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To: Carolyn who wrote (5)	5/6/2000 1:32:00 PM
From: Cisco	Read Replies (1) \| Respond to of 37

A couple quick questions to consider: 1. Didn't you tell me she had been using some of the over the counter red-out eye drops like Visine? Some recent studies suggest that you have to be off these drops for 30-60 days before the rebound hyperemia and dryness clears. 2. How often is she using the artificial tears? It needs to be at least 5-10 times a day. Preservative-free drops are an excellent choice except that they are expensive and lead to noncompliance in long-term therapies. She may want to try GenTear drops. The preservative is broken down quickly after installation. 3. Does she take any systemic medications? Some of systemic medications seems to make dry eyes worse: chlorpheniramine, decongestants, diuretics, steroids, Birth Control Pills, or Alcohol-based medications, or booze. 4. Does she wear contact lenses? If so, she probably should be wearing a disposable lenses, perhaps even a daily disposable. Any contact lens solutions should be carefully chosen. Of course another choice is refractive surgery if the dryness continues with lenses. 5. Is she going to be in Colorado for an extended period of time? If the problem with dryness continue she should consider trying either punctal occlusion with either collagen or silicone plugs. These will help retain her tears. Collagen plugs are temporary and silicone plugs last longer. These are simple to insert in the doctors office. 6. Does she smoke? If so she should quit. 7. Also the following conditions may be a contributing factor in dry eyes: Incomplete lid closure (Lagophthalmos), Dermatological conditions such as Seborrhea Eczema Psoriasis and Rocsacea, Lid inflammatory conditions such as Blepharitis and Meibomianitis, as well as certain systemic conditions such as Thyroid, and Collagen vascular diseases. I hope this gives a little more insight on dry eye. Puntcal occlusion may be new to you but is a great tool when limiting aggravants and artificial tears fail in giving relief.