Treating Dry Eye Disease with Diet: Just Add Water?

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Causes of dry eye disease include LASIK laser eye surgery, but there are dietary approaches to prevention and treatment.

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Dry eye disease is one of the most common eye disorders, causing irritation and discomfort, and can decrease functional vision, and sometimes cause a dramatic deterioration in the quality of life. About five million American men and women over age 50 suffer from moderate to severe dry eyes, and tens of millions more have mild or episodic manifestations of the disease, at a cost of more than $50 billion.

In terms of treatment, there are a bunch of drops and drugs that can help. We spend hundreds of millions of dollars on things like artificial tears, but currently there is no therapy available to actually fix the problem. If drugs don’t work, doctors can try plugging up the outflow tear ducts, but they can cause complications, such as plugs migrating and eroding into the face, requiring surgical removal. Or surgeons can just go in and cauterize, or stitch up the ducts in the first place. There’s got to be a better way.

What about prevention? Well, dry eyes can be caused by LASIK surgery, affecting about 20-40% six months after the operation. With a million LASIK procedures performed annually, that’s a lot of people, and sometimes the long-term symptoms can be severe and disabling.

There’s a long list of drugs that can do it—antihistamines, decongestants, nearly all the antidepressants, anticonvulsants, antipsychotics, anti-Parkinson’s drugs, beta-blockers, and hormone replacement therapy, as well as a few herbal preparations.

In the developing world, vitamin A deficiency can start out as dry eyes, and then progress to become the leading cause of preventable childhood blindness. Vitamin A deficiency is almost never seen in the developed world, unless you do it intentionally. There was a report in the 60s of a guy who deliberately ate a vitamin A-deficient diet, living off bread and lime juice for five years, and his eyes turned into this. Better than this poor woman, the member of some cult who tried to live off just brown rice and herbal tea, whose eyes literally melted and collapsed.

There are also a couple case reports of autistic children who refused to eat anything but French fries, or bacon, blueberry muffins, and Kool-Aid, and became vitamin A deficient. And, there was a case in the Bronx written up as a vegan diet and vitamin A deficiency, but it wasn’t the kid’s vegan diet; he refused to eat vegetables, consuming only potato chips, puffed rice cereal with non-fortified soymilk, and juice drinks. His parents lacked skill in overcoming the child’s tendency to avoid fruits and vegetables.

A plant-based diet may actually be the best thing for patients with dry eye disease, those who wear contact lenses, and those who wish to maximize their tear secretions. People with dry eyes should be advised to lower protein, total fat, and cholesterol intake, and increase complex carbohydrates. Increase vitamin A content by eating red, orange, yellow, and dark green leafy vegetables; increase zinc and folate by eating whole-grains, beans, and raw vegetables—especially spinach; ensure sufficient B6 and potassium intake by eating nuts, bananas, and beans; ensure sufficient vitamin C by eating citrus; eliminate alcohol and caffeine; reduce sugar and salt intake, and increase water consumption to six to eight glasses per day.

Well, we know dehydration can cause a dry mouth; might dehydration cause dry eyes? Seems kind of obvious, but evidently it was never studied, until now. Is the answer to just drink more water? Well, we know that those suffering from dry eyes are comparatively dehydrated. They figure that tear secretion decreases with progressive dehydration, just like saliva secretion decreases, giving us a dry mouth. And indeed, as one gets more and more dehydrated, the urine concentrates, and so does tear fluid. But one can reverse that with rehydration, raising the exciting prospect that improving whole-body hydration by getting people to drink more water might confer important therapeutic effects for patients with dry eyes. The researchers recommend eight cups of water a day for women and ten cups a day for men.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Scott Robinson via Flickr.

Dry eye disease is one of the most common eye disorders, causing irritation and discomfort, and can decrease functional vision, and sometimes cause a dramatic deterioration in the quality of life. About five million American men and women over age 50 suffer from moderate to severe dry eyes, and tens of millions more have mild or episodic manifestations of the disease, at a cost of more than $50 billion.

In terms of treatment, there are a bunch of drops and drugs that can help. We spend hundreds of millions of dollars on things like artificial tears, but currently there is no therapy available to actually fix the problem. If drugs don’t work, doctors can try plugging up the outflow tear ducts, but they can cause complications, such as plugs migrating and eroding into the face, requiring surgical removal. Or surgeons can just go in and cauterize, or stitch up the ducts in the first place. There’s got to be a better way.

What about prevention? Well, dry eyes can be caused by LASIK surgery, affecting about 20-40% six months after the operation. With a million LASIK procedures performed annually, that’s a lot of people, and sometimes the long-term symptoms can be severe and disabling.

There’s a long list of drugs that can do it—antihistamines, decongestants, nearly all the antidepressants, anticonvulsants, antipsychotics, anti-Parkinson’s drugs, beta-blockers, and hormone replacement therapy, as well as a few herbal preparations.

In the developing world, vitamin A deficiency can start out as dry eyes, and then progress to become the leading cause of preventable childhood blindness. Vitamin A deficiency is almost never seen in the developed world, unless you do it intentionally. There was a report in the 60s of a guy who deliberately ate a vitamin A-deficient diet, living off bread and lime juice for five years, and his eyes turned into this. Better than this poor woman, the member of some cult who tried to live off just brown rice and herbal tea, whose eyes literally melted and collapsed.

There are also a couple case reports of autistic children who refused to eat anything but French fries, or bacon, blueberry muffins, and Kool-Aid, and became vitamin A deficient. And, there was a case in the Bronx written up as a vegan diet and vitamin A deficiency, but it wasn’t the kid’s vegan diet; he refused to eat vegetables, consuming only potato chips, puffed rice cereal with non-fortified soymilk, and juice drinks. His parents lacked skill in overcoming the child’s tendency to avoid fruits and vegetables.

A plant-based diet may actually be the best thing for patients with dry eye disease, those who wear contact lenses, and those who wish to maximize their tear secretions. People with dry eyes should be advised to lower protein, total fat, and cholesterol intake, and increase complex carbohydrates. Increase vitamin A content by eating red, orange, yellow, and dark green leafy vegetables; increase zinc and folate by eating whole-grains, beans, and raw vegetables—especially spinach; ensure sufficient B6 and potassium intake by eating nuts, bananas, and beans; ensure sufficient vitamin C by eating citrus; eliminate alcohol and caffeine; reduce sugar and salt intake, and increase water consumption to six to eight glasses per day.

Well, we know dehydration can cause a dry mouth; might dehydration cause dry eyes? Seems kind of obvious, but evidently it was never studied, until now. Is the answer to just drink more water? Well, we know that those suffering from dry eyes are comparatively dehydrated. They figure that tear secretion decreases with progressive dehydration, just like saliva secretion decreases, giving us a dry mouth. And indeed, as one gets more and more dehydrated, the urine concentrates, and so does tear fluid. But one can reverse that with rehydration, raising the exciting prospect that improving whole-body hydration by getting people to drink more water might confer important therapeutic effects for patients with dry eyes. The researchers recommend eight cups of water a day for women and ten cups a day for men.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Scott Robinson via Flickr.

Doctor's Note

This is part of an extended series on the importance of proper hydration. Past videos include:

For eye health in general, here are a few others:

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