Chapter 5 is best summed up in charts for green smoothies, lunch, and dinner.  We have compiled this in a Google doc, which you can print for at home use.  Click here to access this document. 

Treatment for ALL disease should start with drinking plenty of water and exercising daily.  According to the CDC, 80-90% of adults and teens do not exercise. That is 8-9 out of every 10 people that do NOT exercise.  No wonder health care costs are rising and disease is rampant in the United States.  

The biggest problem we see as practitioners is that the advice we give our patients about diet and exercise are completely ignored and patients just want to feel relief from the symptoms of the disease.  A disease is your body’s way of telling you that you are doing something wrong (most likely following a Western diet and failing to exercise).   

With that being said, DO NOT RELY ON YOUR PRACTITIONER TO CURE YOUR DISEASE.  This is up to YOU and YOU alone. You can choose today to start eating better, exercising daily, and healing your body from the inside out.

What Are Some of the Benefits of Exercise?

Exercise is one of the most beneficial activities you can engage in to improve your life, from your mood to your sex drive.  Exercise helps circulate blood in a more efficient manner, which delivers oxygen in a much more efficient way. This delivery of oxygen will help in healing your entire body from inflammation.  

Also, a dopamine hit will come across you and last throughout the day.  Dopamine is responsible for increasing calmness, awareness, and your presence in life while decreasing anxiety, depression, anger, and more.  

Some other benefits of exercise include the following according to the Mayo Clinic: 

• Controls and helps you lose weight

• Combats health conditions and disease

• Improves your mood and combats depression

• Boosts energy levels

• Promotes better sleep

• Puts the spark back into your sex life! 

What a Sedentary Lifestyle Causes… 

Lack of physical activity can cause a list of ailments and symptoms which increase your risk for developing disease.  Sedentary lifestyles cause an extreme dive opposite of those exercise-enhancing benefits above. According to Men’s Health, these are: 

• Depression, anxiety, restlessness, hopelessness, and fatigue

• SIGNIFICANT increased risk of cancer

• Memory loss 

• Increased blood sugar and risk for diabetes

• No more sex… Or at least a decreased sex drive :(

• Terrible sleep 

• Increased back pain (especially lower back)

How Much and What Kind of Exercise?

This depends on the shape that you are in, but we shoot for about 210 minutes of exercise per week (30 minutes per day).  we know this sounds like a daunting task, but we are going to give you a complete action plan to get to 30 minutes per day.  We now do 45-60 minutes per day, five to six days per week. WE DIDN’T START HERE. We gradually worked our way up to it and we blocked off time every morning to work out.

Also, you don’t have to exercise all at once.  You can do five to ten minute bursts of exercise throughout your day, that won’t break a sweat (sometimes) and will help give you more energy throughout your day.  You could also go to the gym in the morning and then take your dog for a walk in the afternoon, for example.

Exercise Plan If You Are Currently NOT Exercising

How do you eat an elephant?  It is a pretty big task that would be tough, but you do it ONE BITE AT A TIME!

Week one is all about getting back into the routine or creating a routine

• Start waking up an hour earlier, hyper-hydrating,  and going on a five minute brisk walk (or as long as you can)

• Do this daily (Pain permitting, and soreness is not pain. Walk through the soreness.)

• FIVE MINUTES PER DAY is all you need to get a habit started.

Week two through six is all about adding time

  - Add five minutes per week.

• Week two = 10 minutes of brisk walking per day

• Week three = 15 minutes of brisk walking per day

• Week four = 20 minutes of brisk walking per day

• Week five = 25 minutes of brisk walking per day

• Week six = 30 minutes of brisk walking per day 

After week six, maintain this 30 minutes per day at the VERY LEAST

 - If you can, continue adding five minutes per week until you get to 60 minutes per day

What we see with our patients that start doing this is they can’t stop and exercise becomes an addiction, but a good one.  We have seen overweight 50 year olds lose 100 pounds and walk a half marathon within a year of starting this. You can do it!

Exercise Plan If You Are Currently Exercising

Keep up the good work!  See how you stack up against 210 minutes per week and try to get there if you are not already there.  You are on the right path.

This can be in one 20 to 30 minute session in the morning or after you get off work combined with short five to 10 minute bursts of exercise throughout your workday or one big session in the morning or evening.    We prefer breaking it up throughout the day to get the heart rate increased after sitting for a while.

You can also look into HIIT training.  The problem with most of our workouts is that we are just going through the motions of an exercise and barely even challenging ourselves.  Think about the last time you were on the elliptical, did you change the resistance at all? HIIT stands for High-Intensity Interval Training and can be done in as little as 15 minutes.  15 minutes of HIIT training is better than doing the elliptical or running for an hour. HIIT burns a tremendous amount of calories in a short time, raises your metabolic rate (fat burning) for hours afterwards, helps you lose fat and gain muscle, improves oxygen consumption, and reduces blood pressure and blood sugar.  

By the way, sitting all day is KILLING us slowly and is as dangerous as eating unhealthy food.  Get up and move! 

We all have breaks or should be taking breaks periodically while working.   I set a 25 minute timer and work hard on whatever I am working on at that time (for example, writing this book).  When the timer goes off I take five to 10 minutes to get up, drink water, do some jumping jacks, planks, run in place, burpees, squats, or whatever you are feeling at that time.  After the five to 10 minutes is up, I jump back in to what I am doing.  

Also, don’t forget about stretching.  Flexibility is a huge benefit to your body and will help reduce pain and allow your body to move more freely without pain. There is a reason that practices like Yoga, Pilates, and stretching centers (yes, it’s true) exist.  Stretching plays a vital role in your health.

Meet Beth (True Story)

Beth was a patient of ours who was always cheerful and full of life.  Beth was about 210 pounds and 55 years old. She did not exercise or eat well.  One night, she fainted in her house. She was rushed to the hospital with a blood sugar of over 700 and on the verge of dying.  Beth did survive and decided she was going to take matters into her own hands.  

She completely changed her diet, eliminated all processed foods (breads, cereals, processed meats) and started an exercise program.  In 90 days, she was able to lose 30 pounds and is feeling better than ever. We are so thrilled!  

She was a diabetic at that ER visit but is now medication free!

This is the power of diet, hydration, and exercise.

ACTION ITEM

1. Print your exercise guide chart by visiting www.RethinkingDryEye.com under the Exercise tab.
2. Bookmark www.RethinkingDryEye.com to watch exercise videos of varying time and intensity and build your way up to 30 minutes per day.  Look for them under the Exercise tab.

Although everything mentioned above will create the biggest difference in your dry eye battle, a few other lifestyle modifications should be taken into account.  We are constantly exposed, either directly or indirectly, to toxins. Toxins in our water, food, air, home, and work are constantly bombarding us whether we know it or not.  

When a toxin is intense enough, or you’re exposed to a large dose, it can cause a severe enough reaction in your body that we notice it.  Toxins can cause reactions such as vomiting, shaking, skin hives, rashes, allergies, fever, dry eyes, eczema, asthma, trouble breathing, and other forms of inflammation.  

But the real problem comes when you are exposed to small amounts of toxins, which don’t cause any acute or immediate reaction, over time and they build up in your system causing problems such as cancer, ADHD, hormonal imbalance, arthritis, and digestive issues.  Most people think that these conditions are just a normal part of aging, which couldn’t be further from the truth. Your body wants to be healthy, you just have to help it get there.

Your body has an amazing response to these toxins as it wants to keep your body in a state of homeostasis or normalcy.  We have systems and organs in place to help detoxify our body such as the skin, liver, and sweat glands. Our body is constantly fighting these toxins throughout the day.  The problem occurs when your body becomes too toxic and the toxins start to win. This, again, comes in the form of cancer, arthritis, chronic illnesses, etc.  

Dr. B.J. Hardick from his book Align Your Health put a great perspective on the difference between subtle toxic events and more intense toxic events.  He said: 

“Consider a food sensitivity with a food allergy, or a gluten sensitivity vs Celiac disease.  Someone with a food or gluten sensitivity has a legitimate problem with that food. Their body won’t break the food down properly, and at some point there will be negative consequences.  But there are often symptoms that we confuse with other things, like a stomach ache, inflammation, or congestion. Unless you’re looking for it, you might not know it’s there. Meanwhile, a food intolerance or a gluten intolerance at the level of Celiac disease usually makes itself known in ways that are difficult to miss.”

What we are about to go over can be a little overwhelming as the amount of toxins in our lives is vast.  I made a special sheet for you at www.RethinkingDryEye.com that will help you go through step-by-step changes that you can easily make in your life that will make a huge difference in the amount of toxins that you are exposed to. DO NOT TRY TO DO EVERYTHING AT ONCE.  You will get overwhelmed and revert back to previous ways.  My goal with this list is to have it with you at all times to revert to and eventually memorize so that everything becomes habit.  

This is similar to the other changes that you are making throughout this book.  Make one change at a time and, when that change becomes a habit, move on to the next change.  You will truly learn what benefits you more and what benefits you less. 

We are going to present to you the most important toxins to watch for and where they are located. We’ll then give you simple solutions to fix or avoid these toxins.  Remember the checklist at www.RethinkingDryEye.com.

