Hey everyone! Welcome to The Dry Eye Show! I'm Dr. Travis Zigler and I'm Dr. Jenna Zigler, coming at you live on July 15th. Thank you for joining us and let us know where you're from and let us know if this is your first time joining us.
We also have an announcement. Prime day is actually tomorrow and Tuesday and we have our prime day sale on our Heyedrate products going on today. So, click the link in the description or in the comments below and then make sure you head over there. There's a 20% coupon there if you buy on our website and there's also a 10% coupon if you buy on Amazon.
So, we're going to go over something first here and it's something that we get a lot of questions on. So, let's dive right into it.
We're going to go over a list of medications that cause dry eye and the first one that comes to mind is hypertensive agents, or high blood pressure. A lot of physicians prescribe beta blockers to treat blood pressure, heart attacks, migraines. These reduce certain things in your blood and it also reduces your aqueous production, which leads to dry eye. Some other guilty parties are Thiazide, which hydrochlorothiazide is the very most most common one that people take, and then diuretics are also prescribed for high blood pressure.
What you can do is if you're on a beta blocker, hydrochlorothiazide, or any diuretics, and you're having problems with dry eye, talk to your physician about taking another blood pressure medication. 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 some alternatives that you could probably do.
Doing the things that we talked about with diet, exercise and hydration can really make quite an impact on blood pressure as well.
Zyrtec, Benadryl, and Other Antihistamines and Decongestants
Number two is antihistamines and decongestants. Most of you already know this, but these are medications that block histamine receptors. They're great for allergies, systemic allergies, nasal conditions, and even itchy skin. If you get a rash or something like that you take Benadryl and that is a major one. Then even things like Claritin. They say that the newer, more site-specific antihistamines, because they only target one histamine receptor (and those are Zyrtec, Clarinex and Allegra), they say that those are better as far as dryness goes, but I beg to differ. I don't think that there's that much difference. You're still going to get dryness with those antihistamines and even things like decongestants are also going to do the same thing.
So, any type of antihistamine or decongestants.
Hormone replacement therapy (HRT) with estrogens
The third medication that can cause dry eye is Hormone Replacement Therapy or HRT with estrogen, or even progestins, as well. This is pretty common place in a lot of women that are postmenopausal. So, you might be in this group. There are additional ways that you can kind of combat the things that HRT does target and hydration is a big one and supplements. Again, talk to your doctor about that.
Antidepressants such as Zoloft and Paxil
The fourth one are antidepressants and anti-anxiety medications. Tricyclic antidepressants are the big ones and well-known ones like Zoloft and Paxil- those are the main ones. They're being prescribed way more than they ever have been and for good reason a lot of the time, but they do cause dry eyes. So, if you're taking one of those for anxiety or depression just be aware that they do cause dry eye.
Pain Relievers like Ibuprofen
So, number five is pain relievers such as Ibuprofen. Especially if you get more of a prescription strength which is 800mg or above. That's been known to cause dry eye and decreased tear secretions. So, be careful how much you take Ibuprofen.
Dermatologic Medications such as Accutane
Then, this next one - dermatologic medications most specifically Accutane. Most of you know that Accutane can affect your eyes. It actually can kill off your meibomian glands and cause them to atrophy. Accutane is just a form of vitamin A in really high doses and that is definitely not good for your eyes. It’s a well known cause of dry eyes.
Gastrointestinal Medications, Prevacid, Prevacid, Prilosec, Nexium, Zantac, and Tagamet
Then next one is the GI medications. So, medications that are proton pump inhibitors such as Prevacid, Prilosec, Nexium, Zantac and Tagamet. So, make sure if you're on those try to limit those. Most of the time when you're taking a GI medication like a proton pump inhibitors it's usually due to GERD or gas or indigestion or acid reflux and that usually can be prevented if you figure out what's causing it. That's a very common thing that's caused from the food you eat or the things you drink. If you avoid those at all costs that's going to help you eliminate those medications which will then in turn help your dry eye.
Up To 60% Of Chemotherapy Patients Develop Dry Eyes
And another really well-known medication or system that can cause dry eye is chemotherapy. The most well known one 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 do develop dry eye. So, that's a big one.
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 do that.
Let's briefly run down the list again. We're talking about medications that cause your dry eye.
Number one was high blood pressure medications such as beta blockers, hydrochlorothiazide and other diuretics. Number two was anti histamines like Benadryl and Claritin being the worst ones, then Zantac and Allegra being better ones. Third is hormone replacement therapy or HRT. Fourth is antidepressants which are very common, unfortunately, with dry eye sufferers because they are depressed and we've talked about ways that you can battle depression many times. Then, a fourth one is pain relievers like Ibuprofen when you get up into those prescription doses of 800 milligrams or above. Then, Accutane is another one that is very commonly taken for acne and it unfortunately kills your meibomian glands causing very low to no oil secretions. GI medications that are taken for acid reflux such as Prilosec, Prevacid, Nexium and Zantac. Chemotherapy. Then finally schizophrenic medications.
