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Laser Doesn't Leave a Dry Eye in the House

September 09, 1986|PATRICK MOTT

For nearly two months, Charles Davidson confined himself to a darkened room in his Laguna Hills home, shutting out the light that sent jolts of pain through his eyes. He could not watch television or read. He could not come out of the room even to eat.

"It got so bad," said the 85-year-old, "that any light at all felt like needles sticking into my eyes. They were always red, they burned and felt scratchy. It was a terrible feeling."

For many people, pain that severe might have brought tears. But Davidson could not have cried even if he had wanted to. There were literally no tears to cry.

Davidson was a victim of a little-known but sometimes highly painful condition known as "dry-eye syndrome." Technically known as keratoconjunctivitis sicca, the syndrome occurs mostly in people 50 years or older and can be brought on by rheumatoid arthritis, a Vitamin A deficiency, certain medications such as antihistamines, decongestants and heart medications, and low humidity in the air, among other things. Those affected suffer from a gritty itching or burning sensation and can develop infections or external damage to the eyes.

Milder cases often respond well to eye drops, "artificial tears" and other over-the-counter lubricating agents. In extreme cases, however, a more drastic measure often has been prescribed: complete closure by cauterization of the duct that carries away lubricating tears from the surface of the eye.

But the cauterization treatment, said Dr. Charles Manger, a Laguna Hills ophthalmologist, proved to be "a very gross method. It was inexact and imprecise. And in more than half the cases the closure would reopen."

Today Manger is using the very thing that hurt Charles Davidson to cure him.

About 4% Employ Method

The Orange County doctor is one of about 4% of American ophthalmologists who are employing light in the form of an argon laser to permanently seal the tear duct.

"The general principle for the procedure has been around for a long time," Manger said. "Ophthalmologists have been doing the closure by cauterizing with a needle or forceps for maybe 30 years. But the laser is much more precise and permanent. Between 80% and 90% of the people who have the procedure done are going to benefit significantly from it. And the punctum reopens in only about 15% of the cases."

The punctum is the opening in the eye near the nose through which tears drain into the nasal passages. If the punctum is too large, the tears that form a lubricating coating on the eye drain away too much and too quickly, leaving the eye dry and susceptible to infection, said Manger. Also, he added, dry eyes can impair vision, causing a blurring effect.

With the punctum closed and the means of drainage cut off, however, even minimal tear production often is enough to properly lubricate the eye, Manger said.

The laser technique, said Manger, was developed about two years ago. Since then, he said, he has performed the procedure on 10 patients, most of whom were 60 or older.

"The main reason dry eye occurs has to do with the glands that are located above the eye producing less tears as people age," Manger said. "About 30% of people have a significant drop in tear production once they pass age 60. And at age 65, the glands produce about 60% less tears than they did at age 18."

The procedure, an outpatient operation that takes less than half an hour, involves injecting a local anesthetic around the eye and aiming a tiny laser beam at the punctum and "making multiple little burns" as the patient's head rests in a type of harness to keep it immobile.

The cost is around $300.

The laser surgery is not for everyone, Manger said. While it presents no danger to the eye, it is used only on patients whose dry- eye condition "is day after day and week after week really affecting their life styles," Manger said.

Test of Treatment

And, he added, there is a test that can be performed to see whether permanent closure of the punctums would be the best treatment. Tiny collagen plugs, about the size of a grain of rice, can be quickly and painlessly implanted in the tear ducts through the punctums. After they dissolve three to four days later, the patient can measure the effects of the plugged ducts before and after the implantation, Manger said.

Sometimes, said Dr. Leslie Garland, a Torrance ophthalmologist who performs the laser surgery, even a collagen implant will not stop dry eye.

"Sometimes you get someone who has a tear duct that's larger than the collagen plug," he said. "In that case, we use double implants. We figure if one log won't dam up the river, maybe two will."

Also, he said, some ophthalmologists use what is known as a "stitch test," closing the punctum temporarily with a suture rather than a collagen plug.

"But," said Garland, "this tends to scare . . . the patients."

Manger performed the collagen implant procedure about a month ago on Irene Larson, who said she had suffered from dry-eye syndrome for more than a decade.

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