Toxins From Water | Detoxify With Edible Essential Oils In Your Drink

Simply by drinking water, something we all must do to live, you put yourself in contact with over 150,000 different toxins (including fluoride, arsenic, and chlorine). This does not include the 500,000 other toxins we experience due to foods and other beverages! Yikes…

Water systems in the United States have to pass certain EPA (Environmental Protection Agency) standards in order to be considered “safe.”  The problem with this is that the EPA allows an “acceptable” level of most toxins in your water, such as lead, arsenic, metals, antibiotics, and other pharmaceuticals.  On top of that, chemicals such as fluoride are added to the water. Even if the EPA is regulating this, they are not always below the acceptable levels. Remember what happened in Flint, Michigan.  

Unfortunately bottled water that is stored in plastic containers also contains chemicals that are leaching out from the plastic, which results in toxin contamination as well.  

So what the heck are you supposed to do?

Take control of your water purity yourself.

To easily minimize the toxins you're exposed to in your water, first of all make sure you're drinking filtered water. We love our Berkey Water Filtration System, and we recommend it to everyone. 

Next, consider adding essential oils such as Lemon, Tangerine, and Grapefruit. All it takes is one drop to notice the difference. You can even add a little Peppermint to your tea for an afternoon pick-me-up.

If you want a great detoxing "cleansing" recipe, try one of these below (can be enjoyed daily):

Dr. Zigler’s Morning Cocktail

1 ounce of Organic, Unfiltered, From-The-Mother Apple Cider Vinegar

1 pinch of Celtic Sea Salt

20 to 32 ounces of distilled or filtered water

"Grapefruit Juice"

3 drops Grapefruit essential oil

3 drops Spearmint essential oil

3 drops Tangerine essential oil

1 quart distilled or filtered water

"Lemonade"

3 drops Lemon Essential oil

1 quart distilled or filtered water 

Stop Drinking Cow’s Milk

Yes, you heard that right. Stop it. Cow's milk can potentially be full of antibiotics and hormones, and dairy has been shown to cause inflammation in the body of many individuals (the opposite of what we're trying to do here!)

Instead of enjoying that glass of milk, use the recipe above to feel more alive and healthier than ever or try alternatives like unsweetened almond, coconut, or cashew milk. 

Toxins From Food

We all love food but, as stated above, the food we're consuming contains over 300,000 toxins, which may range from preservatives to MSG to hydrogenated oils and artificial colors and flavorings. This is outrageous, but there are obviously things you can do to minimize this load.  This should be your first point of attack to eliminate toxins in your life, but also to help heal your dry eye and other inflammatory diseases like heart disease, diabetes, arthritis, and high cholesterol.  

First of all, avoid processed foods at all costs.  Foods that contain a laundry list of preservatives, artificial colorings, and artificial flavorings have no place in your cabinet.  If it is in a box, can, or can be stored long-term then you should not be putting it in your body as the preservation process contains numerous toxins.  Switch to eating whole foods, such as vegetables, fruits, and organic, grass fed meat or wild caught fish (limit meat to once per day if needed). 

Secondly, buy organic whenever possible. By doing so, you avoid many of the fertilizers and pesticides that your produce and other items often come in contact with. With that being said organic isn’t chemical free, so be sure to wash your produce well!  Organic is much better for you than the conventionally raised produce with pesticides and fertilizers.  

Thirdly, avoid genetically modified organisms which I discussed in detail previously, but to summarize... a GMO is an organism, such as corn, that has been genetically modified to be able to withstand harsh conditions such as fertilizer use, temperature fluctuations, and other harsh conditions.    A key point to remember is that if something is labeled “organic” that means it is both organic AND non-GMO.  

A quick aside on the poisons of fertilizers and pesticide use.  There is a lake not too far from my home called Grand Lake Saint Marys in Ohio.  This once bustling lake is beautiful, with small Ohio towns set-up all around to take advantage of the lake life and enjoy a little relaxation.  Over the last 10 to 15 years a small poison has been leaking into the lake rendering it a “no contact” lake. Due to a blue-green algae species called Aphanizomenon gracile, residents are unable to use this lake anymore.  This algae species creates a foul odor and has killed off thousands of fish in the area.  It also releases liver and neurotoxins, which is what makes this lake “no contact”.

So what is causing this problem with the lake?  The root cause is very clear and it comes from runoff manure and fertilizers from watershed lands feeding the lake.  The phosphorus in the fertilizers and manure feed the algae. As the algae blooms and dies, it releases toxins and robs the water of oxygen, which then kills the fish.

Think about that for a minute.  A whole ecosystem taken down by toxic fertilizers and pesticide use.  

Number four on the list of things we can do to avoid toxins from food is to eat more antioxidant rich food.  A diet rich in colorful vegetables is one of the best tools for scrubbing your blood, cells, and the rest of your body clean of oxidative species and free radicals.

A fifth thing we can do is bring essential oils into our kitchen to cook with. Cardamom, Ginger, Thyme, Coriander, and Cilantro can all easily be incorporated into meals. How about Thyme in your next soup recipe? Or Cilantro in your next guacamole dish? Coriander is great for flavoring veggies, and Ginger is great in smoothies.  

There are so many ways to incorporate essential oils into your cooking, and this will accelerate your body's ability to detox from all of the harmful chemicals that are so unavoidable.

Be very careful when adding essential oils to your cooking and add only after the heating process has been done.  Similar to above, you don’t want to heat oils as it damages them. Damaged oils cause damage to your body. Add essential oils AFTER the food is prepared.  

Also, as stated above, be careful with how much you add.  One drop is potent enough to add flavor to any recipe. It is always easier to add more than to take away. We’ve learned this the hard way!

Finally, stop eating so much fast food and especially stop the unhealthy fast food burger joints. Some healthier options for eating out include a salad bowl at Chipotle (no barbacoa, carnitas, cheese, or sour cream), salads at Subway (no dressing), salads at Wendy’s (no dressing), salads at Panera Bread (no dressing), and there are many more options.  Just make sure that the food that you are consuming looks like it would if it were growing in a tree or from the ground.

Toxins From Air

Before we dive in, I want to talk a little bit about the toxins we come into contact with daily. Unfortunately, they're largely unavoidable. But our human bodies are designed to handle detox, and our bodies do a great job of filtering out what they need and what they don't. However, with all of the artificial chemicals and pollution in the air around us in this century, our bodies can sometimes use a little detox boost. There are alternative things you can do to both minimize and eliminate your exposure to toxins, and the ideas I'll present are pretty easy to implement!

Did you know that there are about 200,000 different toxins floating in the air around you? They may be from exhaust, cigarette smoke, fertilizers in the cornfields nearby, or other pollutants. Even if you were living in the far reaches of the rainforest, you'd still be subject to toxins in the air (although yes, better off than someone in New York City).

Air Purifying Essential Oils for Aromatherapy to Detoxify the Air

Our air quality inside our home and workplace tend to be more toxic than the outside air quality.  Most think that with all the pollution in this world that outdoor air is somehow more toxic (well maybe in Iran, India, Los Angeles and Beijing).  This couldn’t be further from the truth. Getting outside, opening your windows to air out your house, and breathing in fresh outdoor air is much better than the toxic air that we have in our home.  

We are going to take some steps in order to enhance the quality of air inside your home, but know that you cannot stop it all.  The construction of your house, your walls, carpet, floors, couches, and beds all contain toxins, so eliminating all the toxins is impossible. However, stressing about it is doing nothing for you either (stop stressing, seriously, because it’s worse than the toxins).

Let’s talk about some ways to enhance your air quality.  

Step number one, like stated above, get outside and enjoy the outdoors.  Also open your windows and air out your home as much as possible.  

Secondly since you can control some of the air quality in your home, why not begin detoxing that air with essential oils? This is as easy as buying a diffuser and a few key oils. Some great oils for air purification include citrus oils like Orange and Lemon, Peppermint, Lavender, Clove, and Ylang Ylang.

Simply place 3-4 drops mixed with water into your diffuser and let it run. These oils aid the liver in detoxification as the oil diffuses from the lungs into the blood steam.  They can also help promote a sense of calm and be energizing (at the same time).

A third thing you can do is buy an air purifier.  Air purifiers can remove up to 99.97% of in-air pollutants and allergens including mold spores, dust, pollen, bacteria, and pet dander, while also capturing odors. 

You can also add indoor plants to your home such as ferns, peace lilies, bamboo, dragon trees, and/or a spider plant.  These plants are usually very easy to care for, thrive with or without sunlight, and survive even the harshest black thumb (like that of my wife, Dr. Jenna).  Plants have been shown to help rid your house of formaldehyde, carbon monoxide, benzene, and other harmful gases and toxins.    

Another addition to detox the air quality of your home is avoiding the use of toxic cleaners in your home.  We are constantly using toxins to clean our house, do our laundry, and on our body that we are exposing ourselves to more toxins than we need to.  

Let’s first discuss a couple of easier alternatives to what you are currently using to clean your house, which can be one area of constant toxins and chemicals.  Walk down your local grocery store cleaner aisle and you can smell all the chemicals, fragrances, and toxins in the air.  I personally get a headache from this and have to avoid the aisle at all costs.  

A very simple fix for replacing your toilet bowl cleaner, kitchen cleaner, bathroom cleaner, shower-head scrubber, window cleaner, and cleaners for pet urine, carpet stains, coffee makers, mopping, and… well you get the idea… Pretty much anything you want to clean can be cleaned with organic white distilled vinegar.  

Mix equal parts distilled or filtered water and vinegar in a spray bottle. It is literally that simple.  Spray this mixture on kitchen and bathroom countertops, stovetops, backsplashes, toilet surfaces, tile, flooring and almost any smooth surface you wish. Wipe it up with a paper towel or sponge.  Vinegar and water solutions can help eliminate dirt, soap scum, sticky spills and hard water.

