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DRY EYE

Bloodshot Eyes – Should You Be Concerned?

You wake up in the morning ready to start your day, only to discover that your eyes are bloodshot. That might not be surprising if you stayed up late to finish a project, had too many drinks at a party or spent time in a smoke-filled room.

But bloodshot eyes can also signal an underlying eye problem. If your eyes appear red or bloodshot, make an appointment with an eye doctor for a comprehensive eye exam to determine the cause and to receive effective treatment.

Why Do I Have Bloodshot Eyes?

When blood rushes to the front of the eye, the tiny red blood vessels on the white of the eye dilate and become visible. This makes the eyes appear red and irritated.

So why do these blood vessels dilate, causing your eyes to look bloodshot?

Bloodshot eyes tend to be caused by:

  • Dry eyes
  • Irritants such as smoke, pollen and perfume
  • Lack of sleep
  • Excessive alcohol consumption
  • Spending too much time in front of the computer

Bloodshot eyes due to lifestyle and environmental irritants may disappear on their own, or you can try to relieve them with over-the-counter eye drops or liquid tears. Lifestyle changes, such as getting more sleep, cutting down on alcohol intake and limiting screen time can often be helpful. If allergies are the culprit, oral antihistamines and antihistamine eye drops may relieve symptoms.

At other times, underlying problems requiring prompt medical attention can cause your eye’s blood vessels to dilate. The following are some of these medical conditions:

Conjunctivitis

You’ve probably heard of “pink eye.” It’s another name for infectious conjunctivitis – an infection of the conjunctiva, the thin membrane covering the eyelid and the front surface of the eye.

There are two types of infectious conjunctivitis – bacterial and viral.

If your child has conjunctivitis, they’re not alone. About 12% of kids get bacterial conjunctivitis every year. This highly contagious condition affects children and adults. In addition to reddish eyes, the following symptoms are associated with conjunctivitis:

  • Bacterial conjunctivitis – irritated eyes, swollen eyelids, eye discharge, crusty eyelids and excessive tearing
  • Viral conjunctivitis – cold or flu-like symptoms, runny nose, fever, itchy eyes, excessive tearing

If you or your child are experiencing these symptoms, it’s important to schedule a prompt appointment with an eye doctor, who can diagnose whether the conjunctivitis is viral, bacterial or due to allergies.

Depending on the diagnosis, your eye doctor will prescribe antibiotic eye drops or creams to treat bacterial conjunctivitis. The viral form may run its course after a few days, but cold compresses and non-prescription eye drops may provide relief.

Dry Eye Syndrome

If your eyes are chronically bloodshot you may have dry eye syndrome (DES). Signs of DES include:

  • Dry, irritated eyes
  • Burning or stinging eyes
  • Discharge from the eyes
  • Light sensitivity
  • A feeling you have something stuck in your eyes
  • Blurred vision
  • Watery eyes

Dry eye syndrome is most commonly caused by a blockage of the tiny meibomian glands in the eyelids. These glands secrete oil that keeps eye moisture from evaporating too quickly. Without the oil, tears dry fast, leaving your eyes feeling dry, itchy and with a bloodshot appearance.

Too much screen time, aging, certain medications such as antihistamines, and medical conditions such as Sjogren’s syndrome can cause dry eye syndrome.

In addition to any medications or in-office treatments your eye doctor recommends, make sure to get plenty of hydration, take frequent breaks from digital screens and use a humidifier in your home.

Uveitis

In addition to bloodshot eyes, if you also experience blurred vision, see floaters or your eyes feel painful, you may have an eye inflammation called uveitis. The causes of uveitis include:

  • Autoimmune or inflammatory condition
  • Infection
  • Medication side effects
  • Cancer (in rare cases)

Unfortunately, uveitis symptoms can often be mistaken for something less serious. That’s the reason it’s important to get an eye exam if your eyes are bloodshot. Left untreated, uveitis can lead to serious conditions such as retinal scarring, cataracts and vision loss.

Depending on the cause and severity, your eye doctor may treat uveitis with prescription eye drops, steroid pills, injections or eye implants.

Eye Injury

It’s vital that all eye injuries receive immediate eye care from an eye doctor.

