Dry Eyes with Dr. Jenna Zigler: Rational Wellness Podcast 150
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Dr. Jenna Zigler talks about having problems with Dry Eyes and what to do about it with Dr. Ben Weitz.
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Podcast Highlights
3:12 The most common symptoms of dry eyes are burning, irritation, that feeling that you have something in your eyes, redness of the eyes, redness of the eyelid margin, and blurred vision. There are two common forms of dry eye: Evaporative and Aqueous deficiency. Evaporative dry eye means that the front of your eyes are evaporating more quickly than they should, so you might have tears but they’re gone within seconds. This is due to dysfunction of your Miebomian glands, of which you have 31 on the top and 31 on the bottom of your eyelids. These meibomian glands are supposed to secrete an oil into your eyes, but these glands can become clogged or dysfunctional. Bacteria tends to build up on our eyelids and if we don’t control it and don’t maintain the good bacteria and get rid of the bad bacteria, that bacteria can start building a biofilm. And this biofilm can affect the Meibomian glands and block the oil from coming out. The oil can harden and stagnate and then those glands stop working and eventually they atrophy. Another factor is that we should be blinking frequently and when we spend too much time watching a computer screen, an ipad, or an iphone, you’re blinking a lot less. If you are working on a screen for a while, you should take a break every 20 minutes and get up from your desk or at least look 20 feet away and let your eyes rest and consciously blink.
10:50 Ultraviolet light has a negative effect on the eyes. Heat applied directly to the eyelids can help the oil to flow from the Meibomian glands, along with gently massaging the eyelids. There are devices that can be used in optometrist offices like LipiFlow that clamp around your eyelids and heat them up and then perform a pulsating massage to pump out the oil. You can apply a warm compress and then do a gentle massage from the crease just above your eyeball down toward your eyelashes and then do the opposite on the bottom of the eye upwards.
15:02 The second form of dry eye that many people have is called aqueous deficiency. This stems from the lachrymal gland. We have a lachrymal gland for each eye, up in your eyelids there. Basically, that secretes the watery portion of your tears. Anything that affects the lachrymal gland can affect that watery portion of your tears, and aging is one factor. Lasik surgery or any type of surgery on the eyes that disrupts the corneal nerves on the front of the eye. When those corneal nerves are disrupted, then your lachrymal glands don’t get a signal that your eyes are dry, and so they stop producing the tears that your eyes need. Before patients get Lasik surgery they should have a good eyelid hygiene regimen in place. That means at the end of the night, you’re removing all of your makeup and washing your face. You should also use an eyelid cleanser. Dr. Zigler recommends a hypochlorous acid cleanser, because it’s naturally made by your body and so it’s gentle on your eyes and gentle on your skin. [Dr. Zigler sells such a cleanser, Heyedrate on her website: Heyedrate]. You should make sure that you drink plenty of water, half your body weight in ounces of water per day. You should also have a healthy diet and avoid processed foods, excess sugar, pesticides, etc. One way is to start your day with a green smoothie instead of having some cereal or donuts. You need to exercise regularly.
24:16 Demodex mites are mites that live on your eyelashes and burrow into your eyelash follicles. They are normal and they actually eat bacteria, but it becomes an issue if they become overpopulated. They can cause inflammation and cause a blepharitis. They may burrow under your Mebomian glands and clog them up. Tea tree oil soap can be be used to help control them.
Dr. Jenna Zigler is the co-owner of Eye Love, whose mission is to heal 1,000,000 dry eye sufferers naturally. Dr. Jenna and her husband use the profits from Eye Love to fund free and low cost clinics in Jamaica and in the US. They also started a charity called the Eye Love Cares Foundation, which provides exams, glasses and sunglasses for those in need, free education, and scholarships for students that align with their mission. Their website is Eyelovethesun.com where you can order their products, including the Heyedrate Lid and Lens Cleanser.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to leading health and nutrition experts and researchers in the field, to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness podcasters. Thank you so much for joining me again today. Please go to Apple Podcasts or wherever you listen to your podcasts and give us a ratings and review. We really appreciate that. If you would like to see a video version, go to the YouTube page, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.
Today, we will be speaking about eye problems, with a focus on dry eye. As we record this, we’re in the midst of the coronavirus pandemic right now, and a number of other interviews I’ve had recently have shifted the discussion to make it relevant for immune strengthening. I admit that today, it’s difficult to focus on almost anything else other than the coronavirus. It seems to dominate all the health news right now, and understandably so. But we are not going to change this discussion to make it relevant for this current crisis. You can think of this discussion as a distraction from the nonstop COVID-19 news, and let’s not forget that constantly washing our hands and worrying about not being able to get face masks or gloves or paper towels or toilet paper or thermometers. We all have other health concerns besides getting the coronavirus, and dry eyes is one of those. In fact, if you’re trying not to touch your face to avoid allowing the virus from getting into your system through your eyes, having dry eyes makes this more difficult.
Today we are going to interview Dr. Jenna Zigler, and she previously owned and operated two optometry practices. But she sold them in 2017 to focus on her company Eye Love, whose mission is to heal one million dry eye sufferers naturally. Dr. Jenna and her husband use the profits from Eye Love to fund free and low-cost clinics in Jamaica and the US, and there are increasingly more people in poverty in the US right now.
