Dry Eyes


Digital Eyestrain


A 2016 report by the Vision Council found that 60% of Americans use digital devices for 5 or more hours each day. 70% of Americans use 2 or more devices at a time.
The term Digital Eyestrain has replaced the term Computer Vision Syndrome due to the increase in types of digital devices. Digital Eyestrain is defined as “physical discomfort of one’s eyes after spending periods of time throughout the day in front of a digital device, such as a computer or smartphone.”

The list of Digital Eyestrain symptoms is long:

Eyestrain, Burning Eyes, Difficulty Refocusing, Grittiness, Dry Eyes, Blurred Vision, Headaches, Irritation, Tired Eyes, Neck/Shoulder/Back Pain, Double Vision, and Redness.

It is reported that we blink an average of 10 times a minute normally, when reading, using a smartphone or other device the blink rate drops to 4 times a minute. Blinking is a vital component to ocular surface health and tear stability. More important than how often we blink is how well we blink. An incomplete blink can cause more tear instability than not enough blinks. A complete blink is necessary to stimulate a muscle on the eyelid margin that releases an important component of the tear film.

Treatment for Digital Eyestrain includes wearing the best visual correction for the task. Reducing glare and fatiguing light with coatings is beneficial also. For contact lens wearers the proper correction for the working distance is important. A clean contact lens surface and proper blinking can minimize dry eye symptoms.


Contact Lens Prescriptions

A contact lens is a medical device, like a breast implant or a hearing aid. Contacts can be worn to correct vision as well as for cosmetic or therapeutic reasons. In the United States, all contact lenses require a current prescription. A contact lens prescription generally expires on a yearly basis. This is to ensure that the eyes are healthy enough to support contact lens wear and that the current contact lenses are still the most appropriate. Dr. Griffith

An eye examination is necessary to determine the suitability of contact lenses and also to determine the size, parameters and limitations of the eye. This typically includes a refraction to determine the proper power to see clearly, keratometry to measure the shape and size of the cornea and a thorough health assessment of the eye.

Conditions that may complicate contact lens wear include dry eye, irregular and high astigmatism and eyelid irregularities.


I See Smoke

A google search looking for “what’s in a cigarette?” produced the list below. Most of the products containing these ingredients earn a special danger or poison label. The substances are not listed on a pack of cigarettes.

Here are a few of the chemicals in tobacco smoke and the other places you can find them (list from the American Lung Association):

Acetone – found in nail polish remover
Acetic Acid – an ingredient in hair dye
Ammonia – a common household cleaner
Arsenic – used in rat poison
Benzene – found in rubber cement
Butane – used in lighter fluid
Cadmium – active component in battery acid
Carbon Monoxide – released in car exhaust fumes
Formaldehyde – embalming fluid
Hexamine – found in barbecue lighter fluid
Lead – used in batteries
Naphthalene – an ingredient in mothballs
Methanol – a main component in rocket fuel
Nicotine – used as insecticide
Tar – material for paving roads
Toluene – used to manufacture paint

How naive am I? I thought all the danger in cigarettes came from the nicotine in the tobacco leaves. I couldn’t understand where all the poisons and toxins on the above list came from. Further googling introduced me to the “additives” in cigarettes. Chemicals are added to the tobacco to flavor and fragrance the cigarette “brand”. There are additives for improving texture and holding the leaves together. I can only assume that burning the tobacco and additives creates more toxins.



Crying man with cigarette So what does this have to do with eyeballs? Unfortunately smoking contributes to many ocular conditions such as cataracts, macular degeneration, dry eye disease, diabetic retinopathy and retinal vascular occlusions. Fortunately if you quit inhaling the toxic chemicals, the risk of related ocular diseases is nearly extinguished to the non-smoker level.


Visual Comfort at the Computer

computer and glasses

There are many symptoms of computer vision strain: eyestrain, headaches, blurred vision, dry eyes, watery eyes, tired or burning eyes, squinting, and eye pain.
If you experience any of the above, here are a few things you can do now to improve your situation.
Lighting is one of the biggest problems. Light should be distributed equally to avoid discomfort. The overhead lights and windows are often too bright. If possible dim the lights over your computer and rearrange your workstation to avoid facing bright light sources such as a window. Use blinds to adjust the light allowed into the room.
If auxiliary lights are used they should be low wattage and not make the documents or desk brighter than the computer screen. Remember you are trying to equalize the lighting.
Workstation set-up is also within your control. Avoid reflective materials such as white or shiny surfaces. Desktops should be matte.
Lower the monitor and increase blink rate to reduce tear evaporation which contributes to dry eyes.

