I’ve just been to one of the leading eye institutes in South Florida. Suffice it to say, relief, as suggested by the cheery computer who routed my call to the appointment desk, was not “Just a visit away.”
Let me begin at the beginning.
For years I have suffered from “dry eye syndrome.” Google will tell you all you need to know about dry eye; commercials run daily on new and emerging drugs that you “should ask your doctor about.” I can add this – it’s annoying – debilitating – leads to bigger issues than just scratchy eyes – and the fact that it remains a chronic and basically incurable (by Western standards) – annoys me no end.
Dry eye syndrome is caused by a chronic lack of sufficient lubrication and moisture on the surface of the eye. In my years of various ophthalmologists, I have been told I have “keratitis sicca”, which is used to describe dryness and inflammation of the cornea – to “Keratoconjunctivitis sicca”, a diagnosis used to describe dry eye that affects both the cornea and the conjunctiva – to “Dysfunctional tear syndrome” – a diagnosis that is used to emphasize that inadequate quality tears can be just as important as inadequate quantity.
That last diagnosis led me, in 2012, to surgery for a blocked tear duct on my right eye. Known as “dacryocystorhinostomy”, this procedure opens the passageway for tears to drain correctly, through your nose, rather than simply pouring down my face. While I had no difficulty in accepting that most everyone thought I was silently sobbing, the surgery became a necessity when my 8th doctor explained that my tears were failures in both the quantity and quality arenas; hence, the yellow-green goop sealing my eye shut throughout the day. While out-patient surgery, it still required a general anesthetic, still required before and after drugs and sprays and drops.
It was not a pleasant experience.
So knowing that a simple case of “dry eye” can eventually lead to this – and knowing I will do anything to postpone going through that surgical procedure again – I am hyper-vigilant about anything to do with my eyes. I am a crazed warm compress person, a night time eye gel user, and jump at trying each and every newly recommended, over-the counter product. And, apparently, I am not the only one concerned with dry eyes; a recent online poll revealed that nearly half (48 percent) of Americans age 18 and older regularly experience dry eye symptoms. Results from a 2015 Gallup poll show that more than 28 million Americans suffer from dry eyes, and that number is expected to double within 10 years. Other sources estimate that nearly 8 million Americans age 50 and older have clinically significant dry eye syndrome, and dry eyes affect nearly twice as many women as men.
Of course it does; let’s hear it for women over the age of 50!
Symptoms of dry eyes and dry eye syndrome include a burning sensation, itchy eyes, aching eyes, heavy and fatigued eyes, red eyes, light sensitivity, a feeling that there is a foreign body in the eye, watery eyes, difficulty driving at night and (the scariest to me of them all) blurred vision.
Last week’s visit had me tested for three hours on two floors of the facility to be sent on my way with prescription for cortical steroid eye drops for an infection from a now scratched cornea caused by excessive rubbing. I could conveniently purchase from the front desk the regularly scheduled day and night preservative-free drops for use when my current infection is cleared up.
I was told to rest my eyes as much as possible; somewhat difficult to do when one is both a reader and writer. I was told to protect my eyes with sunglasses. I was told to limit my screen time – on all devices. I was told while none of the drugs that were currently being advertised on TV every hour could not be prescribed because my insurance would not pay for them without going through a set protocol, which included my new, soon-to-be-picked-up eye drops. I was told about a new, “emerging laser eye lid surgery” – also not covered by my insurance – that could pierce the tear glands and keep them clear and free for up to 8 months. While the surgery would have to be repeated, each time still not covered by insurance – it would lessen my dependence on day and evening eye drops, making my chronic – forever – dry eye more bearable.
First, let me just say this: I can only speak for myself here, but the words “emerging, laser eye lid surgery” do not give me any comfort – on any level. Second: I was a bit annoyed because the combined general medical opinion was that this was somehow my fault – due to either lack of care or my own laziness – and lastly – I somewhat resented that a protocol for my eye health was dictated by insurance guidelines, and not by me – let alone my doctor.
That evening, I used my prescriptive eye drops for the first time. Let me add this note: As I have said, I have insurance. My co-payment for these drops – which were to last for 7 days – was $72.00. I do not know about you, but it’s a known fact that each time I use eye drops of any cost, some excess usually runs down my face. I suddenly realized that I have now upgraded myself from having a few dollars of over-the-counter drops drip down my face to what probably amounts to now nearly $20 with each application of these new, improved, protocol correct drops.
There has to be a better way; if Western Medicine says that dry eye is a forever thing, what does Traditional Chinese Medicine say?
