Susan Laszlo was working at her computer one day when her eyes began to flicker. She couldn't keep the lids open. Taking out her contact lenses didn't help.
"I literally had to force my eyes open with my fingers," says the 51-year-old office manager. For the next nine months she was completely dependent on family and friends for everything that required eyesight.
"I don't know how a blind person does it,'' she said. "Your eyes are your everything."
Unable to drive, go to work or even do household chores, Laszlo was stranded at home, in physical and emotional pain, for almost nine months. Six doctors couldn't figure out what was happening; one even told her it had nothing to do with her eyes and was all in her head.
Then a computer search led her 24-year-old daughter, Krystle Laszlo, to Dr. Steven Maskin, a Tampa ophthalmologist and eye surgeon. He specializes in treating severe cases of chronic dry eye, a condition that few people had ever heard of before the advertising blitz for Restasis, the first FDA-approved prescription eye drops for dry eye.
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Dry eye may sound benign — after all, who hasn't had dry, itchy eyes from time to time?
But a medical diagnosis of dry eye means that there is a chronic problem with natural tear production. The eyes don't produce enough tears, or there's an imbalance in the water, mucus and oils that make up tears. Symptoms include stinging, burning, itching, redness, a gritty feeling under the lids, eye pain, sensitivity to light, eye fatigue, blurred vision and difficulty opening the eyes in the morning because of gluelike mucus.
As the population ages, chronic dry eye is becoming more common. According to the American Academy of Ophthalmology, 4.3 million Americans have the condition, about three-fourths of them women over 50.
St. Petersburg eye surgeon and ophthalmologist Dr. Stephen Updegraff says he sees the condition in people who can't use their contact lenses.
"The reason they can't wear their lenses and come to see me is because they have dry eye and didn't know it," he says.
For many people, over-the-counter eyedrops provide relief. Placing warm compresses on the eyes can help liquefy oils blocking the ducts. Protecting the eyes from wind and circulating air from ceiling fans can help.
"A lot of these patients can be treated with good common sense," Updegraff says.
Maskin says in up to 75 percent of cases, the tears are affected by blockages in the meibomian or oil-producing glands of the eyelids. Fluid backs up, leading to inflammation and other symptoms. (Restasis works by reducing inflammation.)
For the most severe cases, Maskin uses a procedure he developed about five years ago called intraductal meibomian gland probing. It involves opening each blocked gland with a special instrument he developed with a wire probe, the smallest being thinner than a human hair. "We pass the probe into what is essentially an impacted, obstructed tear gland and patients get a 75 percent reduction in symptoms immediately," he said. (A patent is pending on the instruments, which are manufactured at Rhein Medical Inc. in St. Petersburg.) In studies conducted by Maskin and published online in the peer-reviewed journal Cornea, patients reported a 90 percent reduction in symptoms nine months after treatment.
Patients have come to him from around the world for treatment (including five from Australia), but Maskin said more eye doctors are buying the instruments and learning how to do the procedure.
Updegraff agrees that those with blocked meibomian glands may need more than eyedrops. Some see their doctors regularly for a procedure that squeezes the glands to try to clear the accumulated oil. "These are patients who are truly miserable and are looking for anything to help them," he said.
As for Maskin's procedure, he said, "it makes sense and it probably won't hurt anyone, but we don't have the conclusive scientific evidence that says how well it works and how long it works.''
Laszlo had the procedure in April 2009, followed by two additional surgeries to repair another eye condition. After the probing she reported 80 percent improvement and was at work a month later. "It's unbelievable," she says. "I've been just great ever since."
Irene Maher can be reached at firstname.lastname@example.org.
Dry eye risk factors
Age and gender: Most patients are women over age 50.
Medical conditions: People with diabetes, rheumatoid arthritis and Parkinson's are more likely to develop dry eye; so are those who have had laser eye surgery.
Medications and environment: Antihistamines, diuretics and acne drugs can contribute; so can blowing air, wind and smoke.
Diet: Deficiencies in omega-3 fatty acids and vitamin A may contribute.
Cataract Awareness Month
EyeCare America, a public service foundation of the American Academy of Ophthalmology, is offering free cataract eye exams during August. If you're 65 or older and haven't seen an eye doctor in three years, you may qualify for a dilated eye exam and up to one year of eye care. Go to www. eyecareamerica.org for details.