Dry Eye

One of the many risks with NF2 are severe dry eye issues due to brain tumors or when treating brain tumors. This can include total loss of tear production and as a result, can lead to greater problems such as corneal scarring. Below are a few articles on how to treat dry eye and helpful links for further reading.

Looking after Your Eyes

Written by: Anne Duncan
Reprinted with permission.

eye dropper and eye illustration

For many people with NF2 the removal of one or both Auditory Neuromas not only leaves them profoundly deaf, they often have single or bi-lateral facial palsy. One of the major implications of Facial Palsy is that their eye(s) can be affected by lack of natural lubrication and exposure. When someone with full facial function blinks, it is an automated reflex that occurs many times per minute. The eye closes fully and quickly. In doing so, there is minimal disruption to vision, and glands within the eye secrete a minute amount of liquid that is fully distributed, which refreshes and moisturises the eye.

However, for most people with facial palsy, it is not a frequent, automated reflex, the eye does not close fully, and either smaller amounts or no liquid is distributed, or it is distributed unevenly. Therefore, an eye affected by Facial Palsy can easily dry out. This can lead to ulceration and permanent scarring of the eye cornea if not kept in check.

Therefore, people with facial palsy have to use artificial tears (eye drops) to maintain eye lubrication. Below are a few ideas on maintaining a healthy eye in a “dry eye” situation:

  • Get adequate sleep.
  • Avoid or compensate for low humidity.
  • Eye operations to reduce exposed surface area.
  • Wear bike or safety goggles in windy or dirty places.
  • Wear safety glasses in air conditioning or breezes.
  • Use an eye bandage or a large contact lens.
  • Use humidifier inside when humidity is low.
  • Treat blepharitis if needed.
  • Use eye drops frequently.
  • Avoid long exposure to air conditioning.
  • Moisture chamber on eyes when sleeping.
  • Drink plenty of water to minimise dehydration.
  • For long-term use, use drops without preservatives.
  • Remove eyelashes growing the wrong way.
  • Clean top and bottom lids regularly.
  • A variety of Eye Ointments offer most effective lubrication.

For people with facial palsy, the extent to which the eye easily dries out is different from person to person. The range of ideas above covers the mild to severe dry eye.

Lubricating Drops and Ointments for your Eyes

Written by: Keith D. Carter, MD and Jeffrey A. Nerad, MD

Dry Eye Treatment Center
Department of Ophthalmology & Visual Science
University of Iowa, 200 Hawkins Drive
Iowa City, IA 52242-109

The normal ocular surface is covered by a layer of tear film. A stable tear film ensures comfort. Eye irritation caused by lack of tears or poor blinking is one of the most common problems encountered by ophthalmologists.

Eye and Tear Production Diagram

Why do my eyes tear if they are dry?

When the eye is irritated, extra tears are made to “flush” out the irritation. This reflex tearing can be responsible for excess tears that run down the cheeks.

What is the treatment for irritated, dry eyes?

Artificial tears are the first line of therapy. They are typically used 4 times a day or more. It is necessary to use the tears on a scheduled basis as well as prior to any activities that may prolong staring (for example, watching T.V. or driving). A good rule is that if your eyes feel dry at any point during the day, then you are not using the artificial tears enough. A thicker version of the artificial tears can also be used during the day hours such as Celluvisc, Refresh Plus, or Goniosol if you can tolerate a few minutes of blurry vision. For bedtime use, ointments such as Lacrilube or Refresh PM can also be used. Ointments are thick drops and are best used for bedtime use.

It is important to recognize the difference between artificial tears that provide moisture and eye drops that only remove redness from the eyes. Artificial tears come in preservativefree and preservative-containing forms. Those that contain preservatives generally are easier to use “on the go” by patients who need them only a few times a day.

There are many over-the-counter artificial tear brands to choose from, so individuals may need to do some trial-and-error to see what works for them.

People with severely dry eyes who need drops four to eight times a day should use preservative-free artificial tears to avoid developing an allergy to preservatives. Preservative-free drops are packaged in separate vials that each contain one dose.

Hints for applying ocular lubricants:

Use drops and ointments as a preventive measure. Don’t wait until your eyes feel dry! Only use the smallest amounts frequently. When applying ointment, only use a tiny drop and apply to the corner of the eye and then rub the lower eyelid to spread evenly. Do not apply a line of ointment across the eyelid, it will be too much. If your vision is blurred after five minutes, you’ve used too much. Another hint is to keep the ointment bottle warm. The ointment will come out smoother if the bottle is kept warm.

A few Lubricating Drops & Ointment Types:

  1. Thin consistency drops:
    • Any artificial tears
    • Tears Natural II
    • Refresh Tears
  2. Thicker consistency drops:
    • Refresh Liquigel
    • Celluvisc
    • Genteal Gel
  3. Ointments:
    • Refresh PM
    • Lacrilube

All drops should be used at least 4 times a day and can be used as often as you like (even every hour). Ointments are best for nighttime use. Use only a tiny amount placed into the eye.

Other options:

In some cases, a tear duct drain “stopper”, a punctual plug, can help keep the tears in the eye longer. This can be done in the office, taking about 5-10 minutes. Surgical options may be considered in advanced cases that are not treated effectively with other treatments.

Helpful Resources

video iconNF2 Eye Care (link to slide show presentation)

Eye Treatment Brands and Product Information