to correct vision?

A lot of people who wear contact lenses have considered getting LASIK surgery to correct their vision. If you wear contact lenses, you are probably one of them. But we often assume that having eye surgery is riskier than wearing contact lenses every day. Is this true or is this a myth? I will answer this question in today's article.

Contact Lenses vs LASIK Eye Surgery

There are a lot of people who wear contact lenses on a daily basis for vision correction. The CDC has estimated about 45 million people in the U.S wear contact lenses. Although a lot of people wear contact lenses on a daily basis, many of them are unaware that wearing contact lenses is associated with risks of vision loss from certain complications. One of the common risks associated with contact lens wearing is infectious keratitis or a corneal ulcer.

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A cornea ulcer is an infection of the cornea, the clear windshield of the eye. According to the CDC and previously published studies, eye infection can affect up to
1/500 wearers per year. Do you recall the first time when your eye doctor gave you your contact lens prescription?

They also went over with you how to probably clean and wear contact lenses? I hope that you remember those instructions and have been following those instructions while you are wearing contact lenses. Because not following those instructions increase the risk of getting an eye infection from wearing contact lenses.

A study published in 2017 reported 99% of contact lenses wearers responding to the study reported at least one behaviour that was associated with an increase of eye infection. Some examples of poor contact lenses hygiene behaviours are improper cleaning of the contact lenses. wearing the same pair of contact lenses beyond the recommended disposal time, topping off contact lens cleaning solution, etc.

And the biggest risk factor associated with getting an eye infection is wearing contact lenses overnight. Wearing contact lenses overnight can increase the risk of getting an eye infection by 3 to 5 times regardless of the type of contact lenses worn according to previously published studies. Studies have shown that bacteria tend to form a layer of filbiom on the backside of the contact lens, and the backside of the contact lens is in direct contact with the epithelial layer of the cornea. Which is the outermost part of the cornea. Therefore the longer the contact lens stays on the surface of the eye, the bacteria have more opportunity to cause infection.

Also, contact lenses can interfere with the tear fluid exchange that happens naturally on the surface of the cornea. The normal tear fluid not only washes away bacteria and other pathogens but also contains several antimicrobial peptides. Therefore the extended wear of contact lenses and overnight wearing of contact lenses both provide more time for the pathogens to cause infection on the eye and also lowers the natural ability of the cornea to fight against infection. 

Typically the incidence of eye infection associated with contact lens wearing is reported as an annual incidence. And the longer you wear contact lenses, the cumulative risk of getting eye infections also increases. Studies have estimated for someone who wears contact lenses daily for 30 years, the lifetime risk of eye infection becomes one in 100. About 5% of eye infections related to contact lens wearing can result in vision loss to 20/70 or worse.

To put that in context, in California the DMV vision screening requirement for driver's license required one eye's vision to be better than 20/40, while the other eye's vision is better than 20/70. 20/70 vision means that when reading an eye chart or Snellen chart or a letter that a normal person can read from 70 feet away. A person with 20/70 vision can only read the letter from 20 feet away. so 20/70 vision is less than a 1/3 as sharp as 20/20 vision.

The higher the denominator of recorded vision, the worse the vision is. Extended wear contact lenses are available for overnight or continuous wear up to 3o days. Are recognized by the FDA as a Class III medical device. Class III medical devices typically have increased risks of illness or injury. some examples of class III medical devices include implantable pacemakers, breast implants, and extended wear contact lenses.

As a cornea specialist, I have treated many corneal infections related to contact lenses. Typically, the sooner the infection is diagnosed and treatment is initiated, the less long-term vision loss occurs. Unfortunately, I have seen many cases where people continue to wear contact lenses and do not seek care from an eye specialist despite having eye irritation or vision symptoms until the infection is very serious. I have performed many corneal transplant surgeries in cases where the infection is too severe to be controlled with antibiotics.

And I also perform many corneal transplants for severe corneal scars left behind by infection. So if you only remember one thing from this post, it is this:
Do not sleep in your contact lenses or wear contact lenses overnight. There are other complications related to contact lens wearing that is less common than an eye infection such as corneal inflammation, cornea swelling, or abnormal blood vessel growth in the cornea due to damage to the corneal stem cells. That's why it is important to have regular eye exams with your eye doctor to monitor your eye health if you wear contact lenses regularly.