Do I dare bother my acupuncturist with yet another illness – let alone another illness due to aging? The list of complaints he currently treats rivals the length of the longest CVS receipt/ Do I add something new to the list?
My acupuncturist quietly reminded me that a foundation of Chinese Medicine is the belief that no issue is an isolated problem, but rather, is rooted in a person’s well-being. He explained that acupuncture points around the eyes focus on promoting circulation of Qi and blood around the eyes. In some cases, acupuncture is used as a complimentary treatment, along with herbs, for chronic dry eye. He also explained that what I saw as a long list of complaints was in “TCM reality”, all tied to the same imbalances and treated holistically.
And then he brought the conversation back to my Liver, which apparently is still making me pay for my past – and truth be told – present – “liver-thoughtlessness”. Attending too many wine and alcohol fueled concerts in the 60’s and 70’s as well as too many unwise food choices over the past 40 years, apparently takes a toll – and the Liver does not forget.
According to Traditional Chinese Medicine, the Liver is the organ responsible for the smooth flow of emotions as Qi and blood. It is the organ that is most affected by excess stress or emotions. The eyes are the sensory organ related to the Liver. Eye issues, including blurry vision, red or dry eyes, or itchy eyes may be a sign that deep down one’s Liver is not functioning smoothly.
And it needs to be pointed out there was no fault placed on me; this was an empathetic and informed discussion on what best do for me to help me heal myself. An education that included a discussion about “Chrysanthemum Flower”, an herb which clears the liver, improves red eyes, and decreases tearing and improves blurry vision. He told me about “Chinese Wolfberry Fruit” (also known as “Lycium Fruit”) which acts on both liver and kidney deficiencies of Qi, correcting blurred vision and in some cases, vision loss. He told me about “Pagoda Tree Flower”, an herb used to treat dizziness, blurred vision and red eyes due to liver heat. And before I leave, I’ll be sent home with what I need.
Dry eyes are not as easy to treat by adding eye drops. There are layers of tear production and once these layers are understood, you will see that how it is important to treat dry eyes from the inside and out. Most people don’t realize that there are three layers of tear production:
- Mucous layer – closest layer to corneal epithelium. It’s produced by conjunctival goblet cells, and is absorbed by the corneal surface glycoproteins, creating a hydrophilic corneal surface.
- Aqueous layer – this layer helps tears stick to the surface of the eyes.
- Lipid layer – provides a smooth optical surface for the cornea and slows water evaporation from the ocular surface.
Where Western Medicine often recommends drops for dry eyes, TCM and other holistic medicines have other recommendations that actually change the root of the problem. This is how Acupuncture with herbs moisten one’s eyes by treating the imbalance from within. Specific herbs, Chinese teas AND a healthy liver help with internal balance as well. TCM does recognize environmental (external) causes of eye issues, however it stresses a healthy immune system, which is, in turn a function of Qi. According to TCM, a person with a poor Qi flow or imbalance in the Liver may have decreased resistance to environmental causes. Ironic, in that the strength – balance – of ones’ Liver can be drastically improved by diet, lifestyle changes and acupuncture.
I will admit that since my eyes had begun to oozing green and yellow – not a festive look in any season – I had begun the weeks’ worth of cortical steroid eye drops prior to this acupuncture visit. One could say my acupuncturist saw me “mid- ooze.” Most importantly, he explained that I should not look at this experience – no pun intended – as having to make a choice between Western and Chinese Medicine. Both could work together. And, ever the teacher, he then asked if this whole situation had taught me anything?
It has. It is apparent that I need to go back to the basics of eye care and not forget or ignore the importance of balancing of my Qi. I have finished my steroid eye drops; my follow up ophthalmologic visit yielded no new surprises – just a warning that this is “a chronic illness and that vigilance is necessary”.
No added stress there.
Here’s what I know: I’ll make smarter choices about my eye care: I’ll limit my screen time – which includes the computer, tablet and phone. I’ll take my Chinese Herbs. I’ll wear sunglasses. I’ll use warm compresses but I’ll use warmed green tea bags instead of a wash cloth, letting the medicinal tea do its work along with the heat. I’ll drink my recommended teas. I’ll pay more attention to foods that benefit my liver. And yes, I’ll probably use the day and evening eye drops recommended by my ophthalmologist as needed.
But, my dear Liver – be forewarned – you’re my new priority. Here’s hoping you’ll begin to love me as I do you.
Read more about Eye Health and Cataracts in a previous post by Susan
- Dr. Landon Agoado, Care Wellness Center