Dr. Zigler: Yeah.
Dr. Weitz: They also … With the approaching 30% unemployment rate right now. They also started a charity called the Eye Love Cares Foundation, which provides exams, glasses, and sunglasses for those in need, free education and scholarships for students that align with their mission, so that’s a great thing. Dr. Zigler, thank you so much for joining me today.
Dr. Zigler: Yeah, thanks for having me today.
Dr. Weitz: What are some of the most common symptoms people with dry eye struggle from? And maybe you could explain what dry eye is.
Dr. Zigler: Yeah. The most common symptoms that people with dry eye will notice are burning, irritation, that feeling that you have something in your eyes, redness of the eyes, sometimes redness of the eyelid margin so right around the eyes. Sometimes they might notice crustiness on their eyelashes. Blurred vision. There are so many things that somebody with dry eyes might notice. It’s really … It can be devastating for some people, because if you can’t see or can’t keep your eyes open, you have a hard time working and functioning in daily life. Dry eye disease is really a multifactorial disease. There are so many things that play into dry eye or have the potential to be a contributor for dry eye disease.
There are really two different forms. The first one is the more common form of dry eye, and this is evaporative dry eye. What this means is that basically, the tears on the front of your eyes are just evaporating way more quickly than they should, so you might have tears but they’re gone within seconds. This is due to a dysfunction in your Meibomian gland. You have these little glands in your eyelids. There are roughly 31 on the top of each eyelid, and 31 on the bottom eyelids. People will lose those glands over time if they don’t take proper care of their eyelids, and there are certain other things that can cause it as well.
But basically, when you have Meibomian gland issues, the oil that those Meibomian glands are supposed to secrete, that’s what keeps those tears intact. When the oil is not functioning or it’s not high quality, then it causes those tears to evaporate really quickly. The second form of dry eye that many people have is called aqueous deficiency. This stems from the lachrymal gland. We have a lachrymal gland for each eye, up in your eyelids there. Basically, that secretes the watery portion of your tears. Anything that affects the lachrymal gland can affect that watery portion of your tears. It might be, aging is a big one. Just aging plays into almost the atrophy of that lachrymal grand.
Then also medications is huge. People don’t realize that a lot of the medications that they’re taking for other different conditions can contribute to dry eyes in that way.
Dr. Weitz: What are some of those?
Dr. Zigler: Yeah, so some of those are high blood pressure medications, especially your beta blockers, your … The ones that pull the water out, and all of that.
Dr. Weitz: Like the diuretics, yeah.
Dr. Zigler: Exactly. Those diuretics are just pulling all the water out of you, and so that includes your lachrymal glands. Anxiety medications and SSRIs and things like that have a really big effect on the eyes. Then of course antihistamines. If you’ve got allergies and you’ve got dry eyes, it can be really hard to balance that because antihistamines can … They work to dry you out, so they’re going to work to dry out your eyes as well.
Dr. Weitz: Interesting. Let’s start with the Meibomian gland. These are glands that secrete an oil into the eye, essentially?
Dr. Zigler: Yeah. Absolutely. They secrete that oil, and they do that every time you blink. You blink your eyes, and that oil is secreted out onto the front of your eye. It becomes a layer of your tear film. It’s the layer that keeps those tears from evaporating.
Dr. Weitz: What causes that to malfunction? Or for these Meibomian glands to … Do they die, or stop working?
Dr. Zigler: Yeah. They can. In some people, they can atrophy and completely stop working. Most people don’t lose all of them, so they’ll still have some functioning glands. But there are people out there that don’t have functioning glands.
Dr. Weitz: What makes them atrophy or stop working?
Dr. Zigler: Basically, what happens is bacteria on the eyelids, this is the most common cause. Is that bacteria on the eyelids, it builds up. We have natural bacteria on our eyelids, but if we don’t control it and don’t maintain the good bacteria and get rid of the bad bacteria, that bacteria can start building a biofilm. This biofilm is very hard to penetrate. It can start inflicting on those Meibomian glands. It goes down into those Meibomian glands, it blocks the oil from coming out. It causes the oil to harden and stagnate, and then those glands just stop working. That’s how that atrophy occurs.
Dr. Weitz: Wow, so it’s kind of like a dysbiosis of the microbiome of the eyelids, right?
Dr. Zigler: Exactly. Yeah. You know, there are a lot of different factors, but that’s definitely-
Dr. Weitz: Is there some sort of microbiome of the eyelids?
Dr. Zigler: Yeah.
Dr. Weitz: Is that something that-
Dr. Zigler: Yeah.
Dr. Weitz: Can actually be determined or measured?
Dr. Zigler: You know, I don’t know if it’s something that can be measured right now. But it is something that, we know that the eye has natural bacteria, and that’s a good thing. It’s all over our body, so it’s all in our eyes and on our eyes. But yeah, keeping that maintained and keeping it at a good level instead of a pathological level is really important for those Meibomian glands. Also things like screen time, for example. We know that when we’re on a screen like a computer, or an iPhone or iPad, or even when you’re reading a book, truthfully. You’re blinking a lot less. So when you’re staring at a screen, you’re not blinking and letting those Meibomian glands release oil. We’re thinking that we’re starting to see Meibomian gland dysfunction in very young patients. Kids and teenagers, because they’re on these devices all day long. Sometimes the average is seven hours a day.
