Dry-eye epidemic reminds us of the need to blink

Blinking is like breathing. You do both without thinking thousands of times each day.

As long as everything is going well, you won’t even notice when you blink. You also won’t be aware if you forget to blink. When you watch a video on your smartphone or get caught up in correspondence on your computer, you may be so focused that you fail to blink frequently enough.

That may not seem like a big deal, but blinking is critical for spreading tears over the surface of the eye and keeping it moist, clean and well-nourished. Infrequent or incomplete blinking may be contributing to an apparent epidemic of dry eye. A Wall Street Journal article (July 9, 2013) notes that as many as 25 million Americans suffer from this malady.

Optometrists and ophthalmologists are diagnosing this condition in increasing numbers of patients, who describe a persistent sensation of grit or sand in the eye. Sometimes dry eye feels like burning that becomes more intense as the day wears on. Severe dryness can damage the cornea, creating a vicious cycle of pain and dysfunction.

Dozens of medications can contribute to dry eyes. Antihistamines such as cetirizine (Zyrtec), loratadine (Claritin) and diphenhydramine (Benadryl) can do it. So can drugs for overactive bladder like fesoterodine (Toviaz), oxybutynin (Ditropan) and tolterodine (Detrol). Antidepressants such as amitriptyline, citalopram, doxepin, fluoxetine and sertraline also may trigger dry-eye discomfort for some people. For a more comprehensive list, visit www.PeoplesPharmacy.com.

Dry eyes have traditionally been treated with eyedrops to substitute for natural-tear film. Picking artificial tears, however, can be challenging. Some experts caution against products with preservatives, though they lengthen shelf life. Others suggest products such as Soothe XP that can protect the surface of the eye and replenish the tear film lipid layer.

During the past several years, research has shown that tears are more than just salty water. In addition to the aqueous (watery) part of tears, the eyelids have glands that secrete a thin film of oil. Every blink brings the top and bottom lids together, and they squeeze each other gently. This helps the glands release oil that floats atop the watery portion and keeps it from evaporating too quickly.

If you don’t blink often or hard enough, the oil will stay in the glands, thicken and eventually plug the opening. While eyedrops can replenish the liquid, eye doctors have been challenged to help patients restore the natural oil.

Now a company has developed a device that does just that. The LipiFlow machine warms and presses the eyelids to unclog the glands and get the oil flowing again. One study compared LipiFlow to warm compresses (the usual recommendation) and found the device was significantly better (Cornea, April 2012). For most people, one treatment can ease dry-eye symptoms for up to a year (Clinical and Experimental Ophthalmology online, Dec. 14, 2012).

Our ancestors probably suffered dry-eye symptoms much less often than we do. Air conditioning that lowers humidity, computers and many medications all contribute to the current dry-eye epidemic. Since we are not likely to give up our dependence on these modern conveniences, we will need more reminders to blink consciously and completely.

Q: I took cetirizine (Zyrtec) for about four months, and when I stopped, I started to itch horribly. First my feet, and then my hands and scalp acted up.

I didn’t know what was wrong until I read on your website about other people suffering withdrawal from cetirizine. I had all the symptoms.

I would use a hairbrush to scratch the itchy spots without breaking the skin. I also took vitamin C and probiotics, since others suggested they might help. Acupuncture got me through the worst of it.

Nighttime was torture, but now that I am on Day 20 of my cold-turkey withdrawal, I finally slept an entire night without scratching. My advice to others is to tough it out.

A: Neither the label nor the medical literature warns that stopping cetirizine suddenly can result in unbearable itching. Nevertheless, visitors to www.PeoplesPharmacy.com have reported that the hives and itching can be agonizing and last for weeks.

Some people have reported success with gradual tapering of the dose. To do this, some divide the tablets into ever-smaller pieces until they eventually are able to phase off without itching. Others report that taking vitamin C supplements can help ease their symptoms.

Q: My doctor prescribed atorvastatin (Lipitor) even though my cholesterol level was OK. He wanted it even lower.

Please alert your readers that although atorvastatin may work well to lower cholesterol, the cure may be worse than the disease. Not only did I suffer muscle pain, fatigue and leg cramps, but I thought my testicles were on fire. The pain was excruciating. I have spoken with others who experienced similar problems.

A: Many people report muscle or joint pain and fatigue while taking statin-type cholesterol-lowering medicines. Although the official prescribing information lists urinary-tract infections as a possible side effect, there is no mention of testicular pain.

We found one case report in the medical literature, however (Annals of Pharmacotherapy, January 2007). A 54-year-old man had achy testicles when he took lovastatin. He discontinued the drug, and the pain disappeared. This experience was repeated with simvastatin and again with atorvastatin.

We discuss the pros and cons of statins and other ways to reduce cholesterol in our Guide to Cholesterol Control and Heart Health. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (66 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. C-8, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

There also is research to suggest that statins are associated with lower testosterone levels and hypogonadism (Journal of Sexual Medicine, April 2010).

Q: Several years ago, a vet suggested giving our dog Metamucil (psyllium fiber) to prevent chronic diarrhea. I, too, experienced chronic diarrhea due to food allergies. Because our dog had such good results, my wife suggested that Metamucil might help me. To my surprise, it was virtually a miracle.

When he learned of my experience, my son (associate dean of a pharmacy school) tested Metamucil to minimize his own chronic problem with diarrhea and found it beneficial.

A: Although most people think of Metamucil to counteract constipation, it also can be helpful against some types of diarrhea.

“The People’s Pharmacy with Joe and Terry Graedon” airs Saturday at 7 a.m. on WVTF (89.1 FM) and at 4 p.m. Saturdays and Sundays on RADIO IQ (89.7 FM). Joe and Teresa Graedon’s column runs in Tuesday’s Extra.

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