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The Disgusting Cause of Dry Eye Nobody Talks About · See Better without Glasses by Dr. Scott Spector

• 0:00
  SPEAKER_00: Dry eyes are very common and often misdiagnosed.
• 0:03
  SPEAKER_00: If you've struggled with gritty or irritated eyes, you've probably tried a variety of over-the-counter drops.
• 0:09
  SPEAKER_00: Here's a common condition that contributes to dry eyes, but people think it's a little disgusting.
• 0:14
  SPEAKER_00: Right now, there are microscopic organisms living at the base of your eyelashes.
• 0:18
  SPEAKER_00: Yours, mine, everybody's more or less.
• 0:21
  SPEAKER_00: Now before you go scrub your face off, this is completely normal.
• 0:25
  SPEAKER_00: You've had them your whole life.
• 0:26
  SPEAKER_00: Most people carry them and never have one single problem because of it, which is why most people go their whole lives without ever knowing.
• 0:33
  SPEAKER_00: But in some people, the organisms get a little out of control.
• 0:36
  SPEAKER_00: And when that happens, it can make dry eye symptoms worse.
• 0:40
  SPEAKER_00: People may be treated with a variety of drops without getting better.
• 0:43
  SPEAKER_00: The problem is that the drops were not treating the root cause of the problem.
• 0:47
  SPEAKER_00: I'm Dr.
• 0:48
  SPEAKER_00: Scott Spector and I'd like to discuss this very common condition.
• 0:51
  SPEAKER_00: As a busy eye surgeon, I see this all the time.
• 0:54
  SPEAKER_00: The good news is we finally have a way to treat this condition safely and effectively.
• 0:59
  SPEAKER_00: Stay with me on this and I'll tell you what these things really are.
• 1:03
  SPEAKER_00: I'll give you a short list of signs that suggest that yours may have become a problem and what we can do to help you get rid of them.
• 1:09
  SPEAKER_00: The problem is called demodex blepharitis.
• 1:13
  SPEAKER_00: They're mites technically, but I tend to just call them microscopic organisms because the word mites grosses people out.
• 1:20
  SPEAKER_00: You may have seen the TV commercials where they say you might be having a mite party on your eyelids.
• 1:25
  SPEAKER_00: At this point, you stop hearing what I say because you're picturing something crawling across your face and you want to go home and burn the pillowcases.
• 1:33
  SPEAKER_00: Seriously, these are normal skin organisms that live in the hair follicles of your body.
• 1:38
  SPEAKER_00: They prefer the eyelashes because of the oil glands on your lids.
• 1:42
  SPEAKER_00: The mites eat oil and the eyelid is like a smorgasbord.
• 1:45
  SPEAKER_00: These organisms have been on human beings for as long as there have been human beings.
• 1:50
  SPEAKER_00: That's why people shower regularly.
• 1:52
  SPEAKER_00: Having them isn't an infection, it's not poor hygiene, it has nothing to do with how clean your house is or how often you wash your face.
• 2:00
  SPEAKER_00: There's nothing here to be ashamed of.
• 2:02
  SPEAKER_00: The question isn't whether you have them, you probably do.
• 2:06
  SPEAKER_00: The question is whether the number has gotten out of hand on you specifically.
• 2:10
  SPEAKER_00: There are a few signs and symptoms that are highly suggestive of demodex blepharitis.
• 2:15
  SPEAKER_00: Let's review them so you might understand how this condition can affect you.
• 2:20
  SPEAKER_00: One, your eyes feel heavy and may be stuck together in the morning.
• 2:24
  SPEAKER_00: There may actually be a crusting of dry material on your eyelashes.
• 2:28
  SPEAKER_00: Sometimes you actually have to use warm water to pry the lids open.
• 2:32
  SPEAKER_00: Number two, the lids actually itch and there's a red line where the eyelashes meet the eyelid.
• 2:38
  SPEAKER_00: Think of it like a red eyeliner pencil.
• 2:41
  SPEAKER_00: It's one of those things that I can see from across the room in my office.
• 2:44
  SPEAKER_00: It's also the first thing that goes away with treatment.
• 2:47
  SPEAKER_00: Three, you may notice that your long, beautiful lashes are changing.
• 2:51
  SPEAKER_00: They may thin out, fall out, or grow in at odd angles.
• 2:54
  SPEAKER_00: These mites live on your lashes, so it stands to reason that they have an impact on them.
• 2:59
  SPEAKER_00: A little more bad news.
• 3:01
  SPEAKER_00: If you have eyelash extensions, I can almost guarantee that these lashes will require treatment.
• 3:07
  SPEAKER_00: The last thing is something that actually requires a doctor.
• 3:09
  SPEAKER_00: Using the microscope in my office, I can examine your lashes for something called collarettes.
• 3:15
  SPEAKER_00: There's a little cuff of debris that forms right at the base of your lash, like the collar around it, hence the term collarette.
• 3:21
  SPEAKER_00: When I see those, I know exactly what I'm dealing with, and more importantly, I know how to treat it.
• 3:26
  SPEAKER_00: The problem with identifying these skin organisms correctly is that everything I just described also describes a variety of conditions like dry eye and ocular rosacea, burning, grittiness, redness.
• 3:38
  SPEAKER_00: This does contribute to the diagnosis of dry eye, but it's an incomplete diagnosis.
• 3:42
  SPEAKER_00: There's a lot more going on.
• 3:44
  SPEAKER_00: Along the edge of your eyelids, there's a row of small glands that make the oil layer of your tears.
• 3:49
  SPEAKER_00: That oil is what keeps the film on your eye from evaporating between blinks.