Even a minor eye injury can cause a big red blotch to form on the white part of the eye (sclera). The cause is a broken blood vessel or a subconjunctival hemorrhage.

Although the appearance of this blood looks severe, and can make the entire white part of the eye appear bright red, a subconjunctival hemorrhage is usually painless and doesn’t cause vision loss. Any time you notice excessive blood on the eye following an eye injury, schedule an appointment with an eye doctor to assess the health of your eye.

Glaucoma

In rare cases, bloodshot eyes may signal the presence of glaucoma – a leading cause of vision loss and blindness.

While some types of glaucoma don’t show symptoms in the early phases, bloodshot eyes can indicate the type of glaucoma that requires immediate medical care. This disease causes damage to the optic nerve due to excessive pressure within the eye. When this pressure suddenly rises, the eye’s blood vessels become dilated and visible, making the eye appear red.

If you have bloodshot eyes and/or have the following risk factors for glaucoma, immediately schedule an appointment with your eye doctor.

  • Family history of glaucoma
  • Aged 60+
  • African American, Asian or Hispanic
  • Diabetes
  • High blood pressure

Bloodshot Eyes Won’t Go Away?

Talk to Us Any time you notice bloodshot eyes or blood on the front of the eye, don’t wait. Schedule your eye exam with Dr. Stephanie Woo at The Contact Lens Institute of Nevada in Las Vegas today.

Q&A With Your Local Optometrist

Can I get bloodshot eyes after LASIK surgery?

LASIK surgery is highly effective minimally invasive laser eye surgery that can correct refractive errors, but like all surgical procedures, it can have side effects. Your eyes may be bloodshot or you could see halos from a few days to three weeks after surgery. Additionally, you may experience other dry eye symptoms. Eye drops and liquid tears can alleviate these symptoms, but if you have any concerns about your eyes following LASIK surgery contact your eye surgeon.

What Should I Expect from a Glaucoma Exam?

If you have a family history and/or other risk factors for glaucoma, and if your eyes look bloodshot, consider scheduling a glaucoma exam. Your eye doctor may perform the following tests:

  • Tonometry – eye pressure test
  • Gonioscopy – to see how fluid is draining out of your eye
  • Vision field test – to examine the functioning of the optic nerve
  • Dilated pupil exam – to detect any damage to the optic nerve
  • Retinal photo or OCT – digital examination of the retina and optic nerve health

Why Is My Eyelid Twitching?

What Is An Eyelid Twitch?

Myokymia, more commonly known as an eyelid twitch, occurs when the eyelid muscles spasm uncontrollably. This sensation is generally felt in either the upper or lower eyelid of one eye.

An eyelid twitch can develop for a number of reasons, and can last anywhere from a few moments to several days, depending on the underlying cause. 

Eyelid twitches are usually nothing to worry about, though persistent eyelid spasms can signal a more serious underlying condition. 

What Causes Eyelid Twitching?

There are a range of factors that could be causing your eyelid to twitch, including:

Stress.

This is the most common cause. Any type of physical or mental stress leads to the release of cortisol, a steroid hormone in the body that acts as a stimulant and puts your body into “flight or fight” mode. It can affect the nervous system in uncharacteristic ways, including making the nerves stimulate your muscles to twitch.

Fatigue.

Have you stayed awake later than usual, or are you juggling work and family commitments? Your eyelid twitch may be a sign that your body is craving a few more hours of rest and shut eye.  

Allergies.

Itchy, watery, irritated eyes can cause eyelid spasms.   

Dry eyes.

Dry, sore eyes may sometimes lead to an eyelid twitch.

Eye strain.

Eye muscle fatigue from prolonged reading or using a digital device can lead to blurry or double vision, dry eyes, headaches and, sometimes, an eyelid twitch.

Caffeine.

Consuming too much caffeine can over-stimulate your mind and body, including the muscles in your eyes.

Alcohol.

Similar to caffeine, excessive alcohol intake can have stimulating effects on your eye muscles.

Nutrient deficiencies.

According to research, a deficiency in vitamins B12 or D, or magnesium, or other electrolyte imbalance can cause an eyelid twitch. 

Blepharospasm.