Take a Break. Follow the 20-20-20 rule. Take a 20 second break every 20 minutes. Focus your eyes on images at least 20 feet away.

It is important to have an accurate spectacle or contact lens prescription for computer use. Often a prescription designed just for the computer can relief most eye symptoms. Call (707-762-8643) or schedule an appointment online to resolve your computer vision issues.


Red Winter Eyes

Colder temperatures, winter winds and moisture zapping heaters can cause dry, red and irritated eyes. Tears are essential for good eye health and clear vision. They bathe the eye, washing out dust and debris, and keep the surface moist and clear. The natural tear film also contains enzymes that neutralize microorganisms, reducing the risk of eye infections. Tear FilmThe most common signs and symptoms of dry eyes are persistent dryness and irritation, scratchiness, a burning feeling in your eyes and red eyes. Oddly enough, dry eye syndrome also can make your eyes watery, as dryness can cause a protective overproduction of the watery component of your tears.

How to prevent dry eyes in winter:

  • Cold winter wind outdoors and dry heat indoors can cause or worsen dry eyes. Follow these tips to keep dry eyes at bay.
  • Wear sunglasses or goggles. Wearing close-fitting sunglasses outdoors reduces exposure to sun and wind that can dry out your eyes. If it’s especially cold and windy, try foam-lined goggles that provide even greater protection from tear evaporation.
  • Supplement your diet. Fish oil and other nutritional supplements containing omega-3 fatty acids can help prevent or relieve dry eye symptoms.
  • Drink more water. Mild dehydration often makes dry eyes worse, especially during dry and windy weather.
  • Switch contact lenses. If your contact lenses feel dry and uncomfortable, ask me about trying different lenses that are replaced more frequently and/or are better for someone with dry eyes.
  • Maintain good eyelid hygiene. This includes thorough removal of all make-up and cleaning of the eyelashes and eyelids.

Dry eyes may not be completely curable but the dryness, scratchiness and burning sensation can be managed. In addition to dry eye evaluations, Westside Optometry carries products we have found most beneficial for dry eye treatment.

bruder mask

Bruder Masks   – a reusable hot compress      



Cliradex  – Individual wipes to naturally clean and promote overall eye and skin health


Avenova – A daily spray that cleans debris and microorganisms from eyelids and eyelashes, as well as reducing inflammation.

Oasis Tears

Oasis  – A preservative-free artificial tear that contains long-molecule hyaluronic acid which keeps the moisture on the eye longer.



Dry Eyes and Sleep Deprivation

Woman rubbing her eyes after waking up

Sleep deprivation has been reported to contribute to several disease processes and to reduce longevity. It leads to hormonal and neurochemical changes. In the short term lack of sleep reduces performance and alertness. Cognition and memory are impaired and the risk of injury increases with sleep deprivation. In the long term the consequences of sleep deprivation are worse: high blood pressure, heart attack, stroke, obesity and depression. Now you can add dry eye to the list.

A recent study of very healthy young male subjects implies that the tears are negatively affected by less sleep. The subjects were not allowed to sleep for 24 hours. When multiple measurements of their tears were compared to the subjects that slept for 8 hours there was a significant difference. The tears evaporated quicker, the tear volume was less and inflammatory markers were higher. It doesn’t take much to imagine that combined with other factors that contribute to dry eye disease such as medications, hormones and eyelid health, sleep deprivation will worsen the condition. Dry eye disease is a common ocular surface disease associated with symptoms of eye discomfort, grittiness and visual disturbance.

Conquering the causes of sleep deprivation should be foremost in maintaining good health, and having a dry eye evaluation to improve the tear quality is also recommended.



Westside Goes to Seattle

It’s been nearly a month since Maureen, Nannette and I came home from the American Optometric Association (AOA) meeting in Seattle.  seattle starbucksWe had amazing weather, it was in the mid-80’s! Besides enjoying the weather, the abundance of coffee and a beautiful city, we attended some excellent classes.
Nannette participated an ocular anatomy workshop where she dissected a cow’s eye to better understand the structures and function of the eye. She and Maureen also went to a lensometry workshop to learn the intricacies of measuring lens prescriptions and parameters such as power, astigmatism and axis postition.
The new buzz in eyecare is the effect of blue light that is emitted from digital devices. It is thought that exposure to the blue light can cause sleep disruption and even macular damage. It’s nearly impossible to avoid our phones, tablets, computers and even TVs so blue light filters and gaming glasses are available.
Maureen went to a contact lens course which emphasized the importance of proper care, cleaning and replacement to maintain successful wear of contact lenses.
OCT AOAAll 3 of us spent time looking at new equipment and asking the vendors questions about instruments we use in our office. We found and purchased some items to use for our dry eye treatments. I also bought a device to aid in determing spectacle prescriptions for my pediatric patients.
The courses that I learned the most at were one on glaucoma and another on cataracts. In particular the cataract course described new technology and how it compared to current surgical procedures. The educator also talked about the “premium” intra-ocular lenses (IOLs) that include multi-focal and toric designs to correct most refractive errors.

