Dry Eye Workshop II (DEWS II) Releases New Standard of Card for Dry Eye Treatment

Hey there Dr. Travis Zigler with Eye Love. I wanted to go over the newly released Dry
Eye Workshop Part 2 Report . This is a report that about 150 clinicians come together and
kind of define the definition of dry eye and how to treat it according to different protocols,
research, clinical based evidence and so I’m just going to go over here briefly and kind
of phase 1 of dry eye is a trace to mild dry eye syndrome. This usually as clinician I see some meibomian
gland dysfunction very early great for that. Um usually maybe have some complaints of dryness
not much maybe some irritation in your eyes but this is the trace to mild dry eye. This is what I push a lot because the treatment
for this is what I push a lot because my wife and I treat more holistic, or treat things
more holistically than with medications. We still use medications but holistic is the
way to go because again because a disease is your body’s way of telling you that you’re
doing something wrong, figuring out what’s wrong, fixing what’s wrong, that’s going
to make you feel a lot better and it’s going to give you a more natural healing process
without the use of artificial medications and prescriptions that come with are all sort
of side effects. So, Stage 1 is what I really love and that’s
the trace to mild dry eye. And anybody at any stage should be doing these
treatments. So, modifying the local environment. That’s example would be what’s behind
me in that mirror. You could see that fan blowing, that’s an
example of an environment, environmental factor that not as good for your eyes because it’s
wind blowing, air conditioning in your car that’s going to cause you a little bit more
dry eye as well. Being outside in the wind, being around smoky
environment that’s going to cause dryness. Pets is going to cause dryness so, unfortunately
if your pet is causing it you might have to get rid of them but that’s when you start
to weigh the benefits versus the non benefits. So, secondary thing is dietary modifications
and I push this quite a bit too at our clinic. Omega 3 fatty acids or supplements that’s
going to help out tremendously or eating things like salmon, walnuts, flax seed, chia seed,
um farm fresh herb, free range egg is going to help with that. Increasing your omega 3 supplementations like
our supplement that we have the Omega 3 for dry eye and then also increasing leafy green
consumption with carotenoids. So leafy greens have lutein, carotenoids are
brightly colored vegetables like red peppers, green peppers, not green but red, yellow,
and orange peppers, um carrots. Those are all good for eyes because they have
a lot pantothenic acid such as lutein, violaxanthin, capsanthin. Um, eliminating synthetic and topical medications. So preservatives and topical medications drops
can cause a lot of problems. So, getting a non-preserve drop if you must
take a drop and then synthetic medications for blood pressure and for anti-histamines,
birth control, hormone replacement those can all cause a lot of dryness. Getting rid of those if you can. Again, you can get rid of all these medications
if you go back to number 2, dietary modifications. My wife and I eat mostly vegetarian diet. Vegetarian does not mean eating pasta and
things like that. That’s still very processed. Vegetarian to us is we almost all produce,
from the produce aisle we really eat anything out of cans or boxes and we do and we occasionally
eat meat. We eat meat once to twice a month and we just
don’t eat it at home and so that’s the challenge I give to you is if you want to
shift your lifestyle switch to almost all produce and eat meat once to twice a month
then don’t eat meat at home. Just try to eat it when you’re going out. Easier than you think and if we can do it,
you can do it. We did it about 5 years ago and we relapse
once and now we’re back at it. We did about 7 years ago we’re back to eating
meat now we’re back for about 5 years stricken, I think this one is going to stick. Um, let’s see anything with preservatives,
so eliminating medications, drops, and food with preservatives let’s kind of just brief
touch on that preservatives being cans, boxes anything like that. Regarding a drop a liquid base drop such as
a new Refresh Omega 3, Refresh Advance Sustain Balance again try to go preservative free
when you can. Lid hygiene, lid hygiene is a big one. That’s when we talk about quite a bit and
lid hygiene is just her eyelid and lash cleanser is going to help with that and you’re just
cleaning up those eyelids which is going to make your eyelids function better and then
finally warm compresses. Very great for symptom relief so warm compresses
is just a nice heated mask. Usually about a 20 to 30 seconds in the microwave
