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You're Treating Dry Eye WRONG (Doctors Never Mention This) · See Better without Glasses by Dr. Scott Spector

• 0:00
  SPEAKER_00: If you've got three different bottles of eye drops in a drawer and your eyes still feel like sand by four in the afternoon, that bottle was never going to be the thing that fixes this.
• 0:08
  SPEAKER_00: Hi, I'm Dr.
• 0:09
  SPEAKER_00: Scott Spector, and I'm an eye surgeon, and dry eye is the most common problem in my entire specialty.
• 0:15
  SPEAKER_00: For every person searching for information about cataract or laser vision correction like LASIK, there are about 100 people searching the internet for information about dry eyes.
• 0:25
  SPEAKER_00: Just watch TV.
• 0:26
  SPEAKER_00: There are at least 10 eye drops advertised, and the vast majority of them are for dry eye.
• 0:31
  SPEAKER_00: Dry eye is big money for big pharma.
• 0:33
  SPEAKER_00: In fact, every pharmacy dedicates almost an entire aisle to different eye drops.
• 0:37
  SPEAKER_00: With all this information, the problem hasn't gone away.
• 0:40
  SPEAKER_00: Here's why.
• 0:40
  SPEAKER_00: Everything in that aisle is treating the outside of the eye.
• 0:43
  SPEAKER_00: What actually fixes this is your own eye making tears again, and almost nobody gets treated for that.
• 0:49
  SPEAKER_00: People spend 10 years in that aisle with gritty eyes and they just don't get better.
• 0:53
  SPEAKER_00: In my experience, many people respond in a couple of weeks when somebody treats the right thing.
• 0:58
  SPEAKER_00: So I'll show you what a drop is actually doing, why it stops working after about 20 minutes, and what to do instead to get your eyes comfortable again.
• 1:05
  SPEAKER_00: Let me deal with the obvious question first, which is why nobody has told you this already.
• 1:09
  SPEAKER_00: Your doctor knows this.
• 1:11
  SPEAKER_00: You come in, your eyes are red and gritty, and there's a product that will make you feel better this afternoon.
• 1:15
  SPEAKER_00: So you get told to try that drop.
• 1:17
  SPEAKER_00: That's a completely reasonable thing to do, and it's where almost everybody starts.
• 1:21
  SPEAKER_00: The problem is that's also where most people stop.
• 1:24
  SPEAKER_00: Unless you understand the complexity of the dry eye, people just want symptomatic relief.
• 1:29
  SPEAKER_00: Nobody goes back and says the drops didn't work because the drops did work for 20 minutes.
• 1:34
  SPEAKER_00: So you assume the 20 minutes is what's available and you buy a bigger bottle.
• 1:38
  SPEAKER_00: So here's what's actually happening when you put a drop in your eye.
• 1:41
  SPEAKER_00: You've got a thin film of tears across the front of your eye.
• 1:43
  SPEAKER_00: The film is doing a lot more than keeping you comfortable, and I've covered that in another video, so go check that out if you're interested.
• 1:50
  SPEAKER_00: When you put a drop in, you're adding fluid to the film that is outside.
• 1:54
  SPEAKER_00: It's a top-up.
• 1:54
  SPEAKER_00: Your eyes feel better immediately because it's now moist.
• 1:57
  SPEAKER_00: After a few minutes, the drop begins to evaporate, and pretty soon you're back where you started.
• 2:02
  SPEAKER_00: Now compare that to what happens if your eye starts making more of its own tears.
• 2:07
  SPEAKER_00: Your own tears aren't the same as what's in the bottle.
• 2:09
  SPEAKER_00: They come out with the right composition, they get spread across the surface every time you blink, and your eye replaces them continuously all day.
• 2:17
  SPEAKER_00: One of them you have to keep doing forever.
• 2:19
  SPEAKER_00: The other one goes back to running on its own.
• 2:21
  SPEAKER_00: People might hear this and think I'm telling them to throw their eye drops away.
• 2:25
  SPEAKER_00: I'm not.
• 2:26
  SPEAKER_00: If your eye is genuinely short of tears right now, putting some in is a sensible thing to do and it makes you feel better.
• 2:32
  SPEAKER_00: The mistake isn't using them.
• 2:33
  SPEAKER_00: The mistake is using them for six years and never once asking why your eyes stop making its own.
• 2:38
  SPEAKER_00: So where does your own tear production get decide it?
• 2:41
  SPEAKER_00: Not on the eyeball.
• 2:42
  SPEAKER_00: It comes from the eyelid.
• 2:44
  SPEAKER_00: The gland that supplies your tears sits on the upper outer corner of your upper lid, close to your ear.
• 2:50
  SPEAKER_00: It's called the lacrimal gland.
• 2:52
  SPEAKER_00: The other glands are part of your eyelid and sit directly behind your eyelashes.
• 2:55
  SPEAKER_00: These are called the mibomian glands.
• 2:57
  SPEAKER_00: Here's one large lacrimal gland and a couple of hundred mybomian glands.
• 3:02
  SPEAKER_00: The lacrimal gland makes the liquid tears, the mibomian gland produces an oil that coats the tears and prevents evaporation.
• 3:09
  SPEAKER_00: Now you see how complicated dry eye management is and why artificial tears alone won't correct the problem.