This vinegar “trick” will help eliminate a huge expense in cleaner, so your wallet will thank you, but it will also decrease your toxin exposure exponentially, which in turn will increase the quality of air inside your home.  Bonus points if you use organic white distilled vinegar.  

Let’s move on to laundry.  Dryer sheets, especially, and laundry detergent are filled with unnecessary chemicals, fragrances, and toxins.    

Replace your dryer sheets with organic wool balls.  Think about this for a second, your clothes are in constant contact with you.  Get rid of the chemicals and make the choice to be toxin free. Wool balls are made of, you guessed it, organic wool.  The best thing about wool balls is they never go bad and will last forever. As of this writing, we are still using wool balls we purchased four years ago and they look as good as new.    

Wool balls are designed to keep your clothes soft and static-free.  They are also great for the environment as you are not constantly throwing away dryer sheets with every batch of laundry.   They can also reduce your drying time by up to 40%, which means more savings on your energy bill.  

Moving on to laundry detergent.  There are a few things that we recommend in this department.  For our everyday non-workout clothes, we use organic Eco Nuts. Eco Nuts are an organic soap berry that have been used for centuries in the Himalayas where they natively grow in the wild without fertilizers, pesticides, or chemicals.  The berry shell naturally contains soap.   

Eco Nuts are safe and recommended for those with sensitive skin, eczema, and allergies, because they are a chemical-free way to do your laundry.  Our experience with eco nuts has been nothing but positive, except for with our workout clothes. It tends not to get all of the stink out of those sweaty garments.  

We wash our workout clothes separately and use a more natural laundry detergent. The natural laundry detergent may change in the future, so to get the most up to date list of everything we use with links to purchase, visit www.RethinkingDryEye.com and check out the toxins section.   

Let’s talk about your poop. No not literally, but we are going to discuss that air freshener that you use around your house.  The chemical and toxic ridden aerosol that you spray joyfully into the air to make your house smell “clean” is actually poisoning everyone who breathes it in.    

Some better alternatives are the air purifier that we discussed above to help eliminate odors, but also using essential oil based air fresheners.  We love the brand Poo-Pourri because it is a non-toxic air freshener made up of essentially oils and other natural compounds, without the use of harsh chemicals, aerosols, parabens, phthalates, or formaldehyde.   We use it for the bathroom, of course, but also to freshen up our sinks, trashcans, laundry (spray it on the wool balls or use plain essential oils on the wool balls), and the children’s rooms. 

Let's get personal next (like poop wasn’t personal enough)… 

What you use for personal care is another toxic environment because you are putting these toxins and chemicals directly on your skin.  From makeup to lotion to deodorant to toothpaste to shampoo and body wash, your personal care routine is filled with toxins.  

Let’s detox.

Toxins From Heavy Metals

Not only are we exposed to all of the toxins above, but we're also exposed to many heavy metals that can do harm to our bodies. Like discussed above, heavy metals come from things like aluminum based deodorants, commercial toothpaste, aluminum cans, light bulbs, cosmetics, cookware, and even our mercury dental fillings. 

Deodorant is filled with toxins and you are putting this on your body non-stop.  Once in the morning, after a workout, after a shower… Your body never gets a break.  Deodorant has cancer causing chemicals like parabens, steareths, triclosans, TEA, and DEA.  It also has other toxic ingredients such as propylene glycol and aluminium. Aluminum is in all antiperspirants to clog your pores and prevent sweating.  This is not healthy. Aluminium exposure has been shown to mess with hormone levels, like estrogen, and contribute to Alzheimer’s disease.  

Of course, you can absolutely make sure that you're using safe deodorants.  We recommend using all-natural deodorant that does not contain aluminium. This will take a little bit of an adjustment, but once adjusted you will notice less staining on the underarms of your shirts (those are toxins being released, by the way) and you will notice less reliance on deodorant.  

Toothpaste is another hidden toxin-filled personal care item with ingredients like triclosan (endocrine disruption), sodium lauryl sulfate (SLS causes canker sores), artificial sweeteners, fluoride (yes fluoride), propylene glycol (organ toxicity), and DEA (hormone disruptor).  

If you get constant canker sores, make sure to find a toothpaste that does not have sodium lauryl sulfate and I can almost guarantee you will never have one again.  This is from experience, because once we dropped SLS from our toothpaste, I went from having one canker sore per month to none. I don’t just mean a small canker sore, I mean a ten out of ten pain, barely being able to eat canker sore.    

Instead, opt for a more natural, SLS-free, fluoride-free toothpaste.  A few that we recommend can be found under the toxins section at www.RethinkingDryEye.com. 

Lotion contains numerous chemicals and toxins.  Try opting for something more natural and organic such as a organic coconut oil or organic jojoba oil.  

Body wash and shampoo have become incredibly complicated and are filled with toxins as well.  There are many natural shampoo bars and bar soaps that contain five ingredients or fewer.  We actually make a soap, Heyedrate Tea Tree Oil Soap, that can be used on the body, face, and as shampoo.  It works incredibly well for dry skin, dandruff, and blemishes.  

Avoid coated cookware and use a cast iron skillet instead.  Cast iron skillets actually get better with age and become non-stick the more you use them, which means you can avoid non-stick aerosols filled with chemicals.  They also maintain a uniform heat and can be used on the stovetop as well as in the oven. Also, a side benefit is that a little iron gets into your food which is great for battling anemia (spinach is good for this too).  

Avoid plastic storage containers and instead opt to reheat and store food in glass containers, such as those from Pyrex. This avoids any leaching of chemicals into your food, which can occur even if the plastic container states it is BPA free.

How about having those old mercury amalgam fillings in your mouth removed and replaced with new, non-toxic cavity fillings?

Best Natural Eye Makeup for Sensitive Eyes, Eyelids, and Dry Eyes

It’s no secret that most women feel great when they wear makeup. It gives them confidence and helps them shine in a world that is so focused on outward appearance (sad, but true). But if you suffer from blepharitis, meibomian gland dysfunction (MGD), demodex, or dry eyes of any kind, makeup can be difficult for you to wear. There are so many irritants in today's cosmetics, and we have to be careful to minimize this when we have dry, irritated eyes, because conventional makeup will only exacerbate the issue.

You can even try out some of the great natural makeup brands on the market or make your own!  Makeup is filled with toxic chemicals that definitely affect your dry, irritated eyes and eyelids.  Let’s discuss this even more and go over some natural makeup brands that we recommend. A big thank you goes out to Dr. Tracy Doll and her fantastic lecture at the American Academy of Optometry about makeup.  Also thanks to my wife, Dr. Jenna Zigler, for writing up this section on makeup, makeup removers, and eyelash extensions, as I do not even come close to being as knowledgeable as her in this area.  

Best Eyeshadow for Sensitive Eyes

Let's start with eyeshadow. This cosmetic comes in powder form, creams, or sticks and can contain quite a few irritants. A few examples to watch out for are mica or talc, pigments such as iron oxides, chrome oxide, iron blue, manganese violet, and others, and emollients like lanolin. 

Your everyday drugstore eyeshadow is likely to contain many of these ingredients, so you may want to check out some of the following. Omiana matte loose powder as well as 100% Pure Fruit Pigmented eyeshadows both have products that meet the needs of many dry eye sufferers, and they're less likely to cause allergic reactions as well. Keep in mind, anyone at any time can have an allergic reaction to anything, but these suggestions are less likely to be problematic! 

Best Mascara for Sensitive Eyes

Ohh mascara...how I love you (says Dr. Jenna). Mascara falls into a few basic categories including classic water-based and waterproof. Waterproof mascara is definitely worse for you in terms of dry eyes, ocular surface disease, and the potential for complications. Fiber lashes are also an option now, but these are even worse than waterproof because the small fibers can easily fall into the eyes and cause irritation. Dr. Doll notes that problematic mascara ingredients may include isoparaffins, polyvinylpyrrolidone resins, pigments, and stearic acid. 

Another thing to note is that liquid makeups, such as mascara, should be discarded at least every 3 months to prevent bacterial build-up. The longer you wait to discard your liquid makeup, the more at risk you'll be for eye infections, blepharitis, loss of eyelashes, and other irritations. 

A few better brands to try include Lily Lolo, Omiana Barely There, and Zorah Pure Argan Lengthening. 

Best Eyeliner for Sensitive Eyes

Eyeliner is something that helps define our eyes and give us a more "awake" look, yet it can be especially problematic in certain cases. Whatever you do, NEVER tightline your eyelids (placing eyeliner on the inner rim of your eyelids, directly over your meibomian glands...yikes!) Eyeliners come in many forms including liquid, pencil, and gels. Those which you can sharpen away (such as pencils) or wipe away the outer layer before applying (such as twist-up pencils) tend to be safer because you're able to remove some of the bacteria that may be present. Ingredients that may be problematic for dry eye sufferers include silicone resins such as trimethylsiloxysilicate and polymethylsilsesquioxane, pigments, and preservatives.

If you can't give it up and you'd like to try a better eyeliner, check out 100% Pure's brand of fruit-pigmented eyeliners, Alima Pure Natural Definition Eye Pencil, and Red Apple Lipstick Eyeliner. And for those of you who think, "I'll just get it tattooed on!"...not so fast. Tattoo eyeliner is not without risks, and it can still cause swelling, allergic reactions, scarring, and infections. It also doesn't last forever, and the pigment has the potential to fade or migrate. 

