The Dry Eye Show - June 17, 2018
Dr. Travis Zigler here, and Dr. Jenna Zigler, and thank you for joining us for The Dry Eye Show.
We have a couple announcements... You're going to see our link for our six-month supply of our Heyedrate Lid and Lash Cleanser giveaway. You can also go to our blog eyelovethesun.com, click our blog, and then it will pop up for you there. You can win a six-month supply and it's almost a $99 value... that's a GREAT deal! We’re pretty excited about giving that away, so make sure you enter. The draw is going to be next Monday and the contest is over next Sunday.
We're going to jump right into our seven relaxation techniques to help with stress and anxiety relief which will help your dry eye.
So, before we jump into those seven tips we're going to talk about what stress is, what it causes, and what it does to your body. Stress is actually very good but it can also be very bad. It's very good in the sense that it helps us with our fight-or-flight response. When fight-or-flight response happens it's usually because we're in a situation that requires an emergency so our eyes will become dilated so we can see better and we'll have more adrenaline pumping through our body so we can perform better. Our palms will be sweaty, our heart rate will speed up, our muscles will tense, and our breath will shorten and that gets us ready to either run or fight.
Your nervous system controls this cortisol and releases a certain amount of it. It also helps with blood sugar metabolism, inflammation, memory and blood pressure. So, if we release too much of this cortisol over a long period of time it's going to cause chronic stress. What this is going to do is lead to more serious health problems.
What causes stress?
A lot of the time when we think about stress we think about bad stress but there's actually good stress, too. An example of good stress is to think about getting married, having a baby, and moving to a new city. Those are all stressful events, but they're good stress. And then of course there's the bad stress. So examples would be disability, death, divorce, and unemployment. You know money can causes a lot of stress, depression, natural disasters and traumatic events.
But, the most important thing is your attitude and how you view the stress. It’s how you react to a particular situation. Do you have unrealistic expectations of that situation? That's kind of what we're going to focus a little bit on.
Some stress symptoms and some short-term effects of stress on the body are dry eyes, headaches, dilated pupils, stiff neck and back pain, increased heart rate, sweaty palms and feet, upset stomach and depression. The goal of this is to get out of that depression and anxiety state by using these seven tips. The long-term effects are dry eyes, infertility, heart disease, suppressed immune system, hormone fluctuations, asthma, acne, eczema, psoriasis and of course anxiety and depression.
How do we relieve stress?
Tip number one: Get grounded. If you've ever heard about grounding this is a practice of getting back in touch with the naturally negative charged free electrons that are on the earth.
Research has shown that if you place your bare feet on the ground -in the grass at the beach, or in the ocean and not on concrete. No shoes, not on concrete, not on rubber or wood or anything like that.
Electrons from the earth actually can migrate into your body and spread throughout your tissues. This can be incredibly helpful for inflammation and fighting inflammation in your body. When you're grounding electrons from the earth basically travel to the area of inflammation and they can actually help to neutralize that inflammation and render it harmless.
So, it's a really great practice and something that we try to do at least every day.
Tip number two: Getting ten minutes of sunshine before 10 a.m. What you want to do is just sit out in the sun before 10:00 a.m. and just close your eyes and then this will lead to tip number 3, but we'll get to that in a little bit.
Continuing with this tip is to get that sun on your skin because it is going to help increase your vitamin D. Vitamin D plays a a large role in a ton of chronic diseases like dry eye, asthma, type 2 diabetes, high blood pressure and more.
Your skin's going to absorb the sunlight and help convert it into vitamin D which is going to make you feel better. It will also increase your serotonin production which is going to make you feel better and that's going to help you sleep at night because serotonin is going to turn into melatonin at nighttime before you go to bed.
Tip number three: Meditation. Technically meditation means to engage in mental exercise with the purpose of a heightened spiritual awareness. That sounds a little frou-frou, but for people that meditate they know what we're talking about.
You can meditate in a short as 10 seconds a day. A lot of the time meditation is just paying attention to your breathing, maybe saying a mantra or something like that. It's just breathing and paying attention to where that breath is going throughout your body. It can really help you relax and really help you decrease stress.
There's a simple meditation in the blog post that I posted. You can click on that and that will take you over to the meditation I created and it's literally ten seconds long and you can do it any time of day that you want.
Tip number four: Yin yoga. We typically think about flow yoga which is where you're doing constant motion to stretch and do muscle training but the yin yoga is holding a pose for anywhere from 30 seconds up to 10 minutes.
Holding that pose kind of ties back into meditation because you have to meditate to hold that pose. Trust me, your patience will be tested and you're going to have things running through your mind. It's a form of meditation but it also helps stress because it increases your flexibility and it increases your circulations in your joints.