• 3:53
  SPEAKER_00: When these mibomian glands are affected, the gland openings get blocked up and inflamed and the oil stops flowing properly.
• 4:00
  SPEAKER_00: The tear film on the front of your eye starts to break down, and it can even cause one of the glands to get blocked, forming a sty or a shalasian.
• 4:08
  SPEAKER_00: If you are having any of these symptoms, you have probably tried a variety of over-the-counter drops with minimal relief.
• 4:15
  SPEAKER_00: All drops put moisture back on the surface of the eye, which helps for about 20 minutes or so, but it does nothing to the lid margin that's a couple of millimeters away.
• 4:24
  SPEAKER_00: It's a vicious and frustrating cycle.
• 4:26
  SPEAKER_00: That's how somebody can spend years and a lot of money looking for a cure.
• 4:30
  SPEAKER_00: If this is the kind of information you want more of, do me a solid and hit the subscribe button.
• 4:35
  SPEAKER_00: There's a lot to learn about the eyes, and I want to help you make sense of it all.
• 4:39
  SPEAKER_00: I will be producing one of these every week.
• 4:42
  SPEAKER_00: I think you'll find it interesting and informative.
• 4:44
  SPEAKER_00: Back to our talk.
• 4:45
  SPEAKER_00: There are two parts to how you can address an overpopulation of skin organisms.
• 4:50
  SPEAKER_00: The first part is the eyelid itself.
• 4:52
  SPEAKER_00: This is called lid hygiene.
• 4:53
  SPEAKER_00: Warm compressors to loosen everything up, it also feels pretty good.
• 4:57
  SPEAKER_00: You can wash the lashes with soapy water.
• 4:59
  SPEAKER_00: Even your hair shampoo will also help decrease the load of material on your lids.
• 5:04
  SPEAKER_00: Lastly, there's a spray called Avanova that will help keep the lids clean.
• 5:08
  SPEAKER_00: The second part is really the important part.
• 5:11
  SPEAKER_00: Recently, a new medication that specifically treats Demodex blepharitis called XDE was introduced, and this medication is amazing.
• 5:20
  SPEAKER_00: We are constantly getting new medications, but this one really works.
• 5:23
  SPEAKER_00: It goes after the cause rather than the symptoms.
• 5:26
  SPEAKER_00: It's a simple treatment with two drops per day for six to eight weeks.
• 5:30
  SPEAKER_00: Sometimes we use a second bottle, but it has worked in almost everyone I've treated.
• 5:35
  SPEAKER_00: That's a conversation for you to have with your eye doctor.
• 5:37
  SPEAKER_00: This is becoming more and more mainstream as more eye doctors are learning about XDMV.
• 5:42
  SPEAKER_00: At least now you know about it.
• 5:44
  SPEAKER_00: Now you might reasonably ask why a man who spends his weeks surgically replacing lenses inside people's eyes has this much to say about eyelids.
• 5:53
  SPEAKER_00: Two reasons.
• 5:54
  SPEAKER_00: Number one, if I'm going to operate on an eye, whatever is living on the lid margin is sitting right next to where I'm working.
• 6:01
  SPEAKER_00: Any surgeon who's paying attention wants that margin clean and calm before they operate.
• 6:06
  SPEAKER_00: And I won't schedule around it.
• 6:08
  SPEAKER_00: If your lids need treating first, we treat them first and the surgery waits.
• 6:12
  SPEAKER_00: The second is measurement.
• 6:14
  SPEAKER_00: Before I operate, I take a series of complex measurements off the front surface of your eye that allows me to decide exactly what lens to use when I do the surgery.
• 6:23
  SPEAKER_00: Every one of these numbers comes off the surface.
• 6:25
  SPEAKER_00: If the surface is inflamed and the tear film is breaking up, the numbers are off, and a lens chosen from bad numbers is a perfect operation with a disappointing result.
• 6:35
  SPEAKER_00: Remember, the surface of your eye is like the windshield of your car.
• 6:39
  SPEAKER_00: If it's not clear, you are not going to see well.
• 6:42
  SPEAKER_00: That's why I don't treat it as a small problem.
• 6:44
  SPEAKER_00: So tomorrow morning, before you wash your face, get close to the mirror and look at the base of your lashes.
• 6:50
  SPEAKER_00: Not the eye, the line where the lashes come out of the lid.
• 6:53
  SPEAKER_00: You're looking for two things.
• 6:55
  SPEAKER_00: Number one, you're looking at the skin along the edge and you want to see if it's red.
• 7:00
  SPEAKER_00: The other thing you want to do is if there's any crusting or debris on your eyelashes.
• 7:04
  SPEAKER_00: If it's clean, you're good, and you can stop thinking about this.
• 7:07
  SPEAKER_00: And if it isn't, you may have been treating the wrong problem, and the right one has a name and something that works on it.
• 7:13
  SPEAKER_00: Alternatively, if your vision itself is what's been bothering you, going blurry part way through the day and clearing when you blink hard, that's the surface of the eye rather than the lid, and it's the most common complaint that we deal with in my office.
• 7:25
  SPEAKER_00: I did a video on that recently.
• 7:27
  SPEAKER_00: Go watch that one next.
• 7:28
  SPEAKER_00: Subscribe while you're here so you don't miss what's common.
• 7:31
  SPEAKER_00: You've got microorganism passengers on your eyelashes.
• 7:35
  SPEAKER_00: Almost everybody does.
• 7:36
  SPEAKER_00: Now you know the difference between passengers and a problem.
• 7:40
  SPEAKER_00: I'll see you on the next video.