Best Eye Makeup Remover for Sensitive Eyes

Yes, makeup removers can even be harsh for your eyes! Although oil based removers can sometimes be worse for MGD, depending on the brand, they are exceptional at removing even waterproof makeup (and this is super important!) No matter what eye makeup you choose, you need to be sure you're completely removing it at the end of the day.

If you prefer an oil-based remover, you can simply use fractionated coconut oil or an argan oil. If you want to go a step further and ensure that you're also keeping demodex under control, choose an oil-based remover that contains tea tree oil, like Heyedrate Tea Tree Oil Makeup Remover, which contains organic grapeseed oil, organic jojoba oil, vitamin E, and organic tea tree essential oil. 

We all want to look beautiful, and makeup does help enhance our features...but at what cost? If you're going to wear makeup, make sure you're using brands that avoid harsh chemicals where possible, and absolutely ensure that you're taking it off at the end of the day.

Don’t Get Eyelash Extensions… Ever!

If you've ever longed to have long, thick eyelashes, this section is for you. Unfortunately, for those with dry eyes, using loads of mascara is out of the question because the ingredients can be irritating, cause allergies, and lead to more inflammation of the eyes.  You may think that eyelash extensions are the next best option for fuller lashes, but this is not always the case. 

What Are Eyelash Extensions (or Lash Extensions)?

Lash extensions come in many different forms, including less expensive synthetic false lashes, silk lashes, those made of mink, and even magnetic lashes. Although some synthetic lashes can be bought in a drugstore and applied at home, other forms are readily available for application in salons around the world.

Once you've selected your type of eyelashes in a salon, the lashes are applied one at a time using a semi-permanent glue. Sadly,  this glue often contains formaldehyde, latex, and other harsh ingredients that can be horrible for sensitive eyes. Some lashes can actually be tied onto your own, but these are still not free of complications. If you're set on having a full set of lashes applied, you're in for a two hour appointment with touch-ups recommended every few weeks. If you only wish to have a little enhancement, you could also have them apply just a few lashes. 

So, you might ask, what's the big deal? Yes, your eyes will be closed the entire time the procedure is going on. If you're at a reputable, licensed salon, they're going to have trained lash technicians who will avoid getting the glue into your eyes at all costs. However, that doesn't mean you're immune to complications. As we've said before, anyone can react to anything at any time. 

Eyelash Extension Care | How To Prevent Eyelash Extension Complications

Complications from extensions can include allergic reactions to the adhesive, natural eyelash loss, keratoconjunctivitis (inflammation of the cornea and conjunctiva), styes, abrasions, and subconjunctival hemorrhages.

The first step to preventing complications from lash extensions is to make sure you're at a salon with licensed lash technicians. These people have been trained to prevent infection and complications when applying your lashes. Make sure they use a better adhesive, such as Milante Beauty Super Strip Lash Bond.

After applied, avoid getting water onto your eyelashes for 12-24 hours so that the adhesive is able to fully set. Although further care depends on what adhesive is used, it is generally accepted not to use alcohol or oil-based makeup remover products on your eyelashes, as these can damage the adhesive and cause your false eyelashes to fall off.

It is also incredibly important to keep the eyelids and lashes extremely clean when you have lash extensions, because they can breed bacteria and cause nasty infections, such a styes. We recommend using a hypochlorous acid eyelid cleanser each morning and evening for best results. The Heyedrate Lid and Lash Cleanser is perfect for this because it contains no alcohol, no harsh chemicals, and no oil which could damage your lashes. It also ensures you'll be less likely to get an infection if you do decide to try lash extensions. 

How To Remove False Eyelash Extensions

If we see a patient with lash extensions that is having problems with them, especially those who have an infection, we can remove them in office. This can also be done at home, although it is recommended to have them removed by your doctor or esthetician. 

First, a hot, damp compress can be applied to loosen the glue.

Then, oil is used to help soften and remove the adhesive. Oils that are safe to use include olive oil, coconut oil, argan oil, or other similar oils.

By using heat and oil, the lashes can be mechanically removed with your fingertips or with forceps (if you're having them removed by your doctor).

Other ways to remove eyelash extensions include using commercially available remover which, unfortunately, smells like nail polish remover (which means it contains tons of chemicals). Whatever you use, it is best to have them removed by a professional.

Other Forms of Eyelash Cosmetics and Extensions To Be Cautious Of

Magnetic False Eyelashes

Although magnetic lashes do not use any adhesive, they can still be problematic for those with irritated eyes to begin with. Magnetic lashes are applied with magnets around your natural eyelashes. Risks can still include mechanical trauma to your cornea, lashes that fall or break off into the eyes, and bacteria build-up leading to styes and other infections (since the lashes are reusable). Main brands include 3 Second Lash, One Two Lash, ILash, and Ardell Magnetic. Use with caution!

Eyelash Perming

This is an interesting one! Eyelash perming is done by wrapping your eyelashes around a metal or plastic rod while perming solution is applied (NOTE: very close to the eyes!) Although the eyes are closed when this procedure is performed, it is not impossible for the solution to get into the eyes, just like eye makeup remover will get into your eyes because the eyelids do not create a tight seal. Perming solution can cause a whole host of issues including redness and inflammation, allergies to the solution, and infection.

Eyelash Tinting

Eyelash tinting is another interesting one which uses hair dye very close to the eyes. Keep in mind that hair dye is often "permanent" and cannot be removed for weeks or months, so if you happen to be one of the (un)lucky ones who reacts to the dye, you're going to be dealing with complications for months. Allergies as well as contact blepharoconjunctivitis are possible side effects here. Our opinion? Stay away!

Eyelash Growth Serums

Now you're thinking, "I'll just forget about mascara and extensions and use growth serums instead"...Well, I hate to be the bearer of bad news, but this isn't better for those with sensitive eyes either.

Latisse, the only FDA approved eyelash growth serum, was approved in 2008 and was quickly followed by other non-prescription  growth serums flooding the market. Nearly ALL growth serums contain synthetic prostaglandins, which actually cause inflammation in your body. So if you use an eyelash growth serum, you're bound to end up with red, irritated eyes and eyelids, hyperpigmented skin, changes in eye color (light to dark), itching, and other complications.

If you want to try one that may be less irritating, try a non-prostaglandin formula like Ocusoft's Zoria. This still contains some potentially harsh ingredients, but it's the best of the bunch when it comes to those with dry, sensitive eyes.

Eyelid/Eyeliner Tattooing 

Although this doesn't fall under the quest for long, beautiful eyelashes, it does often go right along with it. Because some people with dry eyes cannot tolerate commercially available eyeliner, they turn to tattooing.

However, just like eyelash extensions, this is not without complications! Tattoo ink can cause allergic reactions and inflammation because it contains iron oxides, aluminum silicate, and carbon nanoparticles. Yum...This can cause bruising and swelling, allergies, infections, scarring, granulomas, blepharitis, and the ink will actually fade over time.

So, if you wanted black eyeliner, you may eventually end up with blue eyeliner. Great.

All women want to have lush, amazing eyelashes and defined eyes...but at what cost?

More Heavy Metal Toxin Solutions

There are so many ways that you can decrease the heavy metal exposure in your home. Above we discussed replacing your household cleaners, laundry detergents, dryer sheets, air fresheners, makeup, using more natural deodorant, and others to help reduce heavy metal exposure.  

Another great way to eliminate heavy metals in the body is by using chelating agents.  A chelating agent is simple something that binds to a heavy metal when it is exposed to it.  Chelating foods exist in nature and can be consumed on a daily basis to help eliminate heavy metals.  Adding sulfur rich foods, such as onion, garlic, eggs, cauliflower, brussel sprouts, and cabbage (remember, always organic), will aid so much in excreting heavy metals from your body.  Another easy one to add is cilantro, which can be added to avocado to make some delicious guacamole.

Toxins from Radiation | Block The Dangers of Microwaves 

Lastly, you can imagine that our exposure to all forms of radiation has increased in the past few decades. The microwave is a staple in nearly every household, we're all glued to our cell phones, and many of us work on a computer all day. Toxins from these electronic devices and even hair dryers and fluorescent lighting can all wreak havoc on our bodies. 

We need to combat this! 

Step one… Avoid exposure to the instigator…. I realize that you are not going to get rid of your smartphones or tablets or computers so let’s talk about ways to help avoid these problems.  

Your smartphone is probably the most radioactive device you come in contact with on a consistent and constant basis so let’s discuss ways that you can help reduce radiation.   To start, if you don’t need to be reached, turn your smartphone’s airplane mode on and check it every hour by turning airplane mode off and then turning back on when you are done with it.  

When at work, you don’t need to have your smartphone in your pocket.  Take it out and leave it in your desk in airplane mode. And lastly, at night. Turn your smartphone off, or turn airplane mode on for the night and plug your smartphone in across the room or even better yet in another room.  Don’t bring it into bed with you or put it on your nightstand. This will help promote better sleep, which we will discuss later.  

Try to avoid the use of a tablet or computer for long, extended periods of time on your lap.  And also just limit your time in general on all devices. Get outside, get some fresh air, and get moving by going on a walk after dinner.  You’ll feel much better and more energized than if you went and sat on the couch.  

For the microwave, try to figure out ways to not use it.  You wouldn’t believe how easy this is. Use a toaster oven to heat up leftovers (or your oven), or grab the cast iron skillet and reheat leftovers.  Boil water with a tea kettle on the stove instead of using the microwave.  

If you have to use the microwave, stand back 10 to 20 feet while it is running.  Not all the waves are contained inside that little box. Also try this recipe out:

Fill a wooden bowl half full with peat moss and half full with hazelnuts. Add 10 drops each of Tea Tree Oil, Rosemary oil, and Clove oil. Set the bowl on top of your microwave or other appliance. This will actually absorb any EMFs, microwaves, and energy radiation coming from the device you set it on!