This rare eye condition is caused by a neurological problem that leads to uncontrollable facial and eyelid spasms that generally worsen over time.These spasms may also cause an increase in blink rate and intensity. 

Neurological disease.

Although uncommon, an eyelid twitch can be a symptom of multiple sclerosis (MS), Parkinson’s disease or Bell’s palsy. 

How to Stop Your Eye Twitch

  • Schedule an eye exam to find out what may be causing your eyelid twitch. Your eye doctor may prescribe glasses to relieve eye strain, or recommend dry eye treatments, Botox injections or oral medication to treat the underlying problem. 
  • Practice stress-relieving activities such as yoga and deep breathing exercises, or simply take some time out of your day to relax.
  • Use eye drops to alleviate eye allergies or dry eye symptoms.
  • Take frequent breaks from the screen and consider wearing computer glasses to reduce eye strain. 
  • Limit caffeine and alcohol consumption to determine if these stimulants may be the cause of your eyelid twitch.
  • Speak with your physician to find out if you can benefit from taking nutritional supplements and to rule out a neurological disorder, especially if other symptoms are present.

 Although an eye twitch is generally not a cause for concern, if it persists for longer than a few days or you notice any changes to your vision, contact Dr. Stephanie Woo at The Contact Lens Institute of Nevada today to schedule an eye exam. 

Q & A

What is dry eye syndrome?

Dry eye syndrome (DES) is a chronic condition that occurs when your eyes don’t produce enough tears or the quality of your tear film is compromised. This results in a range of symptoms that may include dry, itchy, irritated eyes, and sometimes eye twitches. While mild DES can often be alleviated temporarily with over-the-counter lubricating eye drops, moderate to severe DES generally requires specialized in-office treatments.

How can I relieve eye strain after prolonged screen time?

Digital eye strain, also known as computer vision syndrome, can cause a host of uncomfortable symptoms, including headaches, eye fatigue, dry eyes and blurry vision. Computer vision syndrome may cause your eyelid to twitch. 

If limiting screen time isn’t practical on a daily basis, try to follow the 20-20-20 rule: every 20 minutes, look at something around 20 feet away for at least 20 seconds. It is also important to remember to blink frequently and to close your eyes completely. Lastly, speak to your optometrist about wearing computer glasses while you work, as they are designed to eliminate glare from the screen, and reduce eye strain.

What Is the Long-Term Impact of Virtual Learning on Children’s Eyes?

Kids, like adults, are spending more time online. At some point during the COVID-19 pandemic, many children attended school via Zoom and completed assignments online. The trend toward more screen time — whether playing games or being in touch with friends — is likely to continue even after everyone returns to the classroom. 

We already know that prolonged screen time can cause digital eye strain as well as dry eye symptoms, among other problems in children and adults. There is some indication that extended exposure to blue light may impact the development of retinal cells. However, studies on actual subjects still need to be done to establish a clear connection. 

Dry Eyes

Spending a long time in front of screens can impact how quickly our tears evaporate, because we blink around 66% less when using a computer compared to other daily activities. When tears evaporate too quickly and aren’t replenished with blinking our eyes start to feel dry and gritty. So remember to blink every few seconds to prevent your eyes from drying out!

Blue Light Exposure

Screens, such as those that appear on computers, phones and tablets emit blue light. Recent studies have shown that overexposure to blue light can damage the retinal cells at the back of your eyes. This may increase the risk of vision issues such as age-related macular degeneration which eventually leads to permanent loss of vision. 

Excess blue light has also been shown to disrupt the circadian rhythms that regulate our sleep patterns, as it tricks your internal clock into thinking that it is the middle of the day. This may lead to difficulty in falling asleep, insomnia, and daytime fatigue.

Digital Eye Strain

Nearly 60% of people who routinely use computers or digital devices experience symptoms of digital eye strain — also called computer vision syndrome. Symptoms of eye strain include eye fatigue and discomfort, dry eye, headaches, blurred vision, neck and shoulder pain, eye twitching, and red eyes. 

Taking frequent breaks from your screen can help reduce eye strain and neck, back and shoulder pain during your workday.

It is recommended to take at least one 10-minute break every hour. During these breaks, stand up, move about and stretch your arms, legs, back, neck and shoulders to relieve tension and muscle aches. 