That being said, one of the alternatives to contact lenses for vision correctness is laser vision correction surgery. LASIK surgery is the most commonly performed laser vision correction surgery worldwide. About 10 million people in the US have already received LASIK surgery since its FDA approval in 1999. and it is estimated around 1 million new laser vision correction procedures are performed each year in the U.S.

One study reported that out of 32,068 laser vision correction surgeries performed in the US military between the years 2000 and 2003. Those soldiers who had 20/20 or better vision without glasses or contact lenses were 85.6% with 92.4% having vision better than 20/25 and 98.2% better than 20/40.

And two large studies called PROWL1 and 2 which stand for patient-reported outcomes with LASIK 1 and 2, were carried out by the FDA in collaboration with the national eye institute reported less than 1% of patients who receive LASIK surgery experience difficulty performing their usual activities following LASIK surgery and more than 95% of people were satisfied with their vision after Lasik surgery.

This is not to say LASIK and other laser vision correction surgeries do not have any risks. The study that I mentioned reported an incidence of decreased vision of 1 in 1250 soldiers after laser vision correction surgery. In my experience, the vast majority of such cases experience the decreased vision of one line on the vision chart. For example, 2o/20 to 20/25.

Another large study reported an infection rate of 1 in 800 cases with moderate vision loss resulting from infection in one in 3200 cases. Most infections after LASIK surgery occur from few days to a week or more after the surgery. During this post-operative period, patients are monitored closely by their eye doctors. So it is likely that any sign of infection will be diagnosed and treated right away.

In addition to the risk of eye infection, Lasik surgery can cause corneal ectasia, nighttime glare, dry eye disease and there can be complications with the flap. Although it is difficult to have a direct study comparing individuals who have had LASIK surgery with individuals who wear contact lenses daily for decades, the published data from large and peer-reviewed studies strongly suggest that cumulative risk of eye infection and vision loss with decades of daily contact lens wearing is much higher than the risk associated with having LASIK surgery.

Of course, if someone only wears contact lenses for six months or a year, the risk of getting an eye infection from wearing contact lenses is low, probably lower than getting LASIK surgery. But most people who wear contact lenses wear them for years and decades. In addition to LASIK surgery, there are other vision correction surgeries that might be right for you such as ICL surgery. To learn more about ICL surgery you can check out my post on ICL surgery versus LASIK surgery (point).

To find out which vision correction method is best for you, whether it is LASIK surgery, contact lenses, or glasses. It is important to consult with your eye doctor or eye surgeon. As I mentioned earlier, If you do wear contact lenses regularly, it is important to follow the proper care instructions given by the eye doctor and get regular eye exams to monitor the health of your eyes. 

If you have a dry eye disease and wear contact lenses, or have had LASIK surgery. I have also suggested some of the eye drops that I recommend for dry eyes. 

Laser Cataract Surgery vs Conventional Cataract Surgery

Today I would like to answer a question that I often get from my patients before their cataract surgery. What is the Difference between laser-assisted cataract surgery versus conventional cataract surgery? and we will also discuss how does femtosecond laser work and how does it assist in each surgical step during cataract surgery. Now you and your family members may have been diagnosed with cataracts and recommended to have cataract surgery and the surgeon offered you options of having either laser-assisted cataract surgery or conventional cataract surgery which one should you choose? To answer that question first let's talk about How Does Fentanyl Second Laser Work?

Difference Between Laser Cataract Surgery and Conventional Cataract Surgery

During laser system cataract surgery the type of laser we use is called a femtosecond laser. It is called a femtosecond laser it's because each laser pulse only lasts a few hundred femtoseconds. each femtosecond equals 10 to the minus 15th of a second, the femtosecond laser can fire thousands of laser pulses each second to separate the tissue smoothly and continuously to create incisions, and both the location and the pattern of incisions are programmed by the surgeon using an image-guided laser system and it is highly customizable my patients often also ask me dr. Ruman if I choose to have laser system cataract surgery is it painful? Can I feel the laser pulses?