Dr. Weitz: Interesting. So not blinking.
Dr. Zigler: Mm-hmm (affirmative). Yeah.
Dr. Weitz: Wow, so when my wife is telling me something and I keep blinking and she says, “You’re not really listening to me,” my excuse can be that I’m just making sure that my Meibomian glands are working properly.
Dr. Zigler: Exactly. You’re making sure that you’re getting those full blinks in. It’s really important. Yeah. I mean, one of the things we recommend for people is actually when you’re on your computer all day … Many of us work in front of a laptop or in front of a computer now. Take a break every 20 minutes. Either get up from your desk or at least look 20 feet away and let your eyes rest, blink. Consciously blink. Because we’re blinking all day long, but we’re not consciously doing it all the time. It’s important to get those blinks in and take those breaks from your computer screen.
Dr. Weitz: What about heat that’s emitted from electronic devices, or even heat that you get exposed to if you’re out in the sun? Or a lot of people are doing red light therapy or a sauna. Can that have a positive or a negative effect?
Dr. Zigler: There are a couple different things here. I mean, we know that UV has in general a negative effect on the eyes, just because it can cause cataracts and contribute to macular degeneration and things like that. But we know that heat, for the eyelids and for the Meibomian glands, can actually be a good thing, especially when it’s applied directly to them. There are devices out there that kind of clamp your eyelids. There’s one called LipiFlow, and it kind of clamps around your eyelids, and it heats your eyelids up, as well as pulses them. It kind of works that oil out of your glands. That is one treatment for Meibomian gland dysfunction, and it’s a great one.
Dr. Weitz: But when you say it pulses it, it provides some kind of manual sort of massage or pressure to pump the glands? Is that what’s happening?
Dr. Zigler: Exactly, yeah, exactly. It’s kind of pumping those glands out as it’s heating up, and the thought is that we want the oil that’s coming out of our Meibomian glands to be the consistency of olive oil. A lot of the time, it kind of becomes the consistency of hardened butter or of toothpaste, and that’s not what we want. The thought is, if you heat up those Meibomian glands, you heat up that oil. It kind of starts to become a better consistency, and then that pulsation can release that oil onto your eyes.
Dr. Weitz: Interesting. Could you apply hot compresses, and sort of do a manual massage in place of that?
Dr. Zigler: Yeah, absolutely. That’s something that we recommend. You can do it, I would say no more than once a day, but if you suffer from dry eyes this is something that can help with symptom relief. Use a warm compress. You can buy them on Amazon or in most stores. Put it in the microwave for about 20 seconds, and then just lay it over your eyes for about 10 minutes. Then what you can do is kind of just do a massage of your eyelids. You can just kind of work those oils out. It’s not going to be as effective as the machines that are on the market, of course. But it’s going to provide relief for many people.
Dr. Weitz: Those machines, are they for home use, or you go to a clinic to have it done?
Dr. Zigler: These are mostly clinic, yep. A lot of eye doctors, optometrists and ophthalmologists have devices like that.
Dr. Weitz: Now, my wife does the opposite. She has this eye patch thing that she puts in the refrigerator, and then she puts it over her eyes to try to decrease wrinkles. Does that have a negative or a positive effect?
Dr. Zigler: No, you know, I think really it’s all about symptom relief. If she has puffy eyes in the morning, or wrinkling that she’s noticing, absolutely use that cool compress. That’s something that we recommend for people with allergies, because they get a lot of swelling. Then even people that have ocular rosacea, or rosacea in general, can benefit from a cold compress versus a warm compress. Because we know that kind of heat can kind of exacerbate those rosacea symptoms some of the time.
Dr. Weitz: When you say they do the massage, you’re talking about pushing down on this part, down. What about the part about the eyelids? Are there glands in there too, or none?
Dr. Zigler: There’s no glands up here.
Dr. Weitz: Okay.
Dr. Zigler: But down towards your eyelashes, yeah. Kind of from the crease down to the end is where you want to work.
Dr. Weitz: And you should push down gently?
Dr. Zigler: Yep, exactly. Then you do the opposite on the bottom. It’s a little harder on the bottom, but you can kind of push it upward, or just kind of massage down there with it.
Dr. Weitz: Is that fairly safe for everybody to do?
Dr. Zigler: It is. Make sure that you keep your fingers clean, of course. Wash your hands. We’re talking about that all the time now, so hopefully you guys don’t have to worry about that too much.
Dr. Weitz: For 20 seconds.
Dr. Zigler: Exactly. Be careful of fingernails, of course. If you do have long fingernails, don’t scratch the front of your eye, because that will be the worst experience you’ve ever had. But other than that, yeah, it’s pretty safe.
Dr. Weitz: Right, okay. Tell us about … Oh, and then we have the other, besides the Meibomian glands we have the lachrymal glands, is that what you said?
Dr. Zigler: Yeah. The lachrymal glands.
Dr. Weitz: Okay. What do we know about that, and what causes those to diminish or decrease? Is it the same, or different factors?