As you can see, there are so many amazing ways to detox your home and your body. They don't have to be difficult or expensive, and these tips can make a world of difference in the amount of toxins you and your family are exposed to. We can't avoid them all, but we can all do a little bit each day to decrease our exposure and live a healthier life!

Toxins from Medications | Your Medication Could Be Causing Dry Eyes

In this modern world, sometimes it seems just about everyone is taking some kind of prescription drug – sometimes several —and the older the person, the more likely they will be taking more than one prescription medication. Many of these drugs have side-effects. They don’t always hit everyone, but if you are regularly taking more than one, the side effects can begin to add up. One common side effect to be aware of is dry eye!

Have you noticed your eyes becoming dry, feeling like there are scratches on them, or just that you need to blink several times to get a little moisture going? The root cause may lie in your medicine cabinet. Here are several common drugs that can cause dry eye symptoms.

Antidepressants. Antidepressants change chemicals in your brain, which means messages traveling through your nervous system get rerouted and reinterpreted. Any drug that operates in that manner, including ones used for the treatment of mental health issues, can have a negative impact on vision, disrupting the messages received by the cornea (the front of the eye) and optic nerve (the back of the eye). 

As an example, Prozac is reported to have side effects including eye pain, double vision, dry eye, and inflammation of the eyelids.  A few other examples are Zoloft and Paxil.

Antihistamines and Decongestants are medications that block histamine receptors.  Decongestants especially target the eyes and nasal areas because the symptoms they treat are itchiness and runniness of the eyes and nose, and they do this by drying out those areas. If you suffer from allergies and dry eye problems, consider checking with your doctor for something other than over-the-counter drugs. Allegra can often help with both problems because it is site-specific in its effects. If possible, taking an allergy formula without the decongestant can also help.

Hypertensive Agents like Beta Blockers. These are generally prescribed for those with chronic high blood pressure, heart attacks, and migraines, and one of their primary side effects is dry, itchy, and painful eyes. Watch out for this!  Beta blockers cause dry eye be reducing aqueous production from your lacrimal gland. Some others to be aware of are hydrochlorothiazide (HCTZ) and other diuretics.  

You can do something about this.  Talk to your physician about switching to another high blood pressure medication that does not cause dry eyes.  I am in no way saying that you should go off your blood pressure medication because you're probably on that for a very good reason and a heart attack is a lot more deadly than dry eyes. Just make sure you talk to them about alternatives. Speaking of alternatives to medication, a healthy diet, exercise and hydration can really make quite an impact on blood pressure as well.

Oral Antibiotics. Most of these can cause dry eyes, but Amoxicillin and Penicillin can also both cause itching, dryness, and redness of the eyes. For some, they even cause problems with balance – so while taking oral antibiotics, consider adding in some Vitamin C and a probiotic to counteract some of the worst side effects.

OTC Pain Relievers. If you are on a regular regime of over-the-counter pain meds such as ibuprofen or acetaminophen, you may also experience dry eye symptoms. If so, try lowering the dosage slightly and drink more water to help solve the problem.

Hormones and Birth Control. Anything that messes with the hormones in the body is going to cause dryness issues. This is often the reason why many women in menopause experience dryness.  A few examples include Hormone Replacement Therapy (HRT) with estrogen, or even progestin. This is pretty commonplace in a lot of women that are postmenopausal. So, you might be in this group. There are additional ways that you can combat the negative effects of HRT, and these include hydration and eating a well balanced, vegetable rich diet.  

Accutane is taken for severe acne in teenagers and adults, but it can have dire side effects.  It actually can kill off your meibomian glands and cause them to atrophy leaving you with no lipid layer of tears, which will lead to severe evaporation and very dry eyes.  Accutane is just a form of vitamin A in really high doses, which is definitely not good for your eyes. It’s a well known cause of dry eyes. Avoid this at all costs and look for other ways to help calm your acne.

Gastrointestinal Medications: Prevacid, Prilosec, Nexium, Zantac, and Tagamet

These medications are proton pump inhibitors and help with GERD (acid reflux).  Acid reflux, gas, and other digestive issues can usually be resolved by figuring out what foods or drinks are causing the issue, and eliminating those.

Up to 60% of Chemotherapy patients develop dry eyes. The most well known medication to be of issue is Cytoxan. This is also, interestingly enough, used to treat some ocular conditions, such as Sjogren's syndrome, but as many as 60% of patients that take this medication develop dry eye. 

Antipsychotic Medications to manage Schizophrenia. Finally, antipsychotic medications for schizophrenia can cause dry eye as well. They usually decrease your aqueous secretion and symptoms are usually dose dependent. So, if you take a higher dose of course you're more likely to have dry eye.

This section on decreasing toxins was probably extremely overwhelming with a lot of information.  Like I said previously, I made a checklist that you can move down at your own leisure, and I recommend making one to two changes per week until it is habit or until the more natural way takes over your way of doing things.  

ACTION ITEM

1. Print the checklist at www.RethinkingDryEye.com under the Toxins tab and make 1-2 changes per week to decrease toxins in your life.

                a. Move through the whole list until you complete it.

Lifestyle Modification #1: STOP Smoking  

Smoking affects dry eye in two different ways.  The most devastating way is through the inhalation of numerous toxins and chemicals that flood your bloodstream with free radicals, which, as discussed above, increases your risk for dry eye, heart disease, and cancer.  Secondly, the actual smoke is an eye irritant as well.  

I don’t need to go into more detail, as smoking has been proven over and over again to cause problems and you have probably heard it ad nauseum. If you smoke, there’s never been a better time to quit!

Lifestyle Modification #2: Avoid Fans  

Direct wind can cause a lot of irritation, whether it be from air conditioning or heat in your car, overhead or direct fans at home, and natural wind from mother nature.  Turn your vents and fans away from your face if you need to have them on.

To block natural wind, wear a great pair of polarized sunglasses that wrap well and provide a barrier of protection.

Lifestyle Modifications #3: Wear Polarized Sunglasses  

As stated above, find a pair that wraps well and blocks the wind, but any sunglasses are better than none. Make sure you’re wearing sunglasses whenever you’re outdoors. Sunglasses are not just for sunny days! UV radiation can enter the eye even on cloudy days, and getting into the habit of wearing them means your eyes will always be more comfortable. 

Lifestyle Modification #4: Avoid Excessive Phone, Tablet, and Computer Use

So, why do your eyes feel tired after a long day? There are many causes of eye fatigue, but a huge culprit is the technology we're surrounded with daily. Working on a computer or even on your smartphone throughout the day can make your eyes much more tired. This occurs because, when you go to look at something small and close to you, the ciliary muscle inside your eye contracts and changes the focusing system of your eye to allow you to view up close. This small muscle is so important because it controls your ability to focus far away, up close, and at all distances in between!

The longer this muscle has to work, the more eye strain you may feel (the ciliary muscle gets tired just like your other muscles do after a weightlifting session!) Also, working on a computer that emits blue light means that the contrast of what you're viewing is decreased, making it tougher to see clearly.

Eye Strain Symptoms

Like I stated previously, eye strain is an annoying condition which often plagues us with vague symptoms. For those who have experienced it, you know this is true! But did you know that your computer, tablet, and phone use is contributing to your dry eyes?

When someone complains of eye strain, they may complain of blurred vision, pain in or around the eyes, dry eyes, headaches, general fatigue, and even double vision. 

How To Relieve Eye Strain

There are quite a few great ways to relieve eye strain. First of all, you need to give your visual system a break throughout your work day or while working on small-print or needlepoint tasks.

We love to employ the 20-20-20 Rule. This is how it works: Every 20 minutes, look up from your computer (or cell phone, needlepoint project, etc) and look 20 feet away for 20 seconds. Set a timer! This is the best way to ensure that you're giving that ciliary muscle a rest every once in awhile. It’s also a great way to ensure that you’re fully blinking, which we neglect while doing near work.

It is often hard to start a new habit, especially if it is a healthy one. In order to remember to take eye breaks every 20 minutes, it might be helpful to set the alarm on your cell phone. However, this is distracting if a person works in a cube in close proximity to other people, so an alternative might be to set your timer to vibrate until you get in the habit of naturally taking a short eye strain break every 20 minutes.  There are also apps and a Chrome extension that will pop up every 20 minutes to remind you to take a break.  

Also, make sure to adjust the lighting in your work space. Like stated earlier, dark work environments make your eyes work harder, which isn't what you want. Make sure your lighting is good!

Lastly, grab yourself a pair of blue light blocking glasses (or have blue light technology put into your prescription lenses). This technology helps prevent too much blue light from entering your eyes and can help relieve symptoms of eye fatigue and dryness while you work throughout the day. They can also help you sleep better, so that's a welcome bonus! 

Blue Light Blocking Glasses

If you're in the market for a great way to decrease eye strain and dry eyes while you're working, look into a pair of blue light blocking glasses. The slightly yellow lenses help to absorb blue light from your computer and smartphone screens and protect your eyes from the damaging effects of blue light.

Blue light not only causes eye fatigue and makes it more difficult to fall asleep and stay asleep at night, but studies are also starting to show that excessive exposure can put you at risk for macular degeneration. To prevent this, we recommend wearing blue light blocking glasses throughout your work day while you're on the computer or your smartphone.