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fortunately, the answer is no. The phantom second laser portion of the cataract surgery only lasts just a few minutes and during this portion of the surgery. The eye is anesthetized with eye drops so you won't be able to feel the laser pulses but you may be able to see different colors of lights. It's almost like a light show that being said let's talk about how femtosecond laser assists each surgical step. Cataract surgery has four major surgical steps;
  1. Corneal incision
  2. Capsulorhexis
  3. Cataract Fragmentation and Removal
  4. Intraocular lens insertion

1. Corneal Incision

The corneal incision is the first surgical step when the surgeon gains access into the eye through incisions on the cornea. During conventional cataract surgery, the surgeon uses a very small blade usually between two to three millimeters in width to create incisions during laser is the cataract surgery. The incisions size is programmed by the surgeon using an image-guided laser system and then the femtosecond laser creates the incisions in just a few seconds. Not only the location and the size of the corneal incision are highly customizable. The femtosecond laser can also create arc-shaped incisions on the cornea to treat astigmatism and to improve uncorrected vision after surgery.

2. Capsulorhexis

the next surgical step is capsulorhexis and it is the most crucial surgical step during cataract surgery. The capsule is a very thin tissue with an average thickness of seven microns and it wraps around the cataract. Capsulorhexis is the step where the circular opening is made on the capsule and the surgeon has to gain access to the cataract through the circular opening of capsulorhexis. Both the shape as well as the position of capsulorhexis can affect where the intraocular lens sits in the eye and can affect vision after cataract surgery.

Therefore it is very important to create capsulorhexis that's perfectly centered and as circular as possible during conventional cataract surgery. The surgeon creates the capsulorhexis with a very fine instrument manually during laser-assisted cataract surgery. The position and the size of capsulorhexis are programmed by the surgeon using an image-guided laser system and the femtosecond laser creates the capsulorhexis in a second that you can see as a surgeon.

I can see both the position and the size capsulorhexis where exactly I want it to be in my experience. I found that the saturation of the intraocular lens is often improved with femtosecond laser capsulorhexis.

3. Cataract Fragmentation and Removal

The next surgical step is cataract fragmentation and removal. This is the step the cataract is fragmented and removed from the eye. During conventional cataract surgery, the surgeons use a very small instrument called a chopper to disassemble the cataract and remove the cataract from the eye by using phacoemulsification. phacoemulsification means using ultrasound energy to break down the cataract and remove it from the eye.

Durin laser system cataract surgery the cataract is fragmented into different sizes and shapes of smaller fragments by laser designed by the surgeon based on the surgeon's preferences. During this step, it is very important to minimize the amount of time, as well as ultrasound energy used during phaco as increased vehicle time and ultrasound energy used during cataract surgery, are related to increased tissue damage that occurs during surgery.

More tissue damage occurred during surgery can result in increased recovery time after surgery for vision.

4. Intraocular Lens Insertion

The next surgical step is the intraocular lens insertion. During this step both conventional cataract surgery as well as laser-assisted cataract surgery, the surgeon inserts the intraocular lens into the capsular bag through the capsular opening made during capsular rexes. Both the position as well as the centration of the intraocular lens can affect vision after cataract surgery.

If the intraocular lens sits just half a millimeter too forward or backward in the capsular bag. It can result in big differences in glass prescription after cataract surgery. As I mentioned before both the position and the shape of the capsulorhexis can affect the position of the intraocular lens. Now we have discussed the differences between laser-assisted cataract surgery versus conventional cataract surgery and how femtosecond laser assists each surgical step.

I hope this article helps you to understand those differences and you are more prepared when having a conversation with your eye surgeon about your surgical plan. As always please remember cataract surgery has risks just like other types of surgery. Please discuss with your eye surgeon about any specific questions that you may have about your vision and your eye surgery.

ICL vs LASIK Surgery - Which one is Right for you?

In today's article, I would like to talk to you about the lesser-known type of refractive surgery icl surgery to help you have a better understanding of your options when considering refractive surgery. You probably have already heard about Lasik surgery for correcting nearsightedness and astigmatism to eliminate glasses and contact lenses however not many of us have heard about icl surgery as a refractive surgery option. What is icl surgery? how does it work? Are there risks with icl surgery? we are going to cover all of those questions in today's post.