Also, look away from your computer at least every 20 minutes and gaze at a distant object at least 20 feet away for at least 20 seconds. This relaxes the focusing lens inside the eye to prevent fatigue.

How to Make Virtual Learning Safer For Your Child

The following tips can lessen the impact of screens on your child’s eyes:

  • Reduce overall screen time 
  • Encourage frequent breaks
  • Use accessories that filter blue light (for example, blue light glasses)
  • Schedule regular eye exams

Make Sure Your Child Gets Routine Eye Exams

Children need comprehensive eye exams to assess the health of their eyes, correct their vision and spot potential problems which can affect learning and behavior. 

If you are concerned about the effect of virtual learning and screen time on your child’s eyes, or if you’re due for a checkup, schedule an eye doctor‘s appointment at The Contact Lens Institute of Nevada in Las Vegas. 

Q&A

What are blue light glasses?

Blue light glasses, also known as computer glasses, effectively block the transmission of blue light emitted from devices and computer screens. They often include a coating to reduce glare to further reduce eye strain. These glasses can be purchased with or without a prescription. 

What’s the 20-20-20 rule?

If you find yourself gazing at screens all day, whether your computer, smartphone, iPad or television, you’re at risk of experiencing eye strain. So make sure you schedule frequent breaks from your screen and follow the 20-20-20 rule; every 20 minutes, look at something 20 feet away for 20 seconds. And while you’re at it, use this time to get up, walk around, and stretch. 

Keratoconus Patient Referred To Us For Contact Lens Consultation

Thank you Dr. Wellish for your kind referral of your patient to our clinic!

We had a very nice 48 year old patient referred to us for a contact lens consultation.

He was diagnosed with keratoconus in his 20’s, but his corneas remained stable throughout the years, and he was able to get by with spectacles.

Over the last 2 years, he noticed a huge decrease in the vision in both eyes. He was seen by Dr. Abrams, who inserted Intacs in the right eye, and then later Dr. Wellish performed corneal crosslinking on the left eye to stabilize the vision.

Intacs OD OS cornea

NaFL 1 od Nafl os 2 (2) NaFl OS 2

He complains that his vision is very poor and distorted and also his left eye suffers from extreme dry eye. He uses Oasis tears in both eyes, along with autologous serum in the left eye. He also uses Restasis in the right eye twice per day to help with dry eye syndrome.

With glasses, he can see 20/60 “double” in the right eye and 20/150 “distorted” in the left eye.

Due to his highly irregular corneal issues, we decided to proceed with the EyePrint Prosthetic with each eye.

pachy od intacs

topo od

topo os

We took an impression of the ocular surface in each eye and then fit him with a diagnostic scleral lens to check his vision potential. With an over-refraction, he could see 20/40 in the right eye and 20/30-2 in the left eye. He also noticed his left eye felt much less dry with the scleral lens on!

We send the impressions to the lab and we will see him in 1 week for his dispense and training. He will continue to use his Restasis drops as recommended, and he will fill the bowl of the scleral lens with autologous serum and Nutrifill. He will also use Tangible Clean MPS.

We are looking forward to helping him see better!

Keratoconus Patient Wore Gas Permeable Contacts For Many Years

Thank you Dr. Ochiltree for this kind referral!

73 yo female has worn gas permeable lenses for many years due to keratoconus.

Keratoconus patients are not able to wear traditional contact lenses or glasses due to the irregular shape of their eye. Many times, corneal gas permeable lenses, hybrid lenses, custom soft lenses or scleral lenses are needed to improve their vision.

Over the past 8 years, we have successfully managed her with corneal gas permeable lenses.

In the last few months, she reported that the lenses were starting to slip and move around with increase in discomfort. She reported a long history of dry eyes with excessive mucous strands and her primary care optometrist (Dr. Ochiltree) told her that her gas permeable lenses had protein and deposits building up on the lens surface.

Upon our examination, she had several areas of dellen, SPK with staining, corneal neovascularization and pannus. We also found that her gas permeable lenses had heavy protein and lipid deposits and scratches.