So, this isn't all the medications but these are just the most common ones that are used. So, let us know if you're taking any medications that you think might cause your dry eyes.
The best thing you can do to battle this dry eye, if you're taking these medications and you cannot go off of them, is stay hydrated. Key thing is hydration. It can solve so much and that's why we have it as our number one thing to do when you're battling dry eye. Make sure you stay hydrated and drinking lots of filtered water every single day. Waking up and drinking a lot of water and then drinking water before every meal is going to help tremendously. Then, eating eye healthy foods such as omega-3 antioxidants such as lutein and zeaxanthin. We have supplements for that but it's better to eat it in whole Foods and then take supplements on top of that and then discuss it with your eye doctor.
Like we said if you're on a high blood pressure medication or something like that or an antidepressant talk to your doctor about other things that you can do as far as lowering your blood pressure. Getting your depression under control so that maybe you don't have to be on those medications or on as high of a dose as you are.
So, let's head over to the live questions and if you're just joining us this is The Dry Eye Show I'm Dr. Travis Zigler and I'm Dr. Jenna Zigler.
We do have 20% off for prime day prime day is Monday and Tuesday this week. So, 20% off on our website if you click the link in the description and in the comments below on our website and then 10% off Amazon it's the same coupon code just head over to that page and check it out and the top of the page is pretty much good for anything on our website but we just put three products on that page but you can actually take that coupon code take it over to the website and use it for that too and then bottom you can click over to Amazon through our website if you want to buy from there. You only get 10% off on Amazon and our products are more expensive on Amazon just because they take more of our cut.
Some things we talk about with depression are keeping a gratitude journal which is writing down three things you're grateful for every night before you go to bed. What that does is eventually over two to three weeks after doing that it kind of shifts your mind to start looking for the good in the world instead of the bad.
Stop watching the news. Is there anything good on the news anymore? You don't need to know what Trump is doing, and you don't need to know what Russia's doing, you don't need to know any of that stuff. Just know what's right in front of you every single day of your life and be lucky and grateful for what you have right beside you.
I wake up and I'm grateful for having Jenna beside me, Jude waking up in the room next to me, getting to play with him and getting to serve the community that is yourselves and just growing our business is what I'm grateful for every day. I don't care what politics are doing, if that's of course part of your job that's another thing. The news is very negative and it's going to put you in a negative state of mind. Don't wake up with it and don't go to sleep with it, instead wake up with gratitude. Watch a video on YouTube just type in gratitude video, or affirmation video, or even do a prayer in the morning and you're just going to feel so much better throughout the day.
A couple years ago I started doing a gratitude journal every night and then I quit watching the news, that was a big one, but I started doing a gratitude journal and completely my mindset just shifted. It's for real! At first you might think it's a little crazy but it works for real. So, get out those gratitude journals and write down three things that you're grateful for every night. It’s so worth it!
Something I do in the morning is I wake up at 5:55 every morning, she usually sleeps in a little bit longer just because she's up with Jude and so she sleeps in a little bit longer. So I have a half-hour to an hour to myself so I'll listen to positive affirmations, I'll listen to prayers, I'll listen to things to get my mind set right for the morning and then once Jude gets up I'm in a happy state. He's in a happier state because of that and Jenna's in happier state because of that.
Then, we exercise and we drink lots of water during that time when we just hang out for the first two hours of our morning and just get our mind right and just kind of prepare for the day in a good state of mind. If you have to get up a little bit earlier to do that type of stuff it's so worth it. Your body will adjust to what time you get up as long as you're going to sleep at a good time to get up a little earlier. Do some of those things and really spend time on yourself and that's a huge deal.
Do Natural Hormone Replacement Therapy helped or hurt dry eye? Thank you so much and thanks for the super fast shipping.
So, I'm not sure what you exactly mean by Natural Hormone Replacement Therapy but I've been kind of looking into it. Some websites are saying it's pretty much done through diet.
Flaxseed is known as a really good one and we always recommend flaxseed for ingestion. Just make sure it's ground and that's good for your dry eye and it looks like its good for natural hormone balancing as well.
There are a lot of supplements out there that are known to be very good for women's health and those are all fine to take. There really aren't going to be many studies on them, if any, to really tell you if they cause dry eye or anything like that. But I would say they're much safer to take than just taking the hormones.
What we always recommend is diet and exercise for anything like this and it can help tremendously with menopause. Getting your diet right and getting your hydration right.
After eight months of repeated eye infections my right eye spontaneously expelled two contact lenses. They were lost in my eye! Is it possible that lost contacts triggered both my eyes to be dry? This whole thing started after pinkeye in my right eye. Is it possible?