Icl stands for implantable Collamer lens also called implantable contact lens. An icl lens is made out of a bio-compatible Collamer material that sits inside of the eye without altering the shape or the anatomy of the eye. ICL surgery is a surgical procedure to implant an icl lens inside of the eye to correct both nearsightedness as well as astigmatism. In the U.S the type of icl lens available is called the visian icl lens. The visian icl lens received FDA approval in 2005 and the stigmas and correction version of visiting icl lens was approved by FDA in 2018.

By 2019 over a million visian icl lenses have been implanted all across the world. So there is sufficient data to prove both the safety and efficacy of icl surgery. icl surgery is done similarly to Lasik surgery as an outpatient procedure and it typically takes about 15 to 20 minutes for the surgical portion of the procedure. Before the icl procedure, your surgeon may perform a laser procedure to place two small openings in the iris prior to the icl surgery and after the procedure, you go home the same day and do not need to stay overnight in the surgery centre in the U.S. Most icl surgeons perform bilateral surgery on the same day during the surgery you typically receive conscious sedation through oral sedatives or iv sedation.

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The icl surgery itself is painless and after surgery, you typically will be on different kinds of eye drops for a couple of weeks to a month depending on your personal needs and surgeons preferences vision improvement after icl surgery is fairly quick. You will notice improvement of your vision without glasses shortly after the icl surgery procedure and you can potentially have a small amount of vision fluctuation in the following days or weeks. It rarely takes more than a month for full vision recovery.

You are probably thinking is both Lasik surgery and icl surgery are vision correction surgery options to correct near sickness and astigmatism. How do you choose one versus the other and which one is the right procedure for you? Let's go over the differences between those two LASIK and icl surgery procedures.

Difference Between LASIK Surgery and ICL Surgery

Both Lasik and icl surgeries were being performed starting in the early 1990s in the U.S. Lasik surgery is the cornea base laser vision correction surgery. The procedure is performed on the surface of the eye on the structure called the cornea. Which is a clear dome-shaped structure that functions as a windshield of our eye.

I performed all laser Lasik surgery for my patients during the procedure two types of lasers are used first The femtosecond laser creates a thin corneal flap and the flap I lifted then the excimer laser ablates cornea tissue to alter the shape of the cornea in order to correct our vision by correcting our glasses prescription. After the excimer laser ablation, the cornea flap is placed back down the amount of tissue ablation and the shape change of a cornea is proportional to the strength of the glasses prescription therefore the higher our glasses prescription the more tissue of the cornea will be ablated altering the shape of our cornea more.

icl surgery is an intraocular surgery that does not affect the cornea. icl surgery corrects vision by implanting an icl lens inside of the eye. The implant sits behind the iris which is the color part of our eye and in front of our natural lens because the icl procedure does not alter the cornea. It is a great option for people who are not laser candidates due to different corneal conditions.

As I mentioned before the amount of tissue ablation during Lasik surgery is proportional to the glasses prescription. Therefore people who have moderate to high nearsightedness may have a cornea that's too thin to qualify for Lasik surgery or other types of cornea-based laser vision correction also for patients or people who have significant dry disease prior to refractive surgery. They can also be a good candidate for icl surgery instead of LASIK because icl surgery does not involve any corneal tissue ablation that will change the corneal shape. 

It does not affect the natural sensitivity of the cornea. The dry disease is less of a concern when choosing icl surgery lastly for people with moderate to high nearsightedness large amount of corner tissue removal during LASIK surgery can potentially affect the quality of vision after surgery due to a large amount of corneal shape change.

icl surgery does not involve any shape change or tissue removal at the time of surgery and many studies have shown the quality of vision and night vision are better for people with moderate to high nearsightedness with icl surgery compared to corneal based refractive surgery.

The other difference between Lasik surgery and icl surgery is that Lasik surgery is a permanent procedure that alters the shape of the cornea and can be enhanced with additional procedures if needed while icl surgery is reversible as icl lens is removable if desired at a later time. Now we have learned how icl surgery differs from Lasik surgery.

