Dr. Shalu Pal

  • "If you want quality and wonderful service, please go to Dr. Shalu Pal! The patience, care, and true concern that Dr. Pal has for her clients is wonderful. "

    --Seleena J
  • " I was pleasantly surprised by finding a hidden gem within Dr. Pal's office"

    --Naveed
  • "Finally a doctor who is extremely knowledgeable, patient and explains things clearly. She is a wonderful human being who really takes the time to care for your needs. The office has a wonderful atmosphere and the staff are just as helpful as Dr. Pal. "

    --Mikail
  • "I couldn't ask for a better Optometrist. She is a delight to deal with, very patient, helpful and extremely knowledgeable. She was very good with my kids who can be very fussy at times.. And who could ask for a more beautiful location. Highly Recommend! "

    --Natalie M.
  • "My wife and I, highly recommend Dr. Pal. The staff, the service, the merchandise, are all top notch. They really make you feel welcomed. It has been several years since I have been able to see this well !!! You and your staff are the best !!!! "

    --Steve and Maria L.
  • "We barely go to optometrists so when we do, we should look for the best! I am super pleased I chose Dr. Pal\'s office. They were helpful from beginning to end, from booking on the phone to my actual visit. Dr. Pal was very detailed and went in-depth about my eye health. She is very patient and made me feel calm. The optician helped me pick a great pair of glasses, they were genuinely friendly which is a huge bonus."

    --Ahmad S
  • "I have been going to Dr. Pal for several years now. My most recent visit on June 6, 2016 was the best experience there that I have ever had. Firstly, the women on the desk were friendly and efficient - a very good prelude to my examination. Dr. Pal, herself, was, as usual, very thorough and encouraging in her examination. And she puts you at ease before we get into the eyes examination by discussing other things in life. That helps to ease any stress I may have. And they now have a man in the office who does that difficult examination (name of which I do not know!). He is so patient and encouraging and made the exam not so difficult for me this time. After all that, I saw Dr. Pal again before I left and she told me my eyes were good! Even had the news been not so good, I believe that I would be able to handle it because I truly believe that Dr. Pal and her staff would have taken good care of me. I will always go back to Dr. Pal and members of her team because I truly believe"

    --A. Howlett
  • " I have been to a few appointments at Dr. Pal\'s office over the last year for dry eye issues and every time it has been a very positive experience. The 3 receptionists at the front desk are warm and friendly. They are attentive and provide a very high level of customer service. I appreciate that they call me by name and remembered conversations we had at previous visits. I find Dr. Pal to be an excellent practitioner who is very thorough with her exams, has a lovely personality and takes the time to answer any and all questions that may arise. I am happy with the computer glasses I purchased and value the honest opinions I received from the staff when selecting frames. It was refreshing to have multiple opinions on styles and I felt they truly wanted me to walk out with a frame that was best suited to me. I highly recommend Dr. Pal \'s office! As a health care practitioner myself, I think all health care experiences should be this personilzed and friendly!"

    --A. Mclean
Dry Eye Symptoms: Causes and Treatments


Contents

Dry Eye Symptoms: Causes and Treatments

As discussed in the Introduction article, there are three main areas that contribute to dry eye symptoms:

  • Inadequate tear production
  • Tears that evaporate too quickly from the ocular surfaces
  • Imbalance between the three main components of normal tears

Inadequate Tear Production

A tear film that isn’t adequate to cover the surface of the eye completely on each blink can cause discomfort and leaves the eyes open to possible secondary infection. The source of this problem can be an underlying inflammation of the tissues of the eye, medications that are known as anti-cholinergics, and the effects of aging.

Inflammation of the ocular surface tissues often contributes to dry eye symptoms; systemic conditions such as lupus or acne rosacea or other inflammatory conditions may be at increased risk for this type of dry eye. Inflammation causes the immune system to decrease the signals that cause tears to form, creating a shortage in the eye.