If you wear prescription glasses, talk to your optometrist or wherever you buy glasses about getting a blue-light blocking coating added to your lenses.  You can also request a prescription for computer lenses and not have to use your distance prescription on the computer.

Lifestyle Modification #5: Chiropractic Adjustments

Above, we discussed chemical interference on our body with what we put in our body (food and water).  Chiropractic focuses on eliminating the physical interference. This can be one of the simplest steps that you can take to make a difference in your life.  According to Dr. B.J. Hardick in his book Align Your Health, when you routinely visit a chiropractor the adjustments are very simple but can have a profound effect on removing interference in your body and allowing it to heal more naturally.  This is the first step that he recommends, as it is the easiest and can be the most impactful. 

Chiropractic is primarily focused on the nervous system, which affects every part of your body. Think about the anatomy of the spine.  Your brain is attached to the spinal column, the spinal column releases nerves, which communicate with every organ and cell inside your body.  If there is a blockage in these nerves then the organs and cells will be affected by the lack of communication. This limitation by the blockage will reduce the ability of everything else that you are doing to live a healthier life.  

As I write this book I am in my third week of chiropractic care, as I was dealing with debilitating back pain that made it so I could barely play with my son.  After three weeks of care, I was able to run three miles pain free, which I have not been able to do in about two years. Due to me allowing this problem to go on for so long, I will be under chiropractic care three times per week for twelve weeks, then reduce to once a week for maintenance.  

Poor posture, trauma, and stress can all cause problems with your spine.  Visiting a local chiropractor can help improve your health physically and profoundly.  If you are unsure of which chiropractor to visit I recommend looking up a MaxLiving chiropractor. I have no affiliation with MaxLiving, and I’m just a very happy customer that had their life changed as a result. 

Lifestyle Modification #6: Believing in Yourself

In today's world, we've become so accustomed to dealing with diseases and ailments with medications. Which drug works best? What pill can I take to feel better? What eye drop is going to cure my dry eye?

Unfortunately, these are questions doctors now hear on a daily basis. But have you ever considered the role of your mind in healing your dry eyes? Since it may be much easier to simply take a pill or even make diet changes to control dry eyes, we often forget about the power of belief and the way we interact with the world around us. 

Past studies have suggested a strong power in the placebo effect, meaning that the patient will feel relief even when no medication is truly given (the effects are much greater when they believe they have actually been given the medication). It is truly fascinating that the effects of a drug are greater when the subject actually believes they're receiving the drug (or they see it being administered) vs. when they are unaware of the drug being delivered. 

Stated in a different way, the placebo effect is basically getting better from a sugar pill or a sham treatment and the reason that it happens is it actually causes a neurobiological change within your body, where dopamine is released.  It's pretty amazing that belief can shape the way that your treatment works.

Past studies have suggested a really strong power to this placebo effect and a lot of us are unaware that it can happen, but your beliefs can actually make you feel better. So, if you believe that your treatment is going to work then you're much more likely to be successful with that treatment then if you don't believe it's going to work. If you go into it and you say “This is just going to be another treatment, it's not going to work, it's going to be another waste of my money” it's definitely not going to work for you because that's a bad attitude to start with. But if you go into a treatment with a good attitude, you're much more likely to have a good outcome from it.

Can Your Beliefs Help You Find Relief?

Recent studies imply that there's not just an objective aspect to disease, but that there is a subjective aspect as well (which may be difficult to measure in studies). You may very well have dry eye disease, but your belief that you will get better plays a dramatic role on your treatment journey.

One of the greatest tools you have is belief in yourself. Without this, none of the results you wish to achieve will occur. If you want to live a healthier life and finally find relief for your dry eyes or other ailments, you just have to believe you can do it. It sounds cheesy, but it can very well be the missing link in your search for health. For example, we often see patients stop their treatment regimen when it's not going well or even make changes to it constantly. You just have to keep pushing forward and BELIEVE that you can get through the tough time. 

This also goes along with faith. If you have faith in the treatment you are performing or in the medication you are taking than you will perform better.  Also if you are Christian or Islamic or Hindu or whatever you believe in, you will tend to heal faster as a result of having this faith, and believing in something more than yourself is going to help in the healing process. 

We always talk about doing meditation. Believing in something other than just what's around you can actually cause you to experience a more enhanced life because you have faith in something other than just the physical being that is in front of you.

One of the greatest tools that we have is the belief in ourselves.  Without this, none of the results that you want to achieve are going to occur.  If you're setting out on a healthy lifestyle journey and you truly believe you can make positive changes that will affect not only your eyes but your overall health as well, it's the belief in yourself that will get you to the top successfully. It might sound really crazy, but it can be the missing link in your search for health.

I really believe that you can live a healthy lifestyle no matter what.  We hear all too often from patients “Oh I'm big-boned, so I can never lose weight,” or “Diabetes runs in my family.” This is the biggest false belief. It's just not true. It is a series of lifestyle choices over time that put you in the position that you are in.  THIS IS NOT YOUR FAULT. It is the false information that the media throws around of what is and isn’t healthy. Believing in yourself and believing that you are strong enough (because you ARE strong enough) to make the changes to help your lifestyle, to help eliminate your dry eye, and to help eliminate chronic disease is the most important thing you can do.

Do you have that belief in yourself?

Lifestyle Modification #7: Sleep

Sleep is one of the best ways for your body to restore and heal itself from all the damage we put it through, throughout the day.  This is a time for your body to recover from the constant toxic exposure. When we sleep we have more energy for creating new, healthier cells (if following a plant-based diet) to replace the unhealthy cells that no longer work as efficiently.  Try to get at least seven hours (eight is ideal) of sleep per night, and listen to your body! Sleep helps restore the tear layer and repair the surface of the eyes. Most people don’t prioritize sleep like they should. They instead stay up late watching TV or playing on their smartphones.  What is more important, liking that Facebook post or healing your dry eyes (along with all the other great benefits of sleep)?

Sleep Benefits

Getting sufficient sleep (seven to eight hours) has many benefits which include getting sick less often, less brain fog and thinking more clearly, greater ability to focus and concentrate, better mood, better will power to make better decisions, weight loss and maintaining a healthy weight, lowering your risk for serious health problems such as diabetes, heart disease, and dry eyes, allowing your body to repair, better memory, and reducing stress.

Here are some tips on getting better sleep

1. Get 10 to 30 minutes of sunlight in the morning.  More on this below. 
2. Cut off electronics 2 hours before sleep (TV, Phones, Computers).  After the sun goes down, blue light is reduced, which causes an increase in melatonin production, which is your sleep hormone.  All our screens emit blue light therefore preventing this production from occurring. Turning off your devices will help with this. 
3. Wear Blue Light Blocking Glasses when working on a phone, computer or watching TV AND 3 hours before bed.  This will help with the melatonin production as discussed above.
4. Get into your bed at the same time every night (wind down with a paper book). We recommend thirty minutes before going to bed.
5. Get 8 hours of sleep scheduled (go to sleep and wake up at the same time everyday).  Consistency is one of the best ways to fall asleep easily and sleep well through the night. 
6. Turn fans and vents away from you.  The constant breeze from these will cause dryness in your eyes. 
7. Make your room pitch black with black out curtains.   The darker your room is, the better you’ll sleep because any light can disrupt your sleep patterns. 
8. Plug your phone in another room to get rid of it as a distraction and turn it on airplane mode, unless you really need to get notifications in the middle of the night (in case of emergencies). 
9. Remove the TV from your bedroom (bedrooms are for sleep and sex only).  It just keeps you up longer and disrupts your sleep. 
10. Diffuse Lavender into your bedroom starting at 7:00 pm and running all night.   This will help reduce toxins in the bedroom and put you in a calmer state. 
11. Avoid caffeine after noon and avoid alcohol.
12. Move your body.  Exercise and physical activity can help you fall asleep and stay asleep.  Also avoid exercising before bed and try to do it in the morning if you can.
13. Fast before bedtime.  Make your dinner the last thing you eat for the day and don’t eat until breakfast.  Fasting has other health benefits as well, but will help you sleep and will help your body recuperate.
14. If you stay up at night worrying or feeling anxious, try some of the stress techniques outlined below.   Yin Yoga or meditation right before bed could help you fall asleep much faster.  

What does getting 10 to 30 minutes of sunlight in the morning do for you? 

Sunlight in the correct doses is very good for health.  The sun is our ultimate energy source that provides us life on earth.  With that being said it is very powerful and should be approached with caution.  The sunlight we are recommending is before 10:00 am. According to Dr. Jack Kruse, neurosurgeon and longtime proponent of morning sunlight,

“Sunlight releases a[n] opiate (ß-endorphin) when we are exposed to the sun. Guess why nature did that? Could it be that she wanted us going in the sunlight often for its healing powers? …It turns out that the combination of [ultraviolet] and [infrared] solar light humans are designed to get in the AM also pre-treats the skin to lower inflammation. The fact that [UV] light induces a small opiate response tell us nature is trying to get us to come out into the solar light in the morning.”

Who doesn't like a good sunbath?  Getting as little as 10 minutes of sunlight in the morning can provide numerous health benefits for you later that day and for overall health and vitality.  

A reduction in Vitamin D plays a large role in a ton of chronic diseases including dry eye, asthma, type II diabetes, high blood pressure, and more.  Your skin will absorb the morning sunlight to be used later in the day for vitamin D production which helps reduce the risk of these diseases.

Speaking of using later in the day, morning sunlight increases your serotonin production, which your body converts into melatonin later in the day.  Melatonin is increased when the sun goes down, and it starts to signal to your body to go to sleep. 

