Published: 02 March 2022

Dry eye is a very common problem that affects women more than men and becomes more prevalent as people get older.

It can present in many ways, with symptoms that can include a foreign body sensation, burning, stinging, redness, blurred vision, and dryness. Tearing is another symptom and occurs because the eye initially becomes irritated from the lack of moisture and then there is a sudden flood of tears in response to the irritation.

Unfortunately, this flood of tears can wash out other important components of the tear film that are necessary for proper eye lubrication. Signs and symptoms can range from mild to severe.

There are medications that have the potential to worsen the symptoms of dry eye. Here are some of the broad categories and specific medications that have been known to potentially worsen the symptoms:

• Blood Pressure Medications - Beta blockers such as Atenolol (Tenormin), and diuretics such as Hydrochlorothiazide.
• GERD (gastro-esophageal reflux disorder) Medications - There have been reports of an increase in dry eye symptoms by patients on these medications, which include Cimetidine (Tagamet), Rantidine (Zantac), Omerprazole (Prilosec), Lansoprazole (Prevacid), and Esomeprazole (Nexium).
• Antihistamines - More likely to cause dry eye: Diphenhydramine (Benadryl), loratadine (Claritin). Less likely to cause dry eye: Cetirizine (Zyrtec), Desloratadine (Clarinex) and Fexofenadine (Allegra). Many over-the-counter decongestants and cold remedies also contain antihistamines and can cause dry eye.
• Antidepressants - Almost all of the antidepressants, antipsychotic, and anti-anxiety drugs have the propensity to worsen dry eye symptoms.
• Acne medication - Oral Isotretinoin.
• Hormone Replacement Therapy - The estrogen in HRT has been implicated in dry eye.
• Parkinson's Medication - Levodopa/Carbidopa (Synamet), Benztropine (Cogentin), Procyclidine (Kemadrin).
• Eye Drops - In addition to oral medications many eye drops can actually increase the symptoms of dry eye, especially drops with the preservative BAK.

If you are suffering from dry eye and are using any of the medications above you should discuss this with your eye doctor and medical doctor. Don't stop these medications on your own without consulting your doctors.

Article contributed by Dr. Brian Wnorowski, M.D.

Published: 24 February 2022

We are frequently asked if it’s wise to have cataract surgery if you have Macular Degeneration.

Let’s start with some background.

1. Cataracts and Age-related Macular Degeneration (AMD) are both leading causes of visual impairment in the elderly population.
2. Cataracts develop when the normal clear lens gets cloudy with age. This is correctable with cataract surgery, which involves replacing the cloudy lens with a clear, artificial lens.
3. While cataracts affect the front part of the eye, AMD causes damage to the retina, which is the inner back lining of the eye.

In the past, there was a concern about cataract surgery causing progression of AMD. It was thought that there was an inflammatory component to AMD and the normal inflammatory response after cataract surgery may lead to AMD progression.

But studies have looked at patients who underwent cataract surgery compared to patients who didn't have cataract surgery and the progression of AMD was not significantly different between the two groups. However, those patients with AMD who underwent cataract surgery had a significant improvement in vision.

AMD patients can further be characterized as having wet or dry AMD, and only those with wet AMD require treatment. Patients with wet AMD need injections to decrease the growth of new blood vessels and reduce fluid in the retina.

A 2015 study showed that after cataract surgery, there was an increase in fluid in the retina of patients with wet AMD. Therefore, in patients with wet AMD, we usually want the wet AMD to be stabilized before the patient has cataract surgery. Sometimes an injection may be given prior to cataract surgery to prevent any inflammatory changes that may be associated with cataract surgery.

The majority of the studies on the subject conclude that it is safe to have cataract surgery even if you have AMD and in most cases there is a significant improvement in vision. Removing the cloudy lens also helps the ophthalmologist to better monitor the status of the AMD.

Article contributed by Dr. Jan Pan.