It is important to remember that icl surgery is not for everyone because it is an intraocular procedure which means we enter into the eye at the time of the surgery and more precautions need to be taken to reduce risks of infection during surgery. Also, there are more tests and steps needed prior to icl procedure to avoid any short-term pressure spike of the eye after icl surgery because the icl lens is placed in the eye during icl surgery.

There are strict screening criteria for anatomical features of the eye to ensure, there is sufficient in the front part of the eye called anterior chamber to allow safe icl implantation. Therefore people who have very crowded structures at the front part of their eyes, as well as people who have anatomical features that increase the risk of developing glaucoma by obstructing the fluid flow inside of the eye, are not good candidates for icl surgery.

Therefore the choice of which type of refractive surgery is right for you really depends on your glasses prescription and the anatomy of your eye as well as your occupation and lifestyle. It is important to remember icl surgery just like any other eye surgery It has specific risks. So it is very important for you to discuss with your eye surgeon about your case and come up with a surgical plan together to choose the type of refractive surgery that is right for you.

Are Eye Drops Enough? - Best Treatment Options for Dry Eyes

Do you feel your eyes are often red, scratchy, and tired from time to time? You may even notice your vision gets blurry sometimes. If so most likely you are suffering from dry eye disease. We are often told to use over-the-counter artificial tears eye drops to treat dry eye disease. But are those eye drops enough for you? What are the additional dry eye treatment options when the over-the-counter drops are just not enough?

In today's article, We will go over the dry eye treatment options that target different causes of dry eye disease. The treatment options that I mention in this post are based on my own personal clinical experience. If your eyes are controlled with otc eye drops alone, I have written an article about my top five eye drops to help you to find the right one for you to treat dry eyes disease. Click here

Best Treatment Options for Dry Eyes

To understand which dry eye treatment options are right for you, It is important to understand what types of dry eye disease you have. There are three main types of dry eye diseases
  1. Evaporative type
  2. Aqueous Deficient type
  3. Mixed type
There are three different layers of the tear film;
  1. Lipid layer
  2. Aqueous layer
  3. Mucin layer
And each of the three types of dry eye disease is caused by a problem with one of the three different tear film layers.

1. Evaporative Dry Eye Treatments

The evaporative type of dry eye is mainly due to problems with the lipid layer of the tear film, which is the most outer layer. Often the tear film is unstable and evaporates too quickly when the lipid layer is unhealthy. With evaporative type, the eyes feel dry and irritated shortly after applying over-the-counter eye drops and you may feel that you need to put in eye drops over and over again.

The lipid layer of the tear film is secreted by the meibomian glands located in both upper and lower eyelids. If the meibomian glands are clogged or not working or the gland oil contains too many inflammatory particles. The aqueous layer of the tear film underneath, secreted by the tear glands will not remain on the cornea for long enough to lubricate and moisturize the eyes.

One effective treatment you can do at home to open up the oil glands is warm compresses. You can either just use a washcloth soak under hot water and ring it out and place it over closed eyelids for about five minutes once or twice a day, or you can use a heat mask. You can microwave most heat masks for 20 seconds and they will stay hot for 20 minutes. The heat will help open up the clogged oil glands.

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For more severe blockage of the meibomian gland, you may ask your eye specialist about some in-office treatment options, such as ilux or lipid flow. They work like a more intense warm compress and are administered in the doctor's office to aggressively target clogged oil glands. The evaporative dry eyes can also be caused by unhealthy gland oil secreted by the meibomian gland. This is typically due to increased inflammatory particles in the tear film.

In this case, it is important to modulate and restore the health of the meibomian glands and their oil. This is where omega-3 supplements can come into play. Because omega-3 supplements are not a prescription medication and are not regulated by the FDA. Their dosage and composition may vary greatly. Please remember to always consult with your doctor before taking any high-dose omega-3 supplements to make sure if they are safe and right for you.

2. Aqueous Deficient Dry Eyes Treatment

The second type of dry eyes disease is the aqueous deficient type. This type of dry eye affects the aqueous layer of the tear film, which is made by the tear gland. When the tear gland does not produce enough tears, the surface of the eye or the cornea, which is the clear dome-shaped structure that functions as the windshield of our eyes, does not get adequately lubricated and moisturized.