At this point, we reviewed some of the options. The first option is we could keep her into the same corneal gas permeable lens type of lens. We also discussed some of the pros and cons of other lens designs such as hybrid lenses and scleral lenses. After discussing all designs, she chose the custom scleral lens.

Due her dry eye syndrome, corneal neovascularization and high scleral toricity, we felt that she would be most successful in a custom scleral lens.

Patients with dry eye may benefit from scleral lenses. This is due to the fact that there is a layer of liquid that bathes the eye all day. Gas permeable lenses rest directly on the cornea, so they can rub and irritate the eye surface. Scleral lenses do not touch the cornea at all, and rest on the white part of the eye, which has significantly less nerve endings. This results in a very comfortable lens for many dry eye patients.

With the help of Visionary Optics, we were able to design custom scleral lenses using 3D technology.

Switching between GP lens wear and scleral lenses can take some time to get used to. The patient was surprised at the stability of her vision when she looked toward her right and left. She could see 20/20 at distance out of each eye and she was happy with the comfort! Overall, she has been very happy with the change! We are excited to see how she progresses over the next few weeks.

OD corneaOS cornea

OD pannus at 800OS cornea and temporal conj irregularity

cornea OD

cornea OS

Latitude® Custom Scleral Lenses

OD OCT central clearance 152

OD OCT nasal edge

OD OCT temp edge

OS OCT central clearance 165

OS OCT nasal edge

OS OCT temp edge

How to Deal with Contact Lens Discomfort

Do your eyes itch or burn when wearing contact lenses? There are several reasons why you may be experiencing contact lens discomfort. Discover the possible causes behind the problem and see what you can do to relieve your discomfort.

What Causes Contact Lens Discomfort?

Some of the top causes of uncomfortable contacts are:

Dry eyes

Dry eye syndrome is a common condition that arises when your tears can’t keep your eyes sufficiently lubricated due to an imbalance in the tear film. Certain diseases, medications and environmental factors, like high levels of dryness and wind, can cause or contribute to red, itchy or irritated eyes, especially when wearing contacts.

Allergies

Allergens are typically harmless substances that induce an allergic response in certain people. Pollen, mold, dust and pet dander are some of the most common airborne allergens that trigger eye allergies. Cosmetics and certain eye drops, such as artificial tears with preservatives, can also induce eye allergies, which can make contact lens wear uncomfortable.

Corneal irregularities

The cornea at the front of the eye may be irregularly shaped due to astigmatism, keratoconus, eye surgeries (i.e. LASIK or cataract surgery), eye injuries or burns, scarring, corneal ulcers and/or severe dry eye. Irregular corneas often prevent traditional contact lenses from fitting correctly and comfortably.

Symptoms of Contact Lens Discomfort

  • Burning, itchy, stinging eyes
  • Sensation of something being stuck is in the eye
  • Excessive watering or tearing of the eyes
  • Unusual eye secretions
  • Redness of the eyes
  • Reduced sharpness of vision
  • Blurred vision, rainbows, or halos around objects
  • Sensitivity to light

How to Relieve Contact Lens Discomfort

Try Different Contact Lenses

Nowadays, there are many types of contact lenses on the market, including specialty contacts for dry eyes and astigmatism. Meet with our optometrist for a personalized eye exam for contacts.

With the variety of contact lens brands available, switching to a different contact lens may be the simplest answer if you’re experiencing discomfort that isn’t connected to improper fitting or issues with tear production. If your existing lenses fit well but still irritate and dry out your eyes, speak to us about trying a different design or brand of contact lenses, or changing your lens-wearing schedule.

Artificial Tears or Eye Drops

Over-the-counter artificial tears or eye drops are a common way to temporarily relieve contact lens discomfort. However, it’s important to keep in mind that unless prescribed by an eye doctor, they may not be treating the root of the problem.

Moreover, certain eye drops are incompatible with contact lenses, and may damage your contacts or harm your eyes. We also recommend staying away from products that claim to remove redness from your eyes, which temporarily reduce the size of blood vessels to lessen redness, but do not address the underlying cause of the condition, and can actually worsen it over time.