Dr. Zigler: Yeah, so there are a couple of different major factors that can play in. Aging is the first one, and that’s just going to happen no matter what. I think some people are just going to be more susceptible to that than others, just like they are to other disease. But other big ones out there that you might be able to control, the first one is LASIK surgery or surgery on the front of your eyes. Any type of refractive surgery disrupts the corneal nerves on the front of your eye. When those corneal nerves are disrupted, then your lachrymal glands don’t get a signal that your eyes are dry, and so they stop producing the tears that your eyes need. They usually say that this is temporary, and it will resolve itself within six months or so. I will say for the majority of people, that is absolutely the case. They might have dry eyes for a couple of months, and then it’ll resolve itself.
Dr. Zigler: But for many people that we know, it’s been devastating for them. There, right now, are not a ton of things that we can do for those people. I mean, we can teach them how to live an anti-inflammatory lifestyle, but that will only go so far for people who have dry eye after LASIK surgery.
Dr. Weitz: Well, what if people were thinking about going into LASIK surgery now? Is there an approach to decrease the likelihood that they’ll have this negative outcome?
Dr. Zigler: There are. One of the things that I would recommend is the same thing I recommend for people right before cataract surgery, because that’s still cutting into the front of your eye. I would recommend getting a good eyelid hygiene regimen in place. That means at the end of the night, you’re removing all of your makeup really well. You’re washing your face. You’re using an eyelid cleanser. We like a hypochlorous acid cleanser, because it’s naturally made by your body and so it’s gentle on your eyes and gentle on your skin. Just really making sure that you’re keeping that ocular flora in balance, because when it gets off balance is when you’re more likely to have issues afterwards. That’s really the big thing that you can do.
Dr. Weitz: A hypochlorous acid solution?
Dr. Zigler: Yep, hypochlorous acid. We have one, and it works really well for people. There are lots of other brands on the market too, and they work really well for most people. Most people don’t have sensitivities to it or anything like that, which is nice.
Dr. Weitz: Okay. Because acid sounds a little scary around the eye.
Dr. Zigler: It does, doesn’t it? I know. It’s very, very gentle, so yeah.
Dr. Weitz: Okay. Tell us about your approach to dry eye treatment.
Dr. Zigler: Yeah. We really, with every dry eye patient, we start out with the basics. This is going to be stuff that you’ve probably heard before. But we have to start here because so many Americans are living such a horrible lifestyle as far as taking care of themselves. They just don’t take care of themselves. We start out, and we talk about hydration being a huge one. Especially for your eyes, and those that have dry eyes, because when your body’s not hydrated, your eyes, your glands, aren’t going to make the proper tears. We recommend that everybody be drinking … Of course work with your doctor on this, but half your body weight in ounces of water per day. Start there, and you will feel better if you are not drinking any water during the day, I promise.
Then we move into diet changes that you can make. An easy way to make a good diet change is to replace whatever you’re having for breakfast, which is normally eggs, bacon, toast, dairy yogurt, you name it. Donuts, I don’t know. Cereal. Replace that with a green smoothie. Right in the morning you’re getting not only hydration, but you’re packing your body full of greens, full of antioxidants, full of all those nutrients that your body is craving and that your eyes are craving. That really helps a lot of people.
Then we get into talking about processed foods and excess sugar, and things like that. Pesticides. We’re surrounded by that in the grocery store. You go to the grocery store, and all of those middle aisles are full of processed food. It’s hard to stay away from that, especially in times like these. We go to the grocery store, and there’s only so much on the shelves sometimes. There’s not everything that you want to buy. You just have to try to make good decisions in what you’re purchasing. Read the labels. I know nobody wants to read the labels, but it is important. We talk about exercise, because so many people are sedentary. We talk about just starting out with a walk-
Dr. Weitz: And now all the gyms are closed, so it’s even more challenging to get your exercise in.
Dr. Zigler: Exactly. Yeah, it’s amazing. I see way more people out now. We go out every day, a couple of times a day for a walk or a run or whatever, and you see so many people out now, and it’s so refreshing to see. I wish we saw that every other normal day of our lives, you know.
Dr. Weitz: Of course, that started happening in LA and parks started being packed, and then the mayor said, “That’s it, parks are closed now too.”
Dr. Zigler: I know, that’s horrible.
Dr. Weitz: Hiking trails are closed. Beaches are closed.
Dr. Zigler: That’s horrible. I saw pictures, it was horrible.
Dr. Weitz: Golf courses now.
Dr. Zigler: I know. My brother works at a golf course and yeah, they’re closed now. Although you can still go out and play, so that might be …
Dr. Weitz: How’s that?
Dr. Zigler: You can go play, but there are no services. You can go out and bring your clubs and play.
Dr. Weitz: Not in LA.
Dr. Zigler: Maybe not anymore.
Dr. Weitz: Not in LA, no.
Dr. Zigler: Yeah. It’s a little crazy, but do what you can to get some movement in during your day. Then the last big one that we talk about is mindfulness and practicing different techniques that can help you manage stress in your life. There are so many things that you can do to do that.
Dr. Weitz: What do we mean by mindfulness? Everybody throws that term around, everybody thinks they know what it means.
Dr. Zigler: Yeah.
Dr. Weitz: What does it really mean, and how do you apply it?