Eyedrops containing cyclosporine, available by prescription under the trade name Restasis, are useful in treating inflammatory dry eye.

Topical cyclosporine reduces inflammation and is effective in about half of patients with this type of dry eye. It is the only treatment for dry eye symptoms that is NOT an eye lubricant, but an anti-inflammatory drug.

Once cyclosporine drops are started, the eye should begin to make more of its own tears, relieving symptoms, but patients should be aware that relief will not be instantaneous but can take three to six months to significantly increase tear flow. Daily use is important, however; once full effectiveness has been reached, some patients may be able to maintain the effects with a reduced dosage. Others will need to continue use of the medication at full dosage indefinitely.

In the meantime, most eyecare practitioners will ask patients to begin using ocular lubricants on a regular basis for an immediate increase in comfort. If lubricant eye drops several times a day are necessary, unpreserved, single-dose formulations may be recommended because the preservatives in larger bottles may cause a reaction if used four to six times a day.

Another method of reducing inflammation is a steroidal eye drop called Lotemax, which is also prescribed for patients just beginning treatment with cyclosporine to give immediate relief while waiting for the cyclosporine to become effective. Some steroidal drops can cause an increase in the pressure inside the eye, but this particular one is less likely to do so.

Medications with anti-colinergic side effects are relatively common and may be used to treat allergies, gastrointestinal disorders, asthma, hypertension, chronic pain and other conditions. Anticholinergic side effects cause blurred vision and dry eyes, as well as dry mouth drowsiness, sedation and decreased sweating as well as others; if you suffer from dry eyes because you take an anti-cholinergic medication, talk to your doctor about the possibility of using different medications, but do not stop taking any medication without checking with your doctor first.

Tear Evaporation

If there is an adequate supply of tears being produced, but they are leaving the eye too quickly by evaporation, one way to treat this is to partially block the drainage canals so they stay in the eye longer. Blocking the drainage canals, called lacrimal punctae, is accomplished with the use of punctal plugs.

The lacrimal punctae are found in the inner corner of the each eye, one in the upper lid and one in the lower. Those in the lower lids form the major part of the drainage system from the eyes; at first, the eyecare practitioner may want to place temporary plugs in the lower canals which are made from collage and will dissolve over a few days. When the plugs are first inserted, the patient will usually notice decreased dry eye symptoms, allowing both patient and doctor to find out if they will work as expected. Once the initial pair of plugs has dissolved, plugs made from biologically inert silicone can be placed. These are permanent in the sense that they don’t dissolve, but most types of plugs are easily removable if it becomes necessary later.

If some relief from dryness is obtained from plugging the lower punctae, it is possible to place plugs in the upper punctae as well. For most patients, however, plugs in the lower punctae are adequate to solve their discomfort.

Punctal plugs are very effective for some patients, but should not be used when there is eyelid infection or inflammation; the makers of Restasis advise eyecare practitioners not to prescribe it for patients using punctal plugs.

Imbalance in Tear Components

If the dry eye symptoms are due to an imbalance in the components of the tears, such as too much mucin being secreted, treatment will depend on managing the imbalance itself.

Two of the three major components of the tears are produced by glands found in the upper and lower lids called meibomian glands. Their openings are just behind the line of the eyelashes, where they secrete either lipids which act to reduce evaporation, or mucin, which allows the tears to spread smoothly over the surface.

An imbalance of the tear layer can cause dry eye symptoms just as severe as those caused by inadequate tear production. Known as Meibomian Gland Dysfunction (MGD), this imbalance can be caused by poor lid hygiene or inflammation of the lid margins known as blepharitis. MGD is the underlying cause of many cases of dry eyes.

For an overview of dry eye, please read the article titled Dry Eye Symptoms: Introduction.

To learn more about MGD-caused dry eye symptoms, please continue with the article addressing that issue, titled Dry Eye Symptoms: Meibomian Gland Dysfunction.


 
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