In that blog post we have lots of different yin yoga examples and on YouTube anywhere from 15 minutes to 75 minutes. We do this every night at around 9 p.m. before we go to bed because it puts us right to sleep and it increases our flexibility.
Tip number five: My favorite one, a gratitude journal. Basically a gratitude journal is just keeping a journal. This is how I recommend doing it. Keep a paper journal next to your bed every night or every morning (whatever works better for you) and you're going to simply write down three or more things every single day that you're grateful for.
These can be big things like a roof over your head, or the fact that it rained today. They can also be small things like the coffee you had this morning or anything like that.
You can write down anything you want but I guarantee you that when you write down what you're grateful for you won't pay as much attention to the things that are causing you stress in your life!
Tip number six: A mind dump and journaling. It’s very similar to gratitude journaling but a little different. You don't have to do this every day. However, gratitude journaling is great to do every day because it starts to give you focus.
You will start to focus on the positivity of life instead of the negativity. Stop watching the news all the time because that's extremely negative. Mind dump journaling is just pretty much whenever you feel that "state of overwhelmed" because you have too much to do.
Whenever you feel like you have too much to do sit down and play a nice relaxing song. Go to YouTube and just put in "relaxing song 20 minutes", then hit play and just write down everything that comes to your mind for work, for personal, for social, for friends, for kids, for whatever you need to do.
What that's going to do is it's going to just get everything out of your mind. You're just dumping your mind onto the journal. Then after you do that you want circle the top 10 by taking a different colored pen and circle the top 10 that are the most important that needs to get done and that are going to move your life forward the most.
After you have those top 10 circles, pick 3 and write down the 3 on a separate sheet of paper. 1, 2, & 3. One being the most important, two being the second most important and three being the third most important. Focus on number one and don't worry about anything else until you get number one done.
Once you get number one done you then focus on number two. Once you get number two done you then focus on number three. So that is mind dump journaling in a nutshell. Go to the blog post and you'll see an example of my mind dump journal from this past week and then my top 3 and how I narrow it down.
Tip number 7: Getting rid of your victim mentality. I always have the cause is greater than the effect and you want to be on the cause side more than the effect side. Tony Robbins always says that “what if life is happening for us and not to us”. What this means is to stop thinking that everything that happens in this life is happening to us like oh I lost my job because so-and-so, or I don't have any money because it's so and so, and this guy cut me off, and blah blah. That is taking a victim mentality and that's never going to get you anywhere. Instead, think of why did this guy cut me off, what does this mean for me and figuring out a way around that instead of taking the approach that this guy is an asshole and you just cut me off. So, stop taking the victim mentality and start taking control of your life.
Once you take control of your life and you're not on the "affect side" of everything happening to you, you're free. It took me awhile to be on the other side and to get to this I stopped watching the news because that's all victim things. I stopped getting around negative people and I don't talk to some people anymore just because they have that victim mentality. I try to get myself out of those situations as much as I can. I moved out of a city because I felt like there's just too much victim mentality in that city and I'm getting myself to a city that doesn't have that mentality. So, this meditation helps with this. Let's stop being a victim and start taking control of your life and on your time and what you're doing with it.
That's the top seven tips! I'm going to just briefly go over them again. So, tip number one is get grounded by going outside and walking outside in the grass for about five to ten seconds a day. Tip number two is get ten minutes of sunshine before 10 a.m. Tip number three is meditation. Tip number four is the yin yoga. Tip number five is gratitude journaling. Tip number six is mind dump journaling. And tip number seven is getting rid of your victim mentality and take control.
Life bonus tip number one:
Don't sweat the small stuff, and it's all small stuff.
Life bonus tip number two:
Eliminate bad fats and increase good fats.
So, we talked a lot about your diet and you know we talked about how you need to eliminate all of those bad saturated fats in your diet. All those Western foods, those fried foods, baked goods like candies cakes and pies ice cream, all of that is bad fat and it's not going to help out with your stress levels or your anxiety.
Instead, you want to focus on whole foods that are high in healthy omega-6 and omega-3s. So, of course you can take a fish oil like our Heyedrate Omega-3 for Eye Health but you can also eat wild salmon, mackerel, some vegetarian sources, walnuts, chia seeds and spinach. Those type of thing boom so that is everything in a nutshell and how to relieve stress and anxiety.
How do doctors know if we have aqueous deficiency?
Aqueous deficiency versus evaporative dry eye are two separate forms of dry eye. Aqueous deficiency occurs when your lacrimal gland is not making the amount of tears that it's supposed to. Things like Sjogren's syndrome and things that attack the lacrimal gland can cause aqueous deficiency. There are other things too, of course, but those are the main ones.