Dr. Zigler: What it really means is just being aware of how you’re reacting to things, in my mind. That’s how I kind of define it. If I’m having a crazy day and I find myself getting angry, I know that I need to step away from the situation, and maybe I need to go do a meditation or do some reading or journaling for a while. A gratitude journal is an absolutely great way to think about all of the amazing wonderful things in your life, instead of thinking about the horrible dry eyes that you have. That’s a way to kind of be mindful about the good things in your life, and it can help to decrease that stress. Other things like yoga, that can be really. We really like yin yoga before bedtime, because it helps to kind of calm the mind, calm the body. It’s mostly stretching, so that’s also good for you.
Dr. Weitz: We’ve been having an excellent discussion, but I’d like to pause for a minute to tell you about our sponsor for this episode of the Rational Wellness podcast. Our sponsor for today is Metagenics, which is a leading practitioner-exclusive nutritional therapy company offering physicians evidence-based formulas to improve their patients’ quality of life. Metagenics provides functional nutrition support to allopathic, integrated, and holistic practitioners alike. Metagenics offers a number of products that support eye health, which is our topic for today on the podcast, including their new fish oil product, OmegaGenics Neuro 1000, which features a concentrated purified source of Omega 3 fats, with 1000 milligrams in each capsule of EPA and DHA. Which makes it easy to get the therapeutic dosage, which a lot of times is 1 to 2000 milligrams a day.
This product is concentrated with 750 milligrams of DHA and 250 milligrams of EPA. It’s also in a natural triglyceride form. Beyond that, Metagenics adds specific antioxidants. Rosemary, mixed tocopherols, and ascorbyl palmitate which is an oil-soluble form of Vitamin C, are added as antioxidants to make sure that the Omega-3 oils stay fresh. This is an awesome product for eye health, and now back to our discussion.
Dr. Weitz: Can you tell us what demodex are, and what part do they play in eye health?
Dr. Zigler: Yeah, absolutely. Demodex, they are an eyelash mite. Exactly, if you’re not itchy yet, you’re going to be itchy soon. Demodex, there are two different types that live on humans and in our eyelashes. These types of eyelash mites basically burrow into your eyelash follicles, and they cause problems, if you can imagine. They feed on bacteria, they feed on-
Dr. Weitz: I can’t help but have an image of bedbugs in my mind.
Dr. Zigler: I know.
Dr. Weitz: These little creatures on my eyelids.
Dr. Zigler: It’s horrible, and when you start thinking about it … I don’t want people to think about it so much that it freaks them out and that’s all they’re thinking about, because that does happen sometimes. But just think how you have … It’s a normal part of being a human being. We all have bacteria and mites and everything that live on us, and that’s normal. But it’s when they become overpopulated that it becomes a real issue.
They burrow under your Meibomian glands, they clog up those Meibomian glands with … And they go into your hair follicles, that’s where they primarily live. They start to reproduce. They really feed on that bacteria, and they really rely on the bacteria and dead skin cells to live and thrive. By them being there, it’s thought that they cause a lot more inflammation of the eyelids in particular. This can actually lead to different forms of blepharitis, which is eyelid inflammation, and Meibomian gland dysfunction, and then ultimately lead to dry eyes.
It’s devastating for some people. There aren’t a lot of things that we know, as far as controlling demodex. The one thing that we know is tea tree essential oil, is something that you can use to control demodex. Now, tea tree, you do have to be careful with. You can’t just slather tea tree oil on your eyelids, because it’s going to burn like crazy and it is toxic, so you have to be careful with that. We recommend that you just purchase a product that contains tea tree oil, and is made to be used around the eyes.
Dr. Weitz: Then what do you do with that, exactly?
Dr. Zigler: There are eyelid scrubs that are out on the market, that contain that tea tree oil. You would just close your eyes, rub in those scrubs, or if it’s a face wash that’s good to use too, that contains tea tree oil. Just kind of rub it into your eyelashes, rinse it off. That can help control the population. If nothing else, it’s definitely going to help control all that bacteria that they feed on, so it will help decrease that population and hopefully help you feel a little bit better too.
Dr. Weitz: Okay. This blepharitis creates what exactly?
Dr. Zigler: Blepharitis is an inflammation of the eyelids, and technically Meibomian gland dysfunction. We talked about the Meibomian glands earlier. Technically that is a part of blepharitis. It’s kind of a blanket term for all eyelid inflammation. The eyelids really play a big role in dry eye. People don’t realize how important the eyelids are, but they not only allow us to secrete that oil and secrete the tears that we need, but they’re the main source of the problem a lot of the time. That increase of bacteria, that thrown-off flora, that’s what leads to a lot of the dry eye that we see today.
Dr. Weitz: Do people cry a lot? Is that beneficial for the eyes?
Dr. Zigler: That is actually, the tears that you cry because you’re sad are actually a different composition than the tears that your eyes make naturally to lubricate your eyes. They’re a little bit more watery, and so they don’t provide quite the lubrication that your eyes really need. Some people actually find that it’s worse for them if they cry.
Dr. Weitz: What part does stress play on eye health?
Dr. Zigler: Yeah. Stress can be really big. I joke that I know that I’m really stressed when I get a sty, because I feel like every time I’m stressed out-
Dr. Weitz: Can you explain what a sty is?