Avoid phones, TV's and other electronic devices at night as this inhibits melatonin production therefore leading to worse sleep.  Wearing a pair of blue light blocking glasses will also help with increasing your melatonin production.

Sunlight helps increase endorphins in the body, which help to decrease stress and anxiety as well.  

Sunlight has numerous other benefits as well: 

1. Increases melatonin at night and regulates your circadian rhythm, which is your sleep cycle 
2. Increases your vitamin D production
3. Reduces risk of cancer
4. Reduces major chronic diseases
5. Positively affects endocrine and hormonal levels
6. Improves mood and feelings of well being

Lifestyle Modification #8: Reduce Stress

Life comes at us at such a rapid pace, it is no wonder mental and emotional health is difficult to keep in check.  Depression and anxiety are at an all time high. Emotional stress can cause hormonal shifts, weight gain, and inflammation.  So, what is stress?

Adrenaline is pumping through your body, eyes are dilated, palms are sweaty, heartbeat speeds up, muscles tense, breath is short… Sound familiar?  This is your body’s “fight or flight” response that occurs when you are in a stressful situation.  

Your nervous system releases hormones that prepare you to fight whatever the offending agent is or to run.  This is your body’s short-term response to stress and it recovers quickly from this. This is a survival mechanism in the body and does more good than harm.

Cortisol, or the "stress hormone," is an absolutely essential part of your normal health and function helping control blood sugar levels, regulate metabolism, help reduce inflammation, assist with memory, and help control blood pressure. 

However if this stress is present over a long period of time (chronic stress), it can lead to more serious health problems. Aging more quickly, decreased immune system, and higher disease prevalence are just a few of the problems that can occur due to long term stress.

Stress’s effects on the blood and circulatory system are what is thought to cause dry eyes.  Blood is thicker, blood pressure is increased, and blood supply to extremities (legs, skin, arms) is decreased, which also affects the eyes and brain.  This decrease in blood supply is thought to cause dry eyes.

What Causes Stress?  

Everything causes some kind of stress on the body.  It can be good stress and bad stress. When we typically hear the word stress, we think of bad stress, which can be caused by any of the following: 

• Disability 

• Death

• Divorce

• Getting Fired

• Unemployment

• Lack of job satisfaction

• Money 

• Chronic disease

• Injury

• Depression, anxiety, anger, grief, low self-esteem or other emotional problems

• Traumatic events like theft, rape, or violence against you

• Natural disasters such as hurricanes, tornadoes, or floods

• But not all stressors are bad

                - Marriage

                - Moving

                - Taking care of family

• MOST IMPORTANT = YOUR ATTITUDE

                - How you view the world

                - How you react to a particular situation

                - Unrealistic expectations

How To Relieve Stress. 

Tip #1 Get Grounded  

Grounding is the practice of getting back in touch with the naturally negative charged free electrons that the earth has.  Research has shown that if you place your bare feet on the ground (grass, beach, ocean... not concrete) after injury, electrons from the earth will migrate into your body and spread through your tissues.   

During injury when our immune system responds, it releases many chemicals that create an inflammatory cascade. One chemical released is reactive oxygen species, or free radicals, which can leak into healthy tissue causing inflammation in non-injured tissue.  When grounding, electrons from the earth travel to this area and naturally bind to these free radicals, neutralizing them and making them harmless.  

This is a process that is CONSTANTLY going on in your body, so grounding daily is very beneficial.  You have probably heard people talk about the power of the beach and ocean? That is because we finally take our rubber-soled, electron-blocking shoes off and walk barefoot.  You can also sit outside with your bare feet in the grass.

According to the Journal of Environmental and Public Health, grounding benefits can include better sleep and reduced pain (from decreased inflammation). 

Tip #2: Just Breathe / Meditation

According to Merriam-Webster, meditation is to engage in mental exercise (such as concentration on one's breathing or repetition of a mantra) for the purpose of reaching a heightened level of spiritual awareness.  Now before you think I am going all spiritual, or foo-foo, on you, please read this whole short section.  

What if you could meditate in as short as 10 seconds per day?  

What if this meditation could decrease stress levels, therefore decreasing your risks of disease, such as dry eyes, heart disease, neck pain, and more?  

Meditation does NOT have to be an ultra spiritual, out-of-body experience only reserved for Buddhists in the mountains of Nepal.  It can be, but it can also be highly beneficial for other reasons. 

For this article, I am going to teach you how to do meditation to help decrease stress levels in as little as ten seconds by simply doing one thing…

Deep breathing.

How to Meditate to Decrease Disease Risk by Breathing Deeply

This simple meditation technique can be used ANYWHERE. It can be beneficial whenever you’re feeling stressed, depressed, anxious, nervous, or just need to get refocused.   I use it several times a day when I am feeling flustered and need to get refocused or less stressed.  

1. Close your eyes
2. Take a slow deep breath in.  This deep breath in should take five seconds and you should count the five seconds in your head.
3. Hold your breath for two seconds
4. Then a long slow exhale for five seconds

INHALE FOR                                      1… 2… 3… 4…

HOLD BREATH FOR        5… 6… 

EXHALE FOR                                     7… 8… 9… 10…

I have a simple meditation guide and video for you at www.RethinkingDryEye.com under the Lifestyle Modifications tab.  

Tip #3: Yin Yoga

According to Wikipedia, Yin yoga is a slow paced style of yoga with postures, or asanas, that are held for longer periods of time, usually 45 seconds up to five minutes or more. Yin yoga increases circulation in the joints and improves flexibility.  Yin yoga can also be combined with meditation and it aims at cultivating awareness of silence and interconnecting with your purpose or higher being.  

This also allows us to slow down the mind, stretch the muscles, and reduce our stress and anxiety, which will help you fall asleep at night.  We tend to start our yin yoga practice around 9:00 pm at night and then go to sleep afterwards.  

The practice is usually 15 minutes to 60 minutes.  You can do a quick and easy search on YouTube for Yin Yoga or visit RethinkingDryEye.com under the stress tab, to see some of my favorites.  

Tip #4: Gratitude Journaling

This is by far one of the best tips on this list and another favorite of mine.  Gratitude journaling is as simple as writing down three or more things everyday in a paper journal.   Keep a paper journal beside your bed with a pen. Every night before you go to sleep, write anything that happened during that day that was positive and that you are grateful for. 

Expressing gratitude on a nightly basis will help you look for positivity in people and the world around you because you are starting to train your brain to do so. Also, avoid negativity like the news, complainers, and drama.  

Gratitudes can be large or small.  Here is an example journal entry:

1. I am grateful for Jenna doing the laundry today and making lunch for me.  

2. I am grateful that Jude is feeling better after a stomach ache from last night.

3. I am grateful for the Espresso roast coffee that I had this morning.

4. I am grateful for having the freedom to be able to watch the World Cup even though the US Soccer team did not make it :( 

5. I am grateful for a beautiful sunny day.  

Tip #5: Mind Dump Journaling

We live in an overwhelming world.  Do you ever feel like you have WAY too much to do and you can't figure out what to do first, so you end up doing nothing at all?  This is a result of that overwhelm. There is an easy way to deal with overwhelm, and it is what I like to call mind dump journaling.  

1. This is where I like to put on a 20 minute meditation song or video and write down absolutely everything I have to do for work, health, personal life, for my wife and son, and anything else that comes to mind. 
2. After about 5 minutes, take a look at your list and circle the most important ones on your list. 
3. Ask yourself, what is most important right now?  You should have less than 10 items circled on your list.  Label these items in order of importance, one being the most important and 10 being the least important. 
4. On a separate sheet of paper, write the top three things you have to do as labeled one, two, and three.

Focus on finishing number one, before ever thinking about doing number two.  Once finished with number one, move on to number two, without ever focusing on three.  

Continue this process whenever you have a state of overwhelm.  

Tip #6: Get Rid of Your Victim Mentality… Cause Is Greater Than Effect

As Tony Robbins says, “What if life is happening FOR us and not TO us?”  What this means is that we need to stop thinking that everything that happens in our life is happening TO us.  Stop being the victim and reacting to all scenarios. You get to choose how you react to that person cutting you off or your colleague making fun of you.  If you start thinking of life happening FOR you, you start to think about what you can learn from the situation.

Instead of being reactive, be proactive.  Choose to not react to the guy cutting you off or the baby crying or the traffic accident that caused you to be late to work (at least you’re not in the accident).  If something happens to you that is less than pleasant, close your eyes and take a deep breath. 

Go over tip #2 again, meditation.  That is the exact technique I use multiple times per day to avoid these problems and stay on the CAUSE side of the equation.  This technique can save you from doing something that you will regret for the rest of your life.  

Tip #7: Don’t Sweat the Small Stuff, and It’s All (almost) Small Stuff

We tend to stress out about every little thing that happens in our lives.  What if you approached each problem that you came across as just a small bump in the road?  I do realize that there are some things that are harder to overcome than others, like a job loss, death in the family, or something worse.  But for the most part, everything we stress over on a day-to-day basis is pretty small and inconsequential.  

How I like to think of this is when I start to get upset, I ask myself “Will this matter five days from now?”  If it will not, then it is something small and not anything to worry about. 

Tip #8: Eliminate Bad Fats, Increase Good Fats

Here it is again.  The importance of good fats in your diet.  Eating fats in our diet has received a bad rep for several years, but not all fats are created equal.  If you increase the amount of good fats in your diet, this will significantly reduce your dry eyes, depression, and anxiety.