Yes, it could be. With contact lenses stuck in your eye you have a foreign material in your eye that's plastic or silicone and your body doesn't necessarily like it. If it's there for a long period of time it's going to cause lots of inflammation to occur which inflammation in one eye could just lead to kind of a counter reaction in the other eye too. You're just going to have a lot of inflammation period because your body is battling an infection. Your immune response- it's not an infection but it's battling a foreign substance. Your immune response is going to go up when your immune response goes up that's going to cause a lot of other problems to have in your body.
Just think if you're fighting infection in your toe for example you might have a fever because your whole body is fighting the infection. Same thing here is if you're battling something foreign in your eye it could affect the other eye as well.
Funny story about that! In optometry school we had a patient that kept losing contact lenses and I hadn't seen him yet and he came in and we finally saw him. My attending and I we flipped his eyelid and we popped out EIGHT large contact lenses! He had lost eight over the last two years and we popped out eight hard contact lenses from his eyelid and they kept coming and coming!!!
Sometimes we see that on the news, stories about that and you'll say “how can anybody not know that they have a contact lens in there?” but your eye gets used to it. You might think you just got something in your eye but people keep putting contact lenses in and they just think they lose them and fall out and they're really still in there. It happens all the time.
I have dry eyes and use your eye spray but my eyelids stick to my eyeball during the night and it's very painful. Plus I use eye drops during the night. How else can I treat this issue?
First of all, I'd like to know what type of eye drops you're using during the night, because if you're using just a drop that's fine but it's really not going to coat your eye all night. What you really need is a night time ointment which you can look for like a Systane Nighttime, or a Refresh PM. They do not have preservatives in them but they definitely coat your eye a lot better. If you're not already using an ointment that's what you should be using for at night.
Then a lot of people in the community do have success with wearing an eye mask at night or even goggles at night just to kind of keep the moisture in. So, that's something that you can search for in the community, but I know a lot of people have had success with that.
Also, ceiling fans my worst enemy when I sleep at night. I cannot handle having a ceiling fan on because I'll wake up and feel like the front of my eyes being ripped off. So, if you sleep with a fan on, absolutely do not sleep with a fan on.
I have farsightedness with astigmatism and mild-to-moderate MGD. Might LASIK be an option for me?
Absolutely not! That is the worst combination. Being farsighted is not good for LASIK and having any kind of dry eye is just going to make things worse. So, LASIK will not give you the results you want.
I always recommend against my farsighted patients having LASIK. Depending on how old you are, I would recommend a refractive lens exchange and it's where they take out the lens inside your eye and they put a new one inside your eye. That is essentially like cataract surgery without the cataracts. So if you're around the age of 50 to 60, or older that would be an option for you. It's actually a pretty nice procedure for a prescription like yours, and it's a good procedure for somebody that does have dry eye. Your eyes might be a little dry afterwards but I recommend getting your eye surface in check with all the things that we talk about. Using our spray and making sure that the surface of your eye is very healthy before you go in for that surgery.
I have to take both beta blockers and Diurex for hypertension.
Best thing is hydration. Hydration is one of the best things you can do for your body. It can help cure diseases because a lot of the problems with disease, the symptoms that are disease related can be very hydration related too. Don't go off your beta blocker diuretic without the support of your physician but hydration is key with any disease including dry eye, including the high blood pressure, or diabetes and everything.
If you aren't drinking at least half your body weight in ounces of water a day you absolutely need to work on getting that up. You might think you drink a lot of water but you might actually not drink any once you figure out how much water you should be drinking. Definitely drink a lot of water and especially if you're taking a diuretic that's just causing your body to shoot out water constantly. So, that's why it's drying your eyes out and it's drying your whole body out. So, keep up the water there. If you wake up and drink 16 to 32 ounces right when you wake up it actually boost your metabolism by about 30%. So, you're going to lose weight as well and you're already like 16 to 32 ounces in however many you need to drink for the day. This is 101 fluid ounces, so if you weigh 200 pounds this is what you should drink daily. I drink this daily and I weigh about 165. I drink probably around 80 to 85 ounces a day which is a lot for my size but I feel great doing that. I couldn't drink that much at first, neither of us could drink that much right away, but your body does get used to it and you will feel so much better.
So, again this is The Dry Eye Show, I'm Dr. Travis Zigler and Dr. Jenna Zigler.
We have a promotion going on for prime day Prime day in the next two days. We actually have 40% off our blue blockers and 40% off our sunglasses. Then we have 20% off our Heyedrate products click the link in the comments above or below and you can get the Heyedrate. If you want to get the blue blockers or sunglasses just go to our website search for prime day and it should pop right up so make sure you click over there and check it out and then we will talk to you guys in a week.