Then evaporative dry eye is due to mostly meibomian gland dysfunction or a decrease in the quality of oils that you're meibomian glands are producing. It's just a completely different type of dry eye. A lot of the time, an aqueous deficient dry eye person just doesn't make a lot of tears at all. Then with evaporative dry eye it's more of a quality thing versus a quantity thing.
If nighttime gels and/or night goggles make one feel worse, there's no reason to use them or are they doing some good even though we're feeling some bad?
I usually recommend nighttime goggles and gels only when somebody has a problem with keeping their eyes closed at nighttime. If you feel like they're actually making things worse then don't use them because that's obviously not the reason that you have your dry eye. Don't use them if you don't feel a need to.
Is it correct that punctual plugs are just a quick fix?
The inflammation is still there so getting to the source of that inflammation is going to be a hundred times better then plugging your plugs.
If you have all that inflammation and you do a plug then unfortunately what's going to happen is that you're just going to build up more inflammation in the system and that's going to make things even worse. So, definitely get the inflammation under control if you're considering punctal plugs.
Is fish oil good for dry eyes?
According to the dream study they said fish oil had no significant difference in dry eye compared to placebo. Unfortunately, the study used olive oil as placebo which is another healthy fat. So, what the study did show is that both the fish oil group and the olive oil group both helped with dry eye, they just had no difference between the two.
The healthy oils that are coming from whole foods such as fish, a fish oil supplement, avocado, walnuts and any other omega-3 sources or healthy omega-6 sources is going to be good for dry eye. What's bad for dry eye is anything that has saturated fats such as cakes, cookies ice cream, pastries, baked goods and all that stuff. So it means fish oil is good for dry eyes.
If you have Fuchs dystrophy and cataracts, which surgery should be done first?
This is a great question and truthfully it's a tough one. First of all Fuchs dystrophy happens on your cornea on the front of your eye. Where a cataract occurs is behind that cornea, in the center of your eye, in your lens. So, if you have that cataract surgery done and you still have decreased vision because of Fuchs you're still going to have some decreased vision because the cornea issue is still there.
It's hard to know depending on how bad your cataract is but then if you just have the cornea fixed you may still have a cataract there. I would tend to say you would have your cornea fixed first. It's just a more intense surgery though. It's a pretty specialized surgery that is something that you need to talk to both your corneal specialists and your general ophthalmologist who is doing your cataract surgery. Talk to them about which one's worse and which one's going to result in the best benefits. It's huge to talk to them.
How warm do compresses need to be to melt the oils in meibomian glands?
This is a great question. It's been a lot of talk in the dry eye syndrome support community. There's a study that came out that said warm compresses are just good for symptom relief and they don't provide any actual permanent relief. It's not something I agree with totally because you're heating up an oil in an oil gland and it's going to help no matter what.
But, to get the most benefits you have to keep it 141 degrees. That's pretty hot and it's very hard to keep any at home therapy at that temperature. Just make sure you use a good mask and you may have to reheat it in the middle of your session, which is very normal. The only thing that really keeps that heat for a long period of time, and does it 100% correctly, is a lipiflow.
Lipiflow is $1,000 to $2,000 dollars depending on where you're getting it done. It keeps the heat right where it needs to be and it does the pulsation right for how you need to do it according to research but that could change in the future.
Warm compresses are still a great at home therapy that works really well. A lot of people won't use them because the inflammation it causes, but I don't think that it causes more inflammation than it helps and it provides you relief. I mean if it's providing you symptom relief then there's no reason to stop doing them just because a study says that warm compresses don't get hot enough to express your meibomian glands. I don't think it's worth stopping the compresses just because of that.
Is Cymbalta bad for dry eyes?
It can be! Cymbalta is a medication that is on the list of medications that can cause dryness in your eyes. So, a lot of anxiety, depression, high blood pressure, and birth control medications can cause dry eye and anti-histamines is another one. Those will dry your eyes out.
So, if you're on something like that and you haven't thought about if that might be causing your dry eye, it's very possible that it could be.
My Restasis burns my eyes.
It does! According to the studies that Restatis has done it occurs in about 17% of people that take it. In my experience about 50% of people that take it experience this and the reason is because if you have dry eye you most likely have inflammation and if you have inflammation it doesn't matter what you put on your eyes, including our spray our Heyedrate Lid and Lash cleanser, it will kind of burn even your eyelids if you have inflammation. There's going to be open cuts that it's going to burn. Water is going to burn; anything is going to burn just because you have inflammation.
Think about when you get a cut on your skin and you put water on it, it burns! So anything is going to sting a bit if you have inflammation. Once that inflammation starts to go down the burning should kind of subside. For some people it doesn't because the inflammation never goes away.
That's the importance of getting rid of the inflammation and the source of the inflammation before just trying all these drops and everything else. So, if you want to learn more about that go to dryeyecommunity.com.
Dr. Jenna Zigler and Dr. Travis Zigler