This type of dry eye disease needs to be treated with artificial tears eye drops. A lot of times inflammation of the tear gland and the surface of the eye causes decreased tear production and low tear turnover. your eye doctor may prescribe a mild steroid eye drop for a short period of time to decrease the inflammation on the surface of the eye and to improve tear production.

Prescription eye drops containing steroids can have side effects I used long-term such as cataract formation and increased eye pressure. This is why steroid prescription eye drops are typically only used for a short period of time. There are three FDA-approved prescription eye drops that do not contain steroids. These drops have good efficacy and safety profile and can be used long-term to treat dry eye disease. The three eyedrops each work differently and it is important to discuss with your eye doctor.

Sometimes your eye doctor may consider placing plugs in your tear ducts to keep the tears in your eyes longer. For people who suffer from a severe aqueous deficient dry disease such as Sjogren's disease, even the treatment options I just mentioned may not be enough. In those cases, a special type of eye drop purified from the patient's owns blood can be used to treat the disease and control the symptoms. They are called autologous serum eye drops. Your eye physician or cornea specialist can help you determine if your disease is severe enough to need serum drops.

3. Mixed type Dry Eyes Treatment

The last type of dry eye disease is the mixed type of dry eyes, and this is probably the most common type of dry eye disease. For a lot of people with dry eyes, both the lipid layer and the aqueous layer of the tear films are unhealthy. People with a mixed type may need a combination of the dry treatments that I mentioned earlier such as warm compresses and omega-3 oil supplements to improve the oil gland function.

Otc artificial tears eye drops and prescription medications to control dry eye symptoms. It is important to remember there is no one size fits all treatment protocol for everyone. In my clinical practice, I make an individualized treatment protocol for each patient, based on their individual situation and I tailor their treatment plan based on their response to each treatment option.

In this blog post, I have mentioned some of the common dry eye treatment options. There are also other, more invasive, and advanced treatment options that are typically reserved for extremely severe cases. Dry disease is more common than we often think and it is estimated that more than 16 million people in the US suffer from dry eye disease.

If you feel your eyes are still irritated or sometimes have blurry vision, despite using over-the-counter eye drops. It is important to have a full eye exam and talk to your eye doctor about what treatment options are right for you.

Top 5 Over The Counter Eye Drops for Dry Eyes

In today's article, I would like to talk to you about the top 5 choices of the otc dry eye drops. These are the best artificial tears eye drops to treat dry eyes disease. I recommended these drops on the basis of my clinical experience treating dry eyes disease in my practice and the in-depth research I did about the science behind the ingredients of different artificial tears. If eye drops are not enough, other best treatment options are available to treat dry eyes.

As a LASIK surgeon and cornea specialist, I often get patients with varying severity of dry eyes disease referred to me by other eye doctors. For each of my patients with dry eyes disease, I give them a written customized treatment plan. All of the treatment plans include one or more over-the-counter artificial tears and I specify which type of artificial tears that I recommend. However, if you are going to a pharmacy to choose artificial tears on your own, the choices may be overwhelming.

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There are typically more than 20 to 30 different types of artificial tears available over-the-counter. How do you know which one is the best one dry eye drop for you? In this post, I will guide you about the science behind my top five picks of artificial tears for treating dry eyes disease and help you understand the differences between them.

Without further ado, let's talk about artificial tears. Artificial tears are intended to supplements the natural tears that are made by the tear glands in our eyes. Natural tears lubricate the surface of our eyes by forming a tear film. The tear film has three layers:

The most outer layer is called the lipid layer, This layer functions as a protective barrier to prevent tears from drying up too fast.

The middle layer is called the aqueous layer, this watery layer contains the moisture we need to keep the surface of our eye lubricated.

The most inner layer of our tear film is called the " Mucin layer", the mucin layer functions as a bridge to keep the tear film attached to the surface of our eye it is called the cornea and it is the clear windshield of our eye. An ideal artificial tear should be able to supplement all three layers of our tear film.