put it over your close eyes for about 10 minutes and then just massage the eyelids gently,
that’s going to help get the glands moving again. It will help you feel a lot better. So, that’s the very first kind of stage
of dry eye and I’m going to have it all summarized in the notes feed below this and
that’s going to help you guys kind of read over a little bit more. So, once I max out that with patients and
sometimes I will jump right to a prescription we move on to stage 2 which is more of a mild
to moderate dry eye syndrome. So, changing to a non preserve topical lubricant,
I recommend that from the get go. Using tea tree oil if demodex is present and
we have a soap for that should be released in the next couple of months. We did a soft release now we’re just figuring
things out. Tear conservation with punctual occlusion
I don’t do this as much as I use to because I feel like if your eyes are inflamed trapping
those inflammatory kind of markers or inflammatory tears in your eye I don’t think that as
good. There’s kind of mix feelings on that but
this report does say punctual occlusion in stage 2. Moisture chamber goggles when your um going
to sleep or walking around that’s going to help keep more moisture in your eyes. Ointments at night time that’s usually non
preserves so that’s ok. Um, doing things like Lipiflow and IPL intense
pulse light therapy it’s going to be helpful at this stage as well cause we’re treating
the meibomian glands. Anti-biotics, topical anti-biotics such as
doxycycline are helpful at this point. Limited duration topical steroids so a steroid
drop for a very limited time can help with this usually about a month or 2. And then drops like cyclosporn and xiidra
or excuse me cyclosporn restasis and then lifitegrast and xiidra are also used at this
stage well. I tend to jump more on the steroid wagon and
if that seems to work really well then I’ll try restasis or xiidra and let’s see, after
that you go now go to stage 3 which is moderate to severe dry eye. And that’s when we start talking about autologost
serum that’s where they draw your blood separate out the serum and then what they
do is make an eye drop for you, you have to keep it in the refrigerator. Take the drop in the morning usually it’s
about 4x a day depending on what your practitioner prescribes. We can do contact lenses at this stage. Sometimes we do soft contact lenses believe
it or not and most of the time we do scleral lenses which is a big hard lens that bathes
your eye in water at all times which is going to be a lot more comfortable for you. After we kind of explore that phase we go
on to stage 4 which is more steroids long term. I have a couple of patients that are on steroids
long term and that seems to work for them. We just monitor them very closely for side
effects such as cataract causations which cataracts can be removed and glaucoma which
a pressure increased can cause from steroids. We just watch them every 3 to 4 months just
to make sure we are not getting that increase in pressure. Um, this is where an amniotic membrane graft
you probably have heard of prokara this is where that comes in to play. That’s going to really help you out as far
just putting stem cells on your eye that’s just going help soothe and heal every part
of your eye. Some of my patients would do that every 3
months or so. I don’t have that many patients that’s
doing this and I don’t do it myself, I can but I just never had that need to really pull
it out of my tool shed. Um, you can also get permanent punctual plugs
here by getting cauterized. I don’t recommend this as much just because
it’s permanent. And so, you can’t go back where as a punctual
plug we can get those out. And then there’s some other treatments here
but we don’t need to go into them, salivary gland, transplantation, I read an article
about that. um but really what I push is everything on
that 1st stage dietary modifications, exercising, modifying your local environment, moving somewhere
where it’s humid, reducing your use of medications that cause that kind of long term dryness
problem like lasiks and high blood pressure medications, hormone replacement, you can
do this with diet. Dietary modifications with leafy green vegetables
and omega 3 and omega 3 supplements, lid hygiene products such as our Heyedrate Lid and Lash
Cleanser, warm compresses with something like our mask. Hopefully you won’t need a drop but if you
do a drop liquid base drop like Refresh Advance preservative free is a good one, Retain MGD
is another preservative free good one. So, that’s kind of our treatment protocol
that’s a brief overview of the DEWS Dry Eye Workshop Part 2 if you have any questions
put them below and I’ll also put in the notes everything I just kind of went over
I know it’s a lot to digest but enjoy. Thanks! Dr. Travis Zigler with Eye Love.

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