Eliminate, or eat in moderation, bad saturated fats.  These are found in most foods in the Western diet. This includes fried foods, baked goods (cookies, cakes, pies), most desserts (ice cream), most fast foods, pastries, mayonnaise, and more.  

Instead focus on whole foods that are high in quality omega-6 and omega-3 for your fat intake.  Some of the best sources of omega-3s include fish oil in salmon, sardines, halibut or you can take an omega-3 fish oil supplement. Vegetarian sources include flax seed, chia seeds, walnuts, brussel sprouts, kale, and spinach.

Tip #9: Laugh

Laughter could very well be the best medicine.  Here are just a few of the benefits of laughter: relaxes your whole body, boosts your immune system, releases endorphins (happy hormones), protects the heart, burns calories, and may even help you live longer. 

ACTION ITEM

1. Print the checklist at www.RethinkingDryEye.com under the Lifestyle Modifications tab and add or change one thing per week.  There are also accompanying video tutorials for some changes.

I know by now you are probably thinking… I thought this book was about dry eye and how to treat it.  The single most effective way to treat dry eye is to detox your life, hydrate yourself, change your diet, exercise, decrease stress, and sleep better, which I discussed in the first part of this book.  

The goal of everything we have gone over so far is to bring your body’s homeostasis back to normal, which in turn will decrease inflammation and damage throughout the body.  This will decrease inflammation on the eyes, increase tear film stability, decrease damage on the surface of the eye, and therefore decrease your dry eye symptoms.  

You will notice instant relief from some of these changes, like when you start drinking the correct amount of filtered water per day, but most of these changes take time to fully work.  The damage that has been done to your eyes and body was an accumulation of events over the last months, or years, or even decades of your life.  Getting back to normal will take time and dedication.  

Follow what we outlined in the book above, along with a few simple at home dry eye remedies, and you will feel results.  

Let’s now discuss the different ocular surface diseases like dry eye, blepharitis, meibomian gland dysfunction, demodex, and rosacea and how these all play a role in how your eyes feel and how they contribute to dry eye symptoms.  After that we will discuss treatments for each condition. The good news is that most treatments, for all these conditions, are very similar and we will show you a very simple daytime and nighttime routine to help with your symptoms.  

If you want to skip right to the routines to get started on those right away, head to www.RethinkingDryEye.com under the Dry Eye Treatment tab where we have made videos for you as well as a daily dry eye checklist.  

Also, full disclosure, in this section we will be discussing a few different products to help with the conditions listed below and to help with finding relief.  Some of these products are ours, and we have come out with these products as a result of years of practice and seeing what works.  

If you purchase our products, from Eye Love and Heyedrate, which I mention by name, GREAT!! :) 

If not, don’t disregard the messaging as a sales message, but take action on the message itself.  An example of this is increasing your omega-3 intake with our Heyedrate Omega-3 supplement. Don’t think I am just saying this because we sell an omega-3.  We released an omega-3 because we saw the importance of it. Taking a good high quality omega-3 is the goal of that statement, and if you decide not to take ours, that is okay. 

With that out of the way, let’s dig in...

Let’s go back to the DEWS II (The Tear Film and Ocular Surface Society’s Dry Eye Workshop in 2017) definition of dry eye, in which it states that inflammation is one of the key reasons for dry eye.

“Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

Let’s break down this definition a little bit to make it more palatable.  “Dry eye is a multifactorial disease” means that there isn’t one thing that is causing your dry eye. It is a combination of a lot of things that may be causing it to occur.  The problems that are occuring lead to “loss of homeostasis of the tear film,” meaning that the tear film is no longer functioning like it was designed to.  “Accompanied by ocular symptoms” means that you may notice the typical dry eye symptoms listed below.

“Hyperosmolarity” means that the tears actually contain a high salt content, which is a sign that there is “ocular surface inflammation and damage.”  Damage to the ocular surface means inflammation, or irritation, on the front surface of the eye.  “Neurosensory abnormalities” means that the nerves of the eye are damaged and you may not have as much “feeling” in the eyes as you used to or nerve innervation is not what it used to be. On the other hand, your eyes may become even more sensitive. 

Dry Eye Symptoms

Tears рlау a key role in promoting сlеаr vіѕіоn, warding оff infection, and keeping the frоnt ѕurfасе оf thе еуе сlеаn, moist, and comfortable. We will go into more information on the tears and the three layers that are involved in a later chapter.  

Symptoms of dry eye can include:

• Stinging, burning, or gritty feeling in the eye
  

• Stringy discharge from the eye

• Blurry vision, double vision, or vision loss

• Light sensitivity

• Redness of the eyes

• Decreased tolerance of activities requiring prolonged periods of visual attention (such as reading or working on the computer)

• Eye fatigue

• Discomfort when wearing contact lenses

• Excess watering of the eyes, followed by periods of dryness

Why Is My Eye Watering?

This is probably one of the most common symptoms we hear in our clinics regarding dry eyes.  And when we tell our patients, “Your eyes are watering because you have dry eyes”, they look at us like we have two heads.  

You know the feeling. Your eye keeps watering. It just won't stop! You continue to wipe away the tears. You're not crying or emotional, but your eyes just won't stop pouring. For some, this can be not only debilitating but embarrassing as well. So, what could be going on?

Believe it or not, epiphora (the medical term for teary eyes) occurs because the eyes are dry. How can this be? Well, the tears of your eyes are made up of three layers, and these three layers must function properly for the eyes to feel and look great. If even one of the layers is not doing its job, the other layers end up running off of the front surface of the eyes...right onto your cheeks.

What Are The Causes of Excessive Eye Watering?

Let's dive in a little deeper into why your eyes might be watering. Your tears are composed of three layers; An oily (lipid) layer, a watery (aqueous) layer, and a mucin layer. The outer layer of the tear film is the oil one, which seals in the tears and prevents evaporation. The lubricating watery layer is in the middle, and the innermost layer is the mucin layer, which functions to keep the rest of the tears stuck to your eyeball.

When you have meibomian gland dysfunction (MGD), dry eye, or blepharitis, the layers of the tears are disrupted, which can lead to watery eyes. Also, if your eyelids are not positioned tightly against your eyeball, the tears that should stay on your eyes may begin flowing down your cheeks. Another reason for epiphora may be a drainage problem, meaning that the tiny hole where the tears drain may be closed off (this is known as nasolacrimal duct obstruction).

Dry Eye Causes

There are a number of rеаѕоnѕ whу уоu may be getting drу eyes. Aѕ wе get оldеr, thе rіѕk оf getting drу еуеѕ increases, but thеrе аrе ѕоmе mеdіcаl соndіtіоnѕ, mеdісаtіоnѕ, аnd lifestyle factors that саn mаkе уоu mоrе lіkеlу tо develop drу eye:

• Mеdісаtіоnѕ ѕuсh as antihistamines, nasal dесоngеѕtаntѕ, hоrmоnе rерlасеmеnt thеrару, birth соntrоl pills, аntіdерrеѕѕаntѕ, retinoids, dіurеtісѕ, and blood pressure mеdісіnеѕ

• Allergies thаt affect your eyes

• Infrequent blinking due to ѕtаrіng at соmрutеr ѕсrееnѕ or еlесtrоnіс dеvісеѕ for long реrіоdѕ of tіmе

• Long-term uѕе of соntасt lеnѕеѕ

• Cоmрlісаtіоnѕ rеѕultіng frоm rheumatoid аrthrіtіѕ, luрuѕ, Sjоgrеn'ѕ ѕуndrоmе, аnd other аutоіmmunе dіѕоrdеrѕ

• Chrоnіс соnjunсtіvіtіѕ

• Skіn соndіtіоnѕ, such аѕ psoriasis оr rosacea

• Fat malabsorption or dеfісіеnсу

• Nutritional dеfісіеnсіеѕ (lіkе discussed above, vіtаmіn A оr vitamin B12 dеfісіеnсу)

• Cіgаrеttе ѕmоkіng and alcohol use

Our рrесіоuѕ еуеѕ wіll ѕеrvе uѕ for a lifetime, so it іѕ important that we сhооѕе the right ѕоlutіоn to our еуе problems. We want the kind of treatments that not only treat the ѕуmрtоmѕ, but dіrесtlу аddrеѕѕ thе root саuѕе оf those problems. Thе same рrіnсірlе аррlіеѕ tо drу еуе; a major vision concern аffесtіng аn еѕtіmаtеd 30 mіllіоn Americans, whether they know it or not.

Thе саuѕеѕ of dry eye range from іmmunе dіѕоrdеrѕ to the more common causes, like a lасk of tear production. Aѕ a result, thіѕ рrоduсеѕ іnflаmmаtіоn аnd the surface of the eye аnd the inner еуеlіds bесоmе drу.

Some ѕуmрtоmѕ mау include itchy еуеѕ and ѕеnѕіtіvіtу tо lіght. Bеfоrе ѕееkіng ѕоlutіоnѕ yourself, it іѕ сrіtісаllу important to соnѕult уоur еуе саrе рrоfеѕѕіоnаl in mоrе ѕеrіоuѕ саѕеѕ. Fоr еxаmрlе, Dr. Emil Sеnау, the mеdіcаl соrrеѕроndеnt fоr thе CBS Early Show, ѕtаtеd thаt, in ѕоmе cases, сhrоnіс dry еуе mау bе аn іndісаtіоn of dіаbеtеѕ аnd, if left untrеаtеd, саn lеаd to соrnеаl іnfесtіоnѕ and corneal ѕсаrrіng that may damage thе еуеѕ.