Dr. Zigler: Yeah. A sty is basically a bump that forms on your eyelid. It’s kind of like a pimple on your eyelid. It happens when the Meibomian glands get plugged up, and they plug up because of stagnated oil and bacteria, and they start to form this bump on your eyelid. Stress can definitely play a role in this. Stress increases cortisol in your body, which throws off everything else. Throws off your hormones, it can increase inflammation in your body, and so that can absolutely have an effect on your eyes, as well as other parts of your body. Many people will notice, especially with what’s going on right now, that their eyes feel a little bit worse because they are so stressed out from what’s in the media and everything there.
Dr. Weitz: Why should we be stressed out? The whole world is ending.
Dr. Zigler: I know, I know. Don’t be stressed out, you get to spend all the time with your family, except then that causes more stress. Like having a toddler in the house.
Dr. Weitz: You mentioned macular degeneration, and that’s one of the most common problems with aging. What can we do about that?
Dr. Zigler: Macular degeneration can really be … There are studies that have looked at different-
Dr. Weitz: First of all, can you describe what it is?
Dr. Zigler: Yeah. Macular degeneration is just a deterioration of the macula in the back of the eye. The macula is responsible for your central vision. It’s responsible for seeing people’s faces, for seeing road signs, for reading, for all of those things that you use that specific center of your vision for. It’s not going to really affect the vision out to the side, your peripheral vision, as much. Which is a good thing, but it still means that it’s going to make it difficult for you to live your daily life and to do those normal daily activities of living, basically.
This happens mostly due to aging, and it happens because the cells that are in the central macula just start to deteriorate. There’s pigment there that can start to deteriorate. Our macula needs pigment to be healthy, and when that happens, it can lead to inflammation, it can lead to further vision loss. What we know now is that a healthy diet can really help. Those green leafy vegetables, those colored vegetables. Antioxidants and other nutrients are very beneficial. There’s a study out, the AREDS study and the AREDS2 study looked at specific vitamins and minerals that potentially, or they were looking at if they could help in the progression of macular degeneration. It was found that a certain formulation called the AREDS2 formulation now, that certain formulation is beneficial in stopping the progression or halting the progression of those that have moderate macular degeneration. We don’t know much about preventing it in general, but we know that a healthy diet can absolutely play a huge role in that.
Dr. Weitz: Can you describe what are the key nutrients in that AREDS2 formula?
Dr. Zigler: Yeah. It started out with a lot of it is carotenoids.
Dr. Weitz: Right.
Dr. Zigler: Lutein, zeaxanthin. You can get those separately if you want to, but they also come in an AREDS2 formulation. Zinc is in there-
Dr. Weitz: Now, on the carotenoids, I’ve heard some discrepancy. One of them is, let’s see, is it zeaxanthin or cryptoxanthin that comes from corn, is that right?
Dr. Zigler: Maybe it’s cryptoxanthin.
Dr. Weitz: Okay.
Dr. Zigler: Which is … I mean, I don’t know much about that one, but it does scare me a little bit. Just because if it comes from corn, I’m not big on that.
Dr. Weitz: Right. I’ve heard people say, “Well, I’m using astaxanthin.” That has the same benefits as the zeaxanthin, and lutein. Is that true? Do we know? What do we really know?
Dr. Zigler: Yeah, I mean, that can be a great benefit. That is a great one, and one that I recommend to all macular degeneration patients.
Dr. Weitz: Astaxanthin, yeah.
Dr. Zigler: Yes, definitely, yeah. Then there’s one that’s meso-xanthin too. I believe we don’t know as much about that, but it’s definitely something that-
Dr. Weitz: I hadn’t heard of that. Where does that come from?
Dr. Zigler: You know, I’m not sure. I just know it’s one of the other ones that isn’t talked about too much.
Dr. Weitz: We’ve got these carotenoids, right. Then we also have … is beta carotene part of that, or not?
Dr. Zigler: It used to be. In the AREDS, regular original AREDS study, beta carotene was a huge part of it. But then they started finding out that in smokers it can contribute … Or even people that smoked in the past, it can contribute-
Dr. Weitz: The Finnish smokers study.
Dr. Zigler: Lung cancer, exactly. They kind of, in the AREDS2 study, they looked at if they could take that out, and they did take that out. It’s not longer in any AREDS2 formulation, which is fine. I totally get that.
Dr. Weitz: Of course, you know, there’s no way that you’re serious about your eye health if you’re smoking.
Dr. Zigler: Yes, exactly. That’s actually number one.
Dr. Weitz: And that goes for cigarettes or vaping, and all these people who are vaping who think that it’s better for you-
Dr. Zigler: No.
Dr. Weitz: Just give that up right now.
Dr. Zigler: It’s horrible, yeah. And smoking is … I want to say it’s the number one cause. If not aging, then smoking is the number one contributor to macular degeneration, so stay away from those cigarettes.
Dr. Weitz: The number one contributor to-
Dr. Zigler: To everything.
Dr. Weitz: Everything. Yeah. Huge numbers of cancer, heart disease, on and on and on.
Dr. Zigler: Yeah.
Dr. Weitz: What other nutrients are in there? Is vitamin A and D in there?
Dr. Zigler: So C and E.
Dr. Weitz: C and E, okay.
Dr. Zigler: Yeah, those are the big ones. Really, it’s that combination.
Dr. Weitz: I think there’s a few B vitamins, right? Is biotin one of them?
Dr. Zigler: That isn’t one of them, I don’t believe.