We returned to Petaluma inspired and ready to implement our new knowledge.




Rosacea Awareness Month

Rosacea affects the eyes in many patients, and may result in a watery or bloodshot appearance, irritation and burning or stinging. The eyelids may also become swollen, and styes are common.

April has been designated as Rosacea Awareness Month with the intent to educate the public on the warning signs of this chronic but treatable facial disorder. Rosacea is a common but poorly understood disorder of the facial skin that is estimated to affect well over 16 million Americans — and most of them don’t know it. In fact, while rosacea is becoming increasingly widespread as the populous baby boom generation enters the most susceptible ages, a National Rosacea Society survey found that 95 percent of rosacea patients had known little or nothing about its signs and symptoms prior to their diagnosis.

Photo from National Rosacea Society

Photo from National Rosacea Society

Rosacea typically presents anytime after the age of 30 and may initially resemble a simple sunburn or an inexplicable blush. Suddenly, without warning, a flush comes to the cheeks, nose, chin or forehead. This recurs over and over with the redness lasting longer each time and eventually visible blood vessels may appear. Without treatment, bumps and pimples often develop, growing more extensive over time and burning and itching are common.

In severe cases, especially in men, the nose may become enlarged from the development of excess tissue. This is the condition that gave comedian W.C. Fields his trademark red, bulbous nose. The eyes can be affected too. Ocular involvement includes watery, burning and bloodshot eyes.

Ongoing research has suggested that rosacea may be caused by various possible factors, including defects of the immune system, nervous system, facial blood vessels and genetics. Most recently the presence of microbes and Demodex mites on the skin can trigger symptoms. Demodex are normal inhabitants of human skin but occur in far greater numbers in people with rosacea. It is believed that an immune response to bacteria associated with the mites may lead to the inflammatory bumps and pimples.

A study by a dermatologist at Duke University found a significant association between the relative presence of the mites and the development of rosacea, suggestion that the microscopic mites may be involved in the disease process. The study authors also proposed that increased mite density in the skin might trigger inflammatory response, block hair follicles or help transmit other bacteria in the skin , leading to signs and symptoms of rosacea.

Demodex mites also live in the eyelash follicles. they survive on dead skin and protein. We have found that reducing the number of Demodex living on the eyelid can reduce dry eye symptoms of burning and waterness. Controlling the Demodex requires a special cleaning solution containing a derivative of Tee Tree Oil. If you have or suspect you have rosacea and are suffering from burning red eyes, make an appointment in our dry eye clinic for evaluation and treatment.

Although the definitive cause of rosacea remains unknown, a vast array of lifestyle and environmental factors have been found to trigger flare-ups of signs and symptoms in various individuals. Common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, spicy foods, heated beverages, humidity, certain skin-care products and potentially an overabundance of Demodex mites.

Signs and Symptoms of Rosacea

  • Redness on the cheeks, nose , chin or forehead
  • Small visible blood vessels on the face
  • Bumps or pimples on the face
  • Watery or irritated eyes

Omega-3 Eye Benefits

Salmon filet on a wooden carving board.

Omega-3 is an essential fatty acid (EFA). EFAs are important nutrients critical for the normal production and functioning of cells, muscles, nerves and organs. Fatty acids also are required for the production of hormone-like compounds that help regulate blood pressure, heart rate and blood clotting.

Several studies suggest that omega-3 fatty acids may help protect adult eyes from macular degeneration and dry eye disease. In a large European study , participants who ate oily fish like salmon at least once a week had half the risk of developing wet macular degeneration, compared with those who ate fish less than once a week.

In India a study was done with computer users. Half of the group were given 2 capsules of omega-3 fatty acids and the other group was given 2 capsules of a placebo. Each group took the supplements for 3 months. At the end of the 3 month trial a survey of the participants revealed dry eye symptoms diminished after dietary intervention with the omega-3 supplements . The omega 3 users also reduced abnormal tear evaporation and increased the density of the conjunctival goblet cells on the surface of the eye. The goblet cells secrete substances that lubricate the eye during blinks, stabilize the tear film and reduce dryness.