• 3:14
  SPEAKER_00: When I'm evaluating a patient with dry eye complaints, I check the lids first and the fluid second.
• 3:20
  SPEAKER_00: There is one particular cause of a bad lid margin that gets missed more than anything else in this field, and it's got a treatment now that really works.
• 3:29
  SPEAKER_00: I made a whole video on it, and if your lids are itchy and crusty in the morning, go and watch that one because that might be your entire answer.
• 3:36
  SPEAKER_00: If you want more of this, hit subscribe.
• 3:39
  SPEAKER_00: There's a new one every week.
• 3:40
  SPEAKER_00: Now, what actually works?
• 3:41
  SPEAKER_00: Three things, and they get treated in this sequence.
• 3:44
  SPEAKER_00: First, the lid.
• 3:45
  SPEAKER_00: Get the lid margin clean and get whatever inflaming it dealt with.
• 3:49
  SPEAKER_00: Everything after that is easier once it's handled.
• 3:52
  SPEAKER_00: And for a decent number of people, it's the end of the story.
• 3:55
  SPEAKER_00: Second, get your eyes making its own tears again.
• 3:58
  SPEAKER_00: This is a long-term treatment that requires perseverance and patience.
• 4:02
  SPEAKER_00: There are prescription drops whose job it is to get your eye producing more of its own tears rather than topping you up.
• 4:08
  SPEAKER_00: Recently, there have been some improvements in pharmacology of these tear stimulants, and some of the newer options are significantly better than previous drops like prostasis.
• 4:17
  SPEAKER_00: We also have some drops that work like a rescue inhaler works in asthma.
• 4:21
  SPEAKER_00: One drop for this new medication, and your eyes are instantly flooded with tears.
• 4:25
  SPEAKER_00: In my experience, most people notice a real difference within a few weeks of starting.
• 4:29
  SPEAKER_00: The people who've been suffering for years are usually surprised how quickly it changes once it's the right treatment.
• 4:35
  SPEAKER_00: Another option is called punctal plugs.
• 4:38
  SPEAKER_00: We mechanically block the drainage canal for tears using a small collagen pellet that is inserted into the drainage system of your eyelid.
• 4:45
  SPEAKER_00: There's a drain on both the upper and lower lid.
• 4:48
  SPEAKER_00: It's quick, painless, and offers immediate improvement.
• 4:51
  SPEAKER_00: The only negative is that it must be repeated every few months.
• 4:54
  SPEAKER_00: We have many patients that come in every three months for plugs.
• 4:57
  SPEAKER_00: They are amazingly effective and are usually fully covered under most insurance plans.
• 5:01
  SPEAKER_00: Third and only third, the over-the-counter drops.
• 5:04
  SPEAKER_00: They still have a place, but not every day forever.
• 5:07
  SPEAKER_00: A long flight, a dry hotel room in February, a day where you've been on your screen since seven in the morning and you can feel it.
• 5:14
  SPEAKER_00: That's exactly what they're for, and they're very good at it.
• 5:16
  SPEAKER_00: What they were never going to do is change what your eye produces on its own.
• 5:20
  SPEAKER_00: That's a different job and it needs a different treatment.
• 5:22
  SPEAKER_00: Now I'm a surgeon.
• 5:23
  SPEAKER_00: You might wonder why I spend this much time on eye drops.
• 5:26
  SPEAKER_00: Here's why.
• 5:27
  SPEAKER_00: When somebody comes to me wanting their vision fixed properly, the first thing I look at isn't the lens, it's the surface.
• 5:33
  SPEAKER_00: Because every measurement I take comes off the front layer.
• 5:37
  SPEAKER_00: And if that layer is disrupted, my numbers are not going to be consistent.
• 5:41
  SPEAKER_00: Wrong numbers, or else somebody ends up disappointed after a technically perfect operation.
• 5:46
  SPEAKER_00: So I don't ever skip this part.
• 5:47
  SPEAKER_00: I fix the front of the eye first, whether the person came in asking about it or not.
• 5:51
  SPEAKER_00: So here's the one thing I do if I were you.
• 5:53
  SPEAKER_00: Whatever's in that drawer, put it in a bag and take it with you next time you get your eyes checked.
• 5:59
  SPEAKER_00: All of it.
• 5:59
  SPEAKER_00: The one that stung, the one that helped for an hour, the one somebody recommended that you use twice.
• 6:04
  SPEAKER_00: Nobody does this and it changes the whole conversation because what you've already tried and what it did is useful information, and none of it is in your chart.
• 6:12
  SPEAKER_00: It's in your bathroom.
• 6:13
  SPEAKER_00: And if what's actually bothers you is that your vision goes blurry and then clears up again through the day, that's the same surface behavior in a specific way.
• 6:21
  SPEAKER_00: And there are four things to fix it, most of them free.
• 6:24
  SPEAKER_00: I did a whole video on it.
• 6:25
  SPEAKER_00: Go watch that one next.
• 6:27
  SPEAKER_00: Subscribe while you're at it and like us, and you'll get the next one of these videos.
• 6:31
  SPEAKER_00: You've been topping up an eye that stopped making its own tears.
• 6:34
  SPEAKER_00: Deal with the lid, get the tears going again, consider plugs, and keep the bottle for the days you actually need it.