Dr. Weitz: No. One of the B vitamins I think is in there.
Dr. Zigler: B6? I wish I had it in front of me, but yeah. [The AREDS 2 formula includes vitamins C, E, zinc, copper, lutein, and Zeaxanthin]
Dr. Weitz: Okay. Okay.
Dr. Zigler: But I know that B6 and a lot of those B vitamins can be very helpful for the eyes, so yeah.
Dr. Weitz: Then we have fish oil, is an important supplement for eye health, right?
Dr. Zigler: Exactly. Fish oil is a very important supplement, and there have been a couple of studies out on fish oil and dry eyes. We’re specifically talking here about triglyceride-based fish oil, so a higher quality fish oil, medical grade fish oil.
Dr. Weitz: By the way, for those who don’t know. And to be honest with you, over the years the research has gone back and forth and back and forth, and fish oil or fish in the natural form, the fish oil would be in a triglyceride form.
Dr. Zigler: Yeah.
Dr. Weitz: But then when they purify it to get out all the PCBs and mercury and all the other things, it ends up in the ethyl ester form, and then if you want to get it into the triglyceride form, you have to go through another process to process it back into the triglyceride form. The controversy is, which is the better form, the ethyl ester form or the triglyceride form? You’re talking about the fact that the triglyceride form may be the better utilized form.
Dr. Zigler: Yeah. Better absorbed. Most of the studies are done on triglycerides because we know that it’s better absorbed by the body. We found that basically, there was one study that was done with fish oil compared to, the placebo was olive oil. It showed that comparing those two, there was no difference in fish oil for dry eye being better than olive oil. But I have a problem with that study, because olive oil is a very healthy oil.
Dr. Weitz: Right.
Dr. Zigler: To compare it to olive oil is, in my mind, just not fair sort of. I mean, it showed that both of them actually improved dry eye symptoms, in different measures that they looked at. That tells me that fish oil is beneficial.
Dr. Weitz: Yeah. Why don’t we do this? Why don’t we take a McDonald’s cheeseburger and squeeze that out, and compare that oil to fish oil?
Dr. Zigler: Exactly. That’s what we should do, and that’s what some of the newer studies are actually doing. I mean, they’re not taking the burger, but they’re taking an unhealthy Omega 6 fatty acid, and they’re comparing it to those healthy triglyceride-based Omega 3s. Those are starting to find that absolutely there’s a benefit to increasing [crosstalk 00:37:32]
Dr. Weitz: You’re talking about something like corn oil. Despite what the American Heart Association says about polyunsaturated corn oil.
Dr. Zigler: Yep, exactly. Despite what they say, really, the only healthy oils in my mind, there’s fish oil of course. But then avocado oil, extra virgin olive oil, coconut oil. Those are pretty much it. I mean, that’s what we use in our house and that’s what we recommend for our patients.
Dr. Weitz: Yep, yep. Plus the fats that come from nuts and seeds, and avocado. Yeah.
Dr. Zigler: Yep.
Dr. Weitz: Let’s see what else. I know it’s not exactly part of the topic, but I’ve had several patients in the last couple of weeks have these floaters. They see something in the corner of their eye, and it kind of moves around and comes back. What exactly are floaters?
Dr. Zigler: Yeah. Floaters are … They actually occur inside your eyeball, so they’re in the back of your eye in your vitreous. Those floaters are just strands of different proteins and things like that, that start to accumulate. Because the vitreous inside our eye, as we age, just starts to liquefy, and it starts to form these clumps. Floaters are what you see as those little clumps in your vision. You’re kind of seeing the shadow of what’s in the back of your eye. The majority of the time, they’re absolutely nothing to worry about. But we do occasionally see someone that has a big floater right in the middle of your vision. If you’ve experienced this, you absolutely know, and you won’t be able to see through it. It can be very hard to see through.
Those are the people that we want to see, for sure, in our office, because that’s called a posterior vitreal detachment. Which sounds worse than it is. But it just means that that vitreous is kind of pulling away from the back of the eye, and it’s a normal aging process. Happens in tons of people, and it’s very common. But it can potentially lead to other issues, such as tears in your retina in the back of your eye and things like that. We would just want to monitor you if you have a floater that [crosstalk 00:39:48]
Dr. Weitz: Is there a treatment for floaters?
Dr. Zigler: You know, there hasn’t been for a really long time. Now they’re starting to do some laser for floaters. But really, whether it’s incredibly beneficial or not, it’s all patient-dependent. Some people will find benefit from it, other people won’t. It’s not something that’s regularly done. Optometrists usually don’t do it, an ophthalmologist would. But yeah, so that’s out there.
Dr. Weitz: What percentage of patients of floaters … Will they go away and stay away permanently, and in what period of time?
Dr. Zigler: Yeah. I mean, normally we want to see you back. If you have a big floater and you have a posterior vitreal detachment, we would want to see you back in about six weeks, because during that time is usually when if you were going to have a further issue like a retinal tear, that’s when that would happen. For the majority of people, usually within six months or so, those floaters are just going to kind of go out of your vision. Your brain is going to kind of get used to it too, so that helps a little bit because your brain will just turn off to that floater. Some people will just have more issues than others with noticing it and things like that. Probably if you’re more analytical, you’ll notice it more than other people. Yeah.