Take Good Care of Your Lenses

Inadequate contact lens care leaves residue on your lenses, which can discomfort, harmful eye infections and inflammation. Below are a few important contact lens hygiene guidelines to follow:

  • Before handling your contact lenses, thoroughly wash and dry your hands.
  • Remove your lenses before showering, bathing or swimming to prevent infection.
  • Do not sleep in your contact lenses (unless they are approved for sleeping).
  • Replace your contact lenses according to the manufacturer’s instructions (e.g., don’t reuse daily wear lenses).
  • Regularly clean your contact lens case and ask your eye doctor when to replace it.
  • Only use a contact lens solution that is appropriate for your lenses.
  • Never reuse or mix contact lens solutions.
  • Schedule regular appointments with your eye doctor.

If you are experiencing discomfort with your contact lenses, get in touch with The Contact Lens Institute of Nevada in Las Vegas today. We’ll get to the bottom of the problem and provide effective solutions for all-day comfort.

Schedule an contact lenses eye exam with The Contact Lens Institute of Nevada in Las Vegas, Nevada to check your eye health today!

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Q&A

What kinds of contacts are available?

Contact lenses are available in a wide range of materials and replacement schedules. Disposable contact lenses and extended wear contacts are the most convenient for many users.

I’ve already been fitted for contact lenses, so why did my optometrist ask me to come back?

If you’re asked to return a week later, it’s because your optometrist wants to rule out any issues, such as contact lens-related dry eye or irritation.

If it’s been around a year since your last eye checkup, you’ve likely been contacted to check whether your prescription has changed and to evaluate your eye health. The sooner problems are detected and treated, the better the outcome.

Dry Eye Patient Fit Into Custom Scleral Lens

Thank you Dr. Wellish for this kind referral.

66 year old Male was referred to us for a scleral lens consultation for dry eyes. This patient had a h/o of PRK (corneal transplants) in both eyes in the 1990’s and had recently undergone cataract surgery in the right eye

He opted for the Multifocal PC IOL for the right eye (so he could see distance and near without glasses) and was interested in doing the same for his left eye. Unfortunately, his signs of dry eyes were too severe to proceed. Dr. Wellish kindly referred him to us to help heal his left eye with a scleral lens. Our goal was to fit him into a scleral lens to help hydrate and protect the cornea, allowing it to heal for possible cataract surgery.

With a diagnostic lens, his vision improved significantly and was suspected that it could be good enough to delay cataract surgery. Due to his high scleral toricity, we recommended a custom scleral lens to maximize the fit and comfort of the lens.

After wearing the Latitude lens for about 3 weeks, he was able to achieve 20/20 in the distance! The Latitude scleral lens is a custom scleral lens that uses 3D imaging to create a custom fit scleral lens. At this point, we incorporated multifocal optics into the left scleral lens to match the multifocal IOL in the right eye. He has been very happy with his vision near and far in both eyes, and sometimes feels that his left eye is more comfortable throughout the day than his right eye! The plan is to continue monitoring his cataract and managing the signs and symptoms of his dry eyes.

OS Scleral Elevation

OS cornea with NaFl 3

OS cornea with NaFl 2

OS cornea

OD topo axial crop

OS topo axial crop

OS inf edge Medmont

OS latitude Medmont

OCT OS temporal

OCT OS nasal

How Do I Get Insurance to Pay for My Scleral Lenses?

How do I get insurance to pay for my scleral lenses?

If you have medical or vision insurance, they may contribute toward the cost of scleral lenses.

Some insurance companies such as VSP or Eyemed will reimburse eye doctors quite well for scleral lenses, and many offices accept this insurance for scleral lenses.

Other insurance plans reimburse eye doctors poorly for scleral lens fittings. Some of them reimburse less than the cost of the lenses! In this case, it is not feasible or realistic to expect your doctor to fit you into scleral lenses.

One way to get your insurance to cover scleral lenses is to have your doctor write you a letter of medical necessity.