Top 5 Artificial Eye Drops for Dry Eyes

I have divided my best 5 favorite artificial eye drops into two groups based on the severity of the dry eye disease;
  • Mild to moderate
  • Moderate to Severe
And I will list the top three artificial tears that I recommend for mild to moderate dry eye disease, as well as my top two picks to treat moderate to severe dry eye disease.

1. Systane Complete Eye Drops

Systane complete eye drops made by Alcon. It comes in a 10 mL bottle and uses poly quad as its preservative. The reason I like it is that it uses Nanodroplet technology, which is a type of nanoemulsion drug delivery system using negatively charged submicron-sized carrier particles to provide greater surface area to improve the stability and absorption of the drop.

Systane complete eye drop addresses all three layers of the tear film as it contains polyethylene glycol as its active ingredient to form a protective layer over the mucous membrane on the surface of the eye to provide hydration as well as reducing inflammation.

In addition to that, it contains hydroxypropyl guar, AKA HP guar. It is a pH-dependent molecule that can form a cross-linked network, which merges with the natural tear film to form a protective layer to cover the damaged epithelial cells on the surface of the cornea. This allows the damaged epithelial cells to be able to repair themselves in a protective space.

In addition to that, Systane complete eye drop contains mineral oil which targets the lipid layer of the tear film to prolong the effectiveness of the eye drop by reducing evaporation of the eye drop and the aqueous layer of the tear film. This helps to retain moisture on the surface of the eye longer.

2. Refresh Relieva Eye Drops

My number two pick for mild to moderate dry eye disease is Refresh Relieva made by Allergan. It contains active ingredients of carboxymethylcellulose sodium or CMC as well as glycerin.

Both of the ingredients are water-soluble polymers that have characteristics similar to natural tears and therefore they can lubricate the surface of the eye with minimal disruption of the natural tears. The glycerin can decrease the osmolarity of the tear film on the surface of the eye to provide additional lubrication and promote epithelial cell growth.

Among the inactive ingredients, it contains sodium hyaluronate that helps to repair corneal epithelial cells and lower the tear film osmolarity.

The preservative used in refresh relieva is the purite oxidative preservative. Another reason I like refresh relieva is that it comes in both preservative-containing and preservative-free forms. One of the unique things about refresh relieva is that its preservative-free version comes in a multidose 10 mL bottle and this packaging wastes a lot fewer drops and uses much less plastic packaging material comparing to the single-use vial packaging. It saves money and it's convenient.

3. Refresh Digital Eye Drops

My favorite otc dry eye drop for mild to moderate dry eye disease is "refresh digital" artificial tears made by Allergan. The difference between refresh digital versus refresh relieva is the added emollient component in refresh digital artificial tears.

Refresh Digital artificial tears contain castor oil which is a natural ingredient derived from castor beans. It targets the lipid layer of the tear film by reducing evaporation of the tear film and extending the effectiveness of the artificial tears.

Besides, CMC and glycerin, an additional active ingredient in refresh digital is a polysorbate. Polysorbate can help blend the oil component and the water-soluble component of the artificial tears to make the eye drop more soluble and easily spread across the surface of the eye.

The preservative used in refresh digital is the purite oxidative preservative. I do wish the refresh digital preservative-free was also available in the multidose bottle to reduce waste.

In moderate to severe dry eye disease, people often need to use artificial tears very frequently throughout the day due to the severity of the surface dryness. Sometimes as often as every hour to every two hours. It is very important for people with moderate to severe dry eye disease to use preservative-free artificial tears to prevent any toxicity from such frequent application of the preservative onto the surface of the eye.

4. Refresh Celluvisc Eye Drops

One of my two favorites over-the-counter dry eye drops that can be used daily is "Refresh celluvisc". It is preservative-free and contains the active ingredient of 1% CMC. This is double the concentration of the CMC contained in other types of refresh eye drops. The increased concentration of CMC will allow the artificial tears to stay much longer on the surface of the eye.

However, because of the higher concentration of CMC. Celluvisc is a fairly thick eye drop, I often remind my patients who are using it that because the eye drop is very thick you may experience blurry vision for a couple of minutes after putting it in, make sure you blink a few times after putting in the drop and don't put in the drop right before driving or operating other machinery.