Dr. Weitz: If somebody goes for an annual eye exam, will they learn about some of these issues you’re talking about, like the problems with the eyelids and stuff?
Dr. Zigler: Yeah, absolutely. When we do an exam on your eyes, we start out by looking at the front of your eyes. We examine your eyelids, we examine your eyelashes and your cornea on the front of your eye.
Dr. Weitz: Is that something that most optometrists do?
Dr. Zigler: Yeah, absolutely. Most optometrists should be doing that in your comprehensive exam. You put your little chin in there-
Dr. Weitz: Should be? Are they?
Dr. Zigler: Yeah. Yeah, they should be. You put your chin in this little cup, and they look at the front of your eyes, you know. That’s when you know that they’re looking. Then they also look in the back of your eyes. They may do that a couple of different ways. They can look at the back of your eyes with a BIO, which is something they put on their head, and then look at you with a lens. Or they can look with the slit lamp in the back of your eye, which is the same machine they use to look at the front of your eyes as well. They should be educating you, especially if you have any of these symptoms. If you’re noticing dry eye symptoms or blurred vision or anything like that, and you make it known to your doctor, they should be looking for those things.
Dr. Weitz: Okay. To wrap this discussion up, how about if I ask you to give us top five foods to eat that improve eye healths, and top five nutritional supplements?
Dr. Zigler: All right, so. The top five foods that you should eat. First of all, you should be drinking water, plain filtered water, throughout your day. Get rid of all the sodas and all that stuff. Number two is green leafy vegetables. Make sure that you’re filling your plate with green leafy vegetables, or you’re putting it in a smoothie, however you want to get it into your body, that’s totally fine with me. The next is, I want you to be either eating fatty fish, wild-caught salmon, mackerel, things like that, or eating lots of avocado is another one. I’ll say fish and avocado. Then the fifth one, let’s see here. The fifth one, I’m a really big fan of nuts as well. Organic nuts can be really great, like almonds, macadamia nuts, those can be really wonderful. I know a lot of those seem like a lot of healthy fats, and that’s because it’s a huge deal. You need to be filling your body with healthy fats, green vegetables and water for sure.
Dr. Weitz: Okay, cool.
Dr. Zigler: As far as supplements go, the number one thing that I recommend is a fish oil supplement. A good quality fish oil supplement. Then I would move on to a lutein. If you don’t have macular degeneration or a family history of it, then there’s really not … There hasn’t been a benefit shown of taking an AREDS2. Now, lutein is good for everyone, and so I would take a lutein supplement. Then let’s see here, vitamin D. Because most people are vitamin D deficient, and that is going to play a role or has the potential to play a role in all parts of your health. The next one, let’s see here. Probiotic.
Dr. Weitz: Okay.
Dr. Zigler: Good probiotic is going to help that gut flora.
Dr. Weitz: What’s a good probiotic? I know we could spend an hour on what’s a good probiotic, but-
Dr. Zigler: Yeah, we could spend an hour. Of course there are ones out there … I believe it’s lysate based probiotics that have been shown to be beneficial for the eyes. There are some-
Dr. Weitz: What was that term?
Dr. Zigler: It’s lysate probiotics. There’s one by, it’s VSL, and it’s medical-grade, it’s-
Dr. Weitz: Oh yeah, everybody’s heard of VSL.
Dr. Zigler: Yeah, it’s super expensive, so that’s hard for a lot of people. We use one from doTERRA that works really well for us in our lives, so that’s the one that we like to recommend. But probiotics are really going to help to keep that gut flora in check. Gut health is really huge as far as dry eye goes as well. Absolutely take your probiotics. Then you know, the fourth one isn’t really a supplement but it’s something that I recommend every day. The fourth one is an eyelid cleanser, because if you keep your eyelids clean and you do it when you brush your teeth … You brush your teeth twice a day to prevent all that tartar buildup and cavities. If you do the same for your eyes, if you’re cleaning your eyelids twice a day, then you can prevent blepharitis and Meibomian gland issues and dry eyes. Absolutely, those are my five.
Dr. Weitz: Is that your Eye Heyedrate product?
Dr. Zigler: Yeah. We have a product that’s called Heyedrate Lid and Lash Cleanser, and it’s a really great product that … It’s super easy to use, you just spray it on your closed eyelids and then rub it in, just let it dry, and you go. My husband just sprays it on, and he’s out the door. It’s really easy to use. It couldn’t be simpler.
Dr. Weitz: Great. Can you tell us about your contacts, for people who would like to get ahold of some of your eyelid and other eye products?
Dr. Zigler: Yeah, definitely. We do have an offer that you can try, a bottle of our Heyedrate Lid and Lash Cleanser for free. It’s a month’s supply. You just go to freeheyedrate and you’ll … You can purchase it there, you just have to pay shipping. That’s definitely what I recommend. Then if you want to find us, we’re on YouTube on The Dry Eye Show. We put out lots of videos and content all about dry eyes, all about eye health in general, all about health in general really. You can watch some of our videos there. Then we also have a dry eye syndrome support community on Facebook. There are about a little over 10000 people in there that suffer from dry eyes, and we’re in there every day helping out.
Dr. Weitz: That’s great, awesome. Thank you, Dr. Zigler.
Dr. Zigler: Yeah, thank you.