This letter should include”

– Patient’s name

– Patient’s date of birth

– Date patient was seen

– Patient diagnosis

– Patient’s vision (uncorrected)

– Patient’s vision (corrected with glasses)

– Patient’s vision (corrected with scleral lenses)

– Abnormal findings

– Recommended treatment and plan

– ICD 10 codes

– CPT codes

– V codes

The letters we write for patients explain to the insurance company why the patient needs scleral lenses. Usually, our patients suffer from a medical eye condition such as keratoconus, corneal scarring, corneal transplants, RK scarring, post LASIK, etc so the reason they need scleral lenses is to improve their vision. Other patients have medical eye conditions such as extreme dry eye, graft-vs-host disease, sjogren’s, stevens-johnson and other disorders related to the ocular surface. Whatever the reason is, we will write a letter explaining to the insurance company the need for scleral lenses.

before+and+after+severe+dry+eye+with+scleral+lenses

Our patient who has extreme dry eye. Notice the major difference in her eyes before and after scleral lenses.

You can also have your doctor give you a list of diagnosis codes, ICD-10 codes, CPT codes, and V codes, along with the pricing for each service. This will allow the insurance company to see what is being requested, and the specific dollar amount needed.

Your insurance company may also request to speak with the doctor. In this case, your doctor will set up a meeting with the insurance company to explain your medical eye condition and explain why scleral lenses are necessary.

With some help from your doctor, you may be able to get a portion or the entire scleral lens fitting covered through your insurances.

Dr. Woos’ Top 10 Eye Drop Recommendations For Contact Lens Wearers

Many of our patients ask about eye drop recommendations. Some of the key things that I consider:

  • Eye Condition(s)
  • Contact Lens Wearer?
    • What type? soft? hard? hybrid?
  • Age
  • What problems are you having and how often?
  • What have you used before (if anything)?

If a patient has a medical eye condition such as sjogren’s syndrome, graft-vs-host disease, Stevens-Johnson, extreme dry eye, etc., I will always recommend a non-preserved eye drop. This is because the surface of the eye is compromised and I don’t want any unnecessary preservatives sticking around on the ocular surface. Over time, too much exposure to preservatives can lead to a toxic response on the ocular surface.

If a patient wears contact lenses, I also recommend preservative free drops. This is because the preservatives within the eye drops can stick to the contact lens material. Then, those preservatives can stay on the contact lens surface, making contact with the eye for many hours. This continued exposure can cause a sensitivity to the preservative, making your eye red, dry, and irritated. There are some eye drops that are labeled “for contacts” which might be safe for the type of contact lens that you wear. If you have any questions, ask your eye doctor for their recommendations.

Here are my top eye drops, in no particular order (I have no financial interest in any of these eye drops):

oasis

Oasis Tears. I like these because they are individual vials and preservative-free. Many of my patients use they on a routine basis every day. If you have scleral lenses, and suffer from scleral lens fogging, this can be incredibly helpful. Simply fill the bowl of your scleral lens with 1 or 2 drops of Oasis tears, and then fill the rest of the bowl with non-preserved saline. Many of our scleral lens patients who suffer from fogging find that if they use Oasis tears to fill the bowl of their lens, they can wear their lenses for a longer period of time without them fogging up.

 

Blink for Contacts. This eye drop is made for contact lenses (soft and hard lenses). It is in one large bottle instead of vials, so it is NOT preservative free. This is important because if your eye doctor recommends a preservative-free artificial tear, this would not be a good option for you. You can find this eye drop at most local drugstores and grocery stores.

retaine

Retaine MGD. This eye drop is great for anyone who needs to replace the lipid layer of their tears. There are 3 layers of tears. The bottom layer is a mucous layer, which is closest to your eyeball. The middle layer is the aqueous layer, which is made of mostly water. The top layer is a lipid layer. Think of this top layer as an oil layer. It helps to prevent tears from evaporating off the surface of your eye. This is a great option if you have meibomian gland dysfunction.

celluvisc

Celluvisc. This is another more viscous preservative-free tear. It is similar to Oasis tears, but more readily found in local stores. Sometimes it is out of stock, so it can be frustrating for patients who rely on this product. This is another troubleshooting eye drop that I use for scleral lens patients when they have issues with fogging. Simply add 1 or 2 drops of Celluvisc to the bowl of your scleral lens and then fill the remainder of the bowl with your non-preserved saline. If you like this drop, stock up because stores quickly run out of it and it may take weeks or months for you to get it.