The typical American diet, characterized by significant amounts of meat and processed foods, tends to contain 10 to 30 times more omega-6 than omega-3 fatty acids. This imbalance of  fatty acids appears to be a contributing cause of a number of serious health problems, including heart disease, cancer, asthma, arthritis and depression.

One of the best steps you can take to improve your diet is to eat more foods that are rich in omega-3 fatty acids and fewer that are high in omega-6 fatty acids.

The best food sources of a beneficial omega-3 FA are cold-water fish. The American Heart Association recommends a minimum of two servings of cold water fish weekly to reduce the risk of cardiovascular disease, and many eye doctors likewise recommend a diet high in omega-3 fatty acids and/or supplements to reduce the risk of eye problems.

If you don’t care for the taste of fish, another way to make sure your diet contains enough omega-3 is to take fish oil supplements. These are available in capsule and liquid form and many varieties feature a “non-fishy” taste. The best time to take the supplement is with a meal so it is absorbed better.

Other good sources of omega-3 include flaxseed, flaxseed oil, walnuts and dark leafy vegetables. However, your body can’t process the vegetarian sources as easily as the fatty acid found in fish.

Too much Omega-6 can interfere with the body’s absorption of omega-3. To reduce your intake of omega-6s, avoid fried and highly process foods. Many cooking oils including sunflower oil and corn oil are very high in omega-6 fatty acids. High cooking temperatures also create harmful trans-fats.

Trans fats may contribute to a number of serious diseases, including cancer, heart disease, atherosclerosis, high blood pressure, diabetes, obesity, arthritis and immune system disorders.

For a more nutritious diet and potentially better eye health try theses simple changes:

  1. Replace cooking oils that are high in omega-6 fatty acids with olive oil, which has significantly lower levels of omega-6 fatty acids.
  2. Eat plenty of fish, fruits and vegetables.
  3. Avoid hydrogenated oils (found in many snack foods) and margarine.
  4. Avoid fried foods and foods containing trans fats.
  5. Limit your consumption of red meat.

Springtime Allergies

AllergiesEye allergies, or allergic conjunctivitis, develop when the body’s immune system reacts to an allergen that gets into the eyes. This is worse on windy days because the environmental irritants are blowing all over the place. There are mast cells under the upper eyelid. The allergens cause the mast cells to release histamine and other substances or chemicals that cause blood vessels in the eyes to swell and itch.

Although allergic conjunctivitis can’t harm your vision, it can be extremely uncomfortable, annoying and disruptive. You may become intolerant to wearing your contact lenses due to the swelling and discharge. The best way to treat your eyes for allergies is to avoid the allergens that trigger your symptoms. The most common outdoor allergens include grass, trees and weed pollens. Indoor allergens include pet hair/dander, dust mites and mold.

Complete avoidance is impossible, so treatment may be indicated. Many sufferers choose to treat their symptoms with over-the-counter allergy medication. Unfortunately, antihistamine tablets and nasal sprays commonly used for allergies are not designed to relieve eye symptoms; in fact, 73% of patients who take oral or nasal allergy medication still suffer from itchy, red eyes. Clinical research has shown that these antihistamines can cause drying of the eyes, resulting in a reduction of tear flow of up to 50%. This means there is the potential for symptoms to be more severe and longer in duration because pollens aren’t rinsed as quickly from the eyes and may accumulate.

Over-the-counter eye drops may provide some relief, but many consist of a short-acting vasoconstrictor with an antihistamine, which result in a short duration of action (usually 2 hours) and a masking of the redness rather than a treatment of the cause. There are combination drops which treat the mast cells and inhibit the histamine. To work properly, correct usage is required.

Additionally, self-diagnosis and treatment can make other conditions such as an eye infection or  dry eyes worse as some of the symptoms are the same.

Contact lens wearers may suffer added discomfort because allergens can get on the lenses, and can also cause the eye to produce excessive amounts of discharge that adhere to the contact lenses too. Clinical studies have shown that contact lens wearers suffering from allergic conjunctivitis who used prescription eye drops before inserting their lenses had significantly greater comfort. Call to make an appointment at the first hint of allergies. Treating the condition sooner results in faster and less complicated relief.

For temporary relief before you can get an eye examination, use a cold compress ( a clean washcloth with ice cubes) over the eyes for ten minutes. An artificial tear or sterile saline solution can remove allergens from the eyes. Chilling the solution adds even greater comfort.