Is this underdiagnosed disease making you miserable? Phoenix eye doc says it’s possible

“Each blink can be painful.”

PHOENIX, Ariz. (3TV/CBS 5) – When your eyes are red and watery and are so irritated and gritty that you want to claw them out of your face, you probably blame allergies, right? I know I do. But our eye problems might stem from something altogether different. Something that has nothing to do with the pollen count. Something your average eye drops won’t fix and might even make worse. I’m talking about dry eye disease. I know what you’re thinking. “Dry eyes. Big deal.” It is a big deal. A very big deal. It’s such a big deal that one Arizona optometrist has dedicated his practice to it. “That’s literally all I do,” said Dr. Arthur Epstein of the Dry Eye Center of Arizonan. We’ll get back to him in a minute.

“Mildly annoying to completely disabling and life-altering”

Dry eye disease is a progressive condition that can become extraordinarily painful and wreak havoc on your life. Vicki Robinson knows this first-hand. She said it got so bad that her coworkers were concerned that she might have pink eye, which is contagious. She said the whites of her eyes were noticeably red, and she was using eye drops several times a day to try to get some relief. “I was convinced I must have had a bacterial infection,” she recalled.

Vicki Robinson lived with dry eye disease for more than a year before getting a proper...
Vicki Robinson lived with dry eye disease for more than a year before getting a proper diagnosis and treatment.(Vicki Robinson via Linkedin)

That in mind, she threw away all of her eye makeup – everything – and replaced it. Eye makeup can be a breeding ground for bacteria. About the same time, her eye doctor put her on steroid drops. “And that was like the worst thing I could have done,” she said. “So, things just kept getting worse.”

Robinson said she heard people in her office thought she had been crying. A lot. In a real estate office full of men, the perception of an emotional woman can be bad for business. “You do not want to be a female that people are thinking, ‘Oh, she’s having a bad day tough [or] negotiation, so she’s in her office crying. … That’s not the image I wish to project.”

It would be about a year before Robinson found her way to Epstein and the Dry Eye Center of Arizona. A year of colleagues and friends thinking she had a contagious disease, was crying all the time, or worse, had developed a drinking problem. A year of red, gritty, irritated eyes and blurry vision. A year in which she grew increasingly uncomfortable as her undiagnosed disease progressed and frustrated with her doctor’s apparent inability to help.

Pervasive, complex, and difficult to diagnose

According to Epstein, dry eye disease affects between 15 million and 30 million people in U.S., and he believes that number is “grossly underestimated.” What’s more, it’s gotten worse in recent years, partially because of advances in technology. Epstein believes it started with the invention of the printing press and has progressed with the advent and eventual ubiquity of computers and then mobile devices.

Once upon a time, when we were hunters and gatherers, we looked into the distance, watching for both prey and predators, blinking in the relentless sunlight. Today, our focus is generally mere inches in front of our faces, looking into light that’s anything but natural for hours at a time at all hours of the day and night. You already know that harsh blue light from electronics is not our friend.

Because man’s ingenuity changed the way we live, it also changed how our bodies operate – in this the case of dry eye disease, we’re talking about blinking. “The blink drives a lot of these incredibly complex systems that maintain normal [eye] function and normal ocular surface health,” Epstein explains. So, basically, as we got more technologically advanced, our eyes didn’t. They weren’t made to deal that with the way we function today. The way we use our eyes means we’re blinking less, and that’s a problem. “An inhibited blink … really [has] have impacted the way the eyes function and have resulted in dry eye disease because the [eye] system is, you know, is unable to function properly in the existing environment.”

When dry eye disease, which basically did not exist two generations ago, first showed up, it affected mostly postmenopausal women. Epstein says the average age of his patients has dropped from the mid-to-high 60s to the mid-to-high 40s, and he’s seeing more men.

Not as simple as it sounds

The name dry eye disease is deceptively simple. It sounds like it should be easy to fix. It’s not.

When your eyes are dry and irritated, red and gritty, or it feels like you have something in your eye like a grain of sand or an eyelash, your first instinct is probably to find some artificial tears or soothing eye drops. If your dry eyes are due to allergies, those can do the trick. But with dry eye disease, any relief you get is fleeting at best. At worst, those drops can exacerbate the problem.

“It’s not as simple as going to the local pharmacy or supermarket and buying some artificial tears,” Epstein said. “It’s actually a crippling, disabling, all-consuming disorder that literally takes over and turns lives upside down. It goes from a minor annoyance to a significant issue to a complete disaster for some patients.”

There’s no cure for dry eye disease, but there are treatments that can make a world a difference. But let’s back up a minute and cover the basics of dry eye disease.

Brief biology lesson (It’s painless. I promise.)

To say Epstein is enthusiastic about his job is an understatement. There is a reason he is No. 1 on Newseek’s 2021 list of America’s Best Eye Doctors. (His partner, Dr. Shannon Steinhauser, is in the top 10.) Passionate might be a better description of Epstein, and his passion is contagious. Eye biology might sound like a dry topic, but he makes it fascinating and easy to understand. An hourlong conversation with him felt more like 10 minutes.

Dr. Arthur Epstein of the Dry Eye Center of Arizona
Dr. Arthur Epstein of the Dry Eye Center of Arizona(Dry Eye Center of Arizona)

One of the most important things to know is that your eyes make two kinds of tears. At least, they’re supposed to. Most of us are familiar with the watery tears that come from our lacrimal glands, also known as tear ducts. Those tears cleanse and protect your eyes. “[Watery tears are] essentially a built-in emergency eyewash station, which is brilliant,” Epstein explained. You get something in your eyes, and the tears wash it away.