systane

Systane Preservative-Free. This is another product that is easy to find at most any store that you already shop. I have seen them at local drugstores and grocery stores. Be careful with this brand (Systane) because they have so many eye drop options, it can be hard to remember which one to use. They have many different eye drops that are very good to use without contacts (such as Systane Balance, Systane Ultra, etc), but if you are using the eye drops in conjunction with contact lenses, please choose the preservative free vials.

zaditor

Zaditor. This is another eye drop you can find over-the-counter at most stores. However, sometimes you have to ask the pharmacist because they keep it behind the counter or they keep it locked up. This is not because you need a prescription to purchase it. This is easily purchased at a store or online. This is a GREAT eye drop for anyone suffering from eye allergies. If you have itchy, runny, irritated eyes, this is a great product to try. This does have preservatives, so please use one eye drop in the morning when you wake up, then wait five minutes and then insert your contact lenses. At night, remove your contact lenses, and then place another drop of Zaditor. This is a great over-the-counter eye drop for eye allergies.

refresh

Refresh Relieva for Contacts. We give a sample of this to all of our patients during their contact lens training. Our Allergan rep gives us samples of these to pass onto patients. Again, this is one that you can easily find at most stores. The larger bottle indicates that it is not preservative free, however, many of our contact lens patients find this eye drop provides relief from dry eye during the day. There is also a preservative-free version which I have never actually seen at a store, but can be found online.

 

Blink Preservative-Free. This is another preservative-free product that I like recommending to patients. However, I have never found it at an actual store - all of my patients have to order this online. It is similar to Systane Preservative Free.

regen

Regener-Eyes. This is the first eye drop of its kind. It is a biologic eye drop, meaning that it is made of stem cells. Many of my patients find this eye drop soothing. If you suffer from dry eye, this is a wonderful product to try, especially if you experience minimal effects from traditional eye drops. I recommend this to any of my extreme dry eye patients. Sometimes the stem cells are very powerful and can heal the damage from an impaired ocular surface. You can’t order this online or find it at a store, it must be prescribed through an eye care professional. Please ask your eye doctor if this is something you want to try.

gel

Systane Gel. This is a great option for patients who suffer from extreme dry eye. You can’t use this during the day (because it is so thick that it will make your vision blurry). After your contacts are removed, you can squeeze a small amount into the lower eyelid cul-de-sac right before bed. This will coat your entire eye with a very thick layer of liquigel. It is much thicker than a traditional eye drop. This is great to use right before you go to bed. It is pretty expensive for such a small tube, but if it significantly helps with your dry eye, it is worth it.

I hope this list of eye drops was helpful to you! Wearing contact lenses can limit the type of eye drops you can use, but hopefully one of these on the list will work for you. As always, it is best to consult with your eye doctor if you don’t know which eye drop to select. They know your eyes the best, and they are true experts when it comes to eye drops.

Lupus patient with extreme dry eye

Thank you Dr. Mallinger for this kind referral.

We have 77 yo F with a h/o of lupus erythematosus and severe dry eyes was referred to us for a scleral lens consult. Her current regime for managing her dry eye symptoms included topical steroids, constant instillation of various artificial tears, and taping her eyelids at night when she sleeps. She has tried punctal plugs, ectropion repair, medicated dry eye drops and stem cell procedures with no improvement. She reports spending most of her time sitting in the dark with her eyes closed due to her severe discomfort and light sensitivity.

When we saw her, she was very light sensitive and was wearing sunglasses inside. She had 2+ inflammation and 4+ diffuse SPK OU. She had a lot of difficulty keeping her eyes open due to her discomfort and pain from the dryness. Her VA was 20/60 right eye and 20/200 left eye with no correction.

With all that she had been through, we felt that it was worth trying a scleral lens to protect her corneas from the outside environment and allow them to bask in continuous moisture to allow them to heal. We recommended the EyePrint Prothesthic due to her highly irregular corneal surface.

It was night and day after the first time we inserted her lenses. She was able to hold her eyes open and reported significant comfort compared to her naked eye. Unexpectedly, she was able to achieve 20/25 vision! Due to the severity of her condition when we assessed her, we plan on having her wear the lenses continuously with close monitoring for the next few weeks.

We will keep you posted