5. Genteal Tears Eye Drops

The other best dry eye drop for moderate to severe dry eye disease is "Genteal Eye Gel" made by Alcon. Genteal Gel is the thickest eye drop among my top five favorite artificial tears. It comes in a gel consistency and contains hypromellose 0.3%. Hypromellose is short for hydroxypropyl methylcellulose or HPMC.

It is an active ingredient to increase the viscosity of the eye drop, to extend the lubricating quality of the eye drop. HPMC can cross-link when contacting the surface of the eye to slow down tear film evaporation.

Genteal Gel provides long-lasting lubrication to the surface of the eye. Because of its long-lasting lubricating quality, I typically recommend my patients with severe dry eye diseases to use Genteal Gel four times a day including at night before going to bed. And also because it is a gel form, it causes less blurry vision than most over-the-counter eye ointments.

It is important to remember Genteal Gel can still cause some blurry vision shortly after putting in the eye drop. So it is important not to put in the drop right before driving or operating other machinery. The preservative used in Genteal Gel is sodium perborate, brand name Genaqua. It is an oxidative type of preservative. 

I hope this article is helpful in learning more about the science and logic behind artificial tears, and that this article will help you to pick the artificial tears that work best for you. Please let me know which over-the-counter artificial tears are your favorite in the comments.

4 Main Reasons for Eye Swelling During and After Pregnancy

In the following article, I decided to emphasize the main reasons for eye swelling during pregnancy and after delivery. You may face different eye symptoms of the eye weakness in pregnancy and postpartum. There are given below the symptoms that affect your vision during and after delivery.

swollen-eyelids-after-pregnancy

Eye Symptoms During and After Pregnancy

  1. Intermittent Blur
  2. Dizziness
  3. Light Sensitivity
  4. Eyestrain
  5. Double Vision
  6. Temporary loss of vision
  7. Appearance of flashing lights
  8. Dry Eyes
  9. Blurred Vision
  10. Preeclampsia

Main Reasons for Eye Swelling in Pregnancy and Postpartum

1. Hormonal Changes

Hormones are changed during pregnancy and after delivery. Some hormones are increased more and some are decreased more. Therefore the size and shape of the cornea of the eyes are changed. 

It is a very common effect due to hormonal changes in pregnancy condition and as result, our vision is blurred or eye become dry and swollen.

You don't need any serious treatment for this common effect of hormonal change on your eyelids because after delivery your eyes or vision recover automatically some days later. Some women are lucky whose vision is recovered within few days or some women face long-term blurred and thier vision is recovered after 9 or 1o months during mother's feeding.

2. Hypertension

Hypertension during pregnancy may be very dangerous it may cause preeclampsia ( A disease that damages the organs system) and as result, your vision may be blurred or it also can lead to blindness but in some rare cases.

High blood pressure during pregnancy place more stress on vision or eyes that's why Swelling or Blurry vision or light sensitivity are the symptoms that you can face. If you are facing these issues you should check out your eyes to your eye specialist.

3. Edema

Edema may occur in women during pregnancy due to extra fluid in the body or pressure from the uterus. Edema can happen in different body parts mostly in feet, ankles, and legs but in some cases in the eyes.

The swelling tends to get swear if a woman's due date is near during pregnancy.

4. Diabetes

During pregnancy, our blood sugar level fluctuates a lot. It damages the blood vessels close to the retina of the eyes. In the result, our vision can damage badly but it is temporary and it is also known as " gestational diabetes". 

Women with diabetes can lead to diabetic macular edema ( swelling in the macula). This disease can lead to partial vision loss or blindness.

Eye Care in Pregnancy

  • Don't wear contact lenses otherwise your eyelids become dry, itchy, swollen and painful.
  • Use Vitamin C or Iron supplements in Pregnancy
  • Keep your body hydrated if you are feeling dryness or itchiness on your eyelid's skin.
  • Wash your eyes with cold water
  • Don't sit before screen
  • If you are going outside in sunlight, wear the sunglasses
  • Use saline water, if your eyelids are swollen and puffy.
  • Use artificial tears drops to minimize swelling and itching.
  • Take balanced diet
  • Use more vegetables in diet because vegetables are naturaly low in fat or colories.
Please Contact to physician or doctor in serious conditions.