Now you might think dry eye disease is the result of a problem with these glands. That seems logical, but it’s not quite right. With dry eye disease, the issue is usually with the meibomian glands, which run through the upper and lower lids of your eyes. These glands produce an oily secretion to lubricate your eyes and prevent the tears from your lacrimal glands from evaporating. This oily film covers your eye, not only focusing light precisely, which is how you see, but also protecting delicate eye tissue from the harsh environment.

When your meibomian glands are not working properly, the result is dry eye disease. “Dry eye isn’t a disease of a lack of tears, it’s actually a disease of the lack of function of the tears,” Epstein said.

“This was so interesting to me,” Robinson said. “We always think there’s just these tear ducts and that’s what produces the tears. You know, the waterfall tears that we get when we cry. But there’s also tear ducts in the glands of your eyes and mine were completely blocked.”

Symptoms can be chalked up to other conditions

Many of the signs of dry eye disease can easily be attributed to other conditions. That’s one reason it’s so difficult to diagnose and is often missed. The symptoms are diverse, but fall into three main categories, according to Epstein.

Most common symptoms

  • Grittiness
  • Dryness
  • Irritation
  • Sense of heaviness
  • General discomfort

“Each blink can be painful,” Epstein said. “It could be quite, quite uncomfortable.”

Another symptom is blurry vision that no prescription reliably fixes. The issue there involves those oily tears that are supposed help your eyes focus. When those tears are not present, your eyes do not focus properly and your vision goes wonky.

The third main symptom is the one that’s most visible to others – redness. It’s aesthetic, but constantly red eyes can lead people to incorrect conclusions about you, as Robinson learned the hard way.

Epstein said symptoms of dry eye disease tend to be like most things in the body – “bilateral, but asymmetrical.” Both eyes are affected to different degrees.

If left untreated, dry eye disease can lead to abrasions on your eye, which is a much bigger problem.

Let’s talk treatment

We’ve already talked about artificial tears and why they won’t fix dry eye disease. Many patients, before they went to Epstein, were told that inflammation was to blame for their symptoms. They were prescribed anti-inflammatories that did nothing for them because inflammation was not the issue. Antibiotics do not work either because there is no infection.

There are a variety of treatments Epstein uses to help ease the symptoms of his patients, but the most promising is light-based therapy. “That has been just an astounding breakthrough; it’s literally transformed our practice,” Epstein said. “We can recover damage, in many cases, in gland tissue and in gland function.” The light therapy helps regenerate tissues. The technology is the same that’s been used in cosmetic skin treatments to lessen the visibility of wrinkles and age spots. “From the eye point of view, it’s transformative,” Epstein said. “It literally can turn the glands back on and stabilize the tears in ways that we couldn’t even dream of before.”

The energy levels of the treatment for the eyes are much lower than what’s used in cosmetic procedures. Epstein says it’s painless. Robinson vouched for the that. But it’s not a one-and-done treatment. The most common course of treatment with the Lumenis OptiLight, which is approved by the Food and Drug Administration for treating dry eye disease, is four sessions about three weeks apart. “Patients like it,” Epstein said. “They come out feeling better rather quickly.”

Robinson did. “After the second session, I [had] marked, noticeable improvement.” She said she’s “100% improved” after the OptiLight treatments.

An OptiLight therapy session is a relatively quick in-office procedure.
An OptiLight therapy session is a relatively quick in-office procedure.(Lumenis)

The therapy is a simple in-office procedure. “It might be a little bit uncomfortable, but you can bear anything for just a few minutes,” Robinson explained. “You can just feel it’s more like a warm sensation. You see a flash even though your eyes are closed and covered. You get that sense of a flash of light off in the distance, and then you feel the heat.” It comes down to how sensitive your skin is, but for most people, there’s little -- if any -- recovery time and no lingering pain or tenderness. “There was absolutely no downtime, no discomfort, no swelling, no nothing,” Robinson said. She did her sessions in the morning and then went to work in the afternoon.

Epstein says some of his patients have reported “collateral aesthetic benefits” like fewer wrinkles around their eyes. Robinson said her eyelashes have become thicker. She said they were sparse and not growing well before her treatments.

The “catch” with the OptiLight, for lack of a better word, is that it is not covered by insurance. “It was absolutely worth the cost,” Robinson said. “I would recommend it.”

Taking time with each patient

Every patient is unique. There’s no one-size-fits-all approach to dealing with dry eye disease. That’s something Epstein keeps in mind when somebody entrusts their eyes to him. And it’s something Robinson appreciated. “He would make you think that you’re the only patient he’s going to see that day,” she said. “He takes so much time. And this is one of the things that I think is key and made a difference in my outcome.”

Robinson said Epstein asked her questions about her symptoms and what she had been doing to treat them, and he listened to her answers. “The fact that he paid attention to all this and took the care and the time to explain why he was recommending things in the sequence that he was recommending and why he was recommending them for my particular case, made all the difference,” she explained. “It’s his mannerisms and his approach made a difference. He educates you.”

Epstein’s goal is not to sell you on OptiLight. If there are other options, he will be the first to share them. His only goal is a good outcome of every patient, including understanding their condition.

“He’s so enthusiastic and passionate about what he does,” Robinson said. “It comes shining through. And he is a wealth of knowledge; he is so much fun to talk to.”