Pandemic pearls: The challenges of maintaining a healthy tear film

It is an understatement to say everyday life has certainly changed compared to just one year ago. As optometrists, we were excited for “our year” of 2020 to finally arrive. We planned special events and patient communications to educate and highlight the importance of 20/20 vision and were eager to have a full year dedicated to increased awareness on the importance of preventive eye care. Our focus sharply pivoted as we entered the spring of 2020. Faced with the threat of a novel virus, our full attention turned to taking care of patients in need of urgent care.

Now, as we head into 2021, we are faced with the clinical challenges of patient care as we continue to navigate pandemic life. Eye care professionals have always been aware of the stresses computer and digital device use put on the eyes and visual system, yet, with our days suddenly turning to a heightened use of these systems, the toll on the eyes has been magnified. To keep our patients comfortably seeing well, I want to share some easy-to-implement, clinical practices that have helped my patients alleviate ocular irritation to successfully go about their day.

Computer/digital device use

With a great percentage of the world shifting to virtual meetings along with distant learning now being a large part of education, the use of computers and digital devices have patients dramatically increasing screen time. A quality tear film is essential for clear, comfortable vision. It is widely known that near work inherently reduces the blink rate, which in turn causes evaporation of the tear film at a much greater rate. Blinking appropriately is essential for proper meibomian gland output. The Tear Film & Ocular Surface Society DEWS II Report highlighted up to 85% of dry eye is attributed to tear evaporation vs. purely from a lack of tear volume. To maintain a sufficient quantity of meibum in the tears, we also need to maintain a healthy quality to the meibum in the glands; we want to avoid meibum from thickening and impeding release. Here are some tips to help our patients maintain a stable tear film:

• Educate patients on the proper blink! This may seem trite but not only an increase in frequency of blink but also a complete, more forceful blink can and should be taught. 
• Increase water consumption and decrease caffeine intake. Proper hydration throughout the day is healthy for many reasons while also helping the quantity of tears in the lacrimal glands. Too much caffeine dehydrates and can contribute to loss of tear volume. The amount of daily proper water intake varies depending on the source; here are recommendations from the Centers for Disease Control and Prevention for daily H2O intake. I generally recommend 10 cups per day minimum (80 ounces) and reducing caffeine to 2 cups (16 ounces) daily. 
• Replenish the oil layer of the tear. Use of lipid/emollient-based tear supplements are quite helpful, especially during extended screen time. I educate patients that the cloudy appearance of emollient-based tear drops surprisingly do not blur upon instillation. 
• Increase omega-3 consumption. I always espouse healthy eating stressing a Mediterranean-based diet, which is higher in omega-3s. This is not only helpful for better quality tear but also helps adult patients reduce their risk of age-related macular degeneration and cardiovascular disease. For those who really suffer with poor tear quality, I prescribe OTC omega-3 supplements with the recommended dosage of 1,000 mg/day. 
• Warm compresses followed by digital massage. Concentrated warm, moist heat has been shown to help liquify meibum. For best results, the heat needs to be at least 5-10 minutes utilizing a compress that holds the heat from dissipating. (A warm washcloth is not affective unless the patient continues to reheat it every two minutes). The use of affordable, commercially available reusable masks works nicely. After proper application of the heat, I instruct patients to gently apply light, digital pressure to the lids (with clean fingers) for a minute or two to help evacuate the now heated meibum. 

Of course, for patients who are still symptomatic, an appropriate dry eye work up and more advanced treatments can be very beneficial. As lifestyle habits evolve while we navigate a global pandemic, we have a great opportunity to continually do our best to help our patients stay focused on healthy habits to keep their eyes as clear and comfortable as can be. Continue to use your AOA as a resource for excellence in clinical care.