Talk:Dry eye syndrome

Citation duplication
I think once per paragraph is enough. If you have different sources in the paragraph put them all at the end of the paragraph.--Chrisdab 03:20, 6 January 2007 (UTC)

The number of citations in this article is absolutely ridiculous. There's no need for a citations after every word. 84.90.41.37 22:03, 15 January 2007 (UTC)


 * That might have been fine had this been a non-medical article, but because this is a medical article, it is very important that there be available a source for every statement. Paragraphs and even individual sentences often comprise of info obtained from multiple sources, and it would otherwise be difficult to determine the source for any particular statement or item. The goal is to maximize trust in the content.


 * Also see . It states:


 * Medical articles should be relatively dense with inline citations. It is too easy for a later editor to change the body text and then nobody is sure which statements are backed up by which sources. Unlike many established scientific disciplines, medicine attracts controversy and opponents on even the most basic and commonly held facts.


 * I actually think this should ideally be the case for every Wikipedia article, although it'd probably be too tedious. --Amit 04:52, 6 January 2007 (UTC)


 * I think at least do it at the end if the sentence. It seems a little overboard and it does make it hard to read. I mean medical journals don't have this many citations in their sentences. I'm a little tired so it may be hard to get my point across but multiple citations for the same source, at least in the same sentence, aren't useful if the link points just to the source article and not the actual text that is cited. thanks --Chrisdab 10:26, 6 January 2007 (UTC)


 * I understand your point that it would probably make for a cleaner and more readable article if the citations are not between two words in a sentence. However, even several individual sentences comprise of info obtained from multiple sources. At present, it is possible to know which item in the sentence is obtained from which source, but otherwise this will not be possible. It is also easy to find the actual text in the ref using the find feature in one's browser. --Amit 22:21, 15 January 2007 (UTC)

For some it wouldnt be a problem to reduce the citations. the 2nd paragraph in Symptons for example has the same citation after every sentence while the citation could just be at the end of the paragraph. it would be a good idea to review the article and make citation changes so it isnt so cluddered. 24.241.227.184 23:46, 19 January 2007 (UTC)


 * Again, that may not be a very good idea, because sentences can be added or modified later on by others, and if this happens in the paragraph under discussion, it'll then later be unclear as to which sentences came from where. In my opinion, what this article and WP in general really need is a better way of citing info, so users reading the article don't have to always be bothered with them. --Amit 02:00, 20 January 2007 (UTC)

Most of the citations are from the same source, so it isn't necessary to put all of these citations after every single phrase. It becomes an eye sore for the article and also becomes difficult to read and print. Citations should be added at the end of the paragraph. -Vlad (talk) 00:43, 13 December 2007 (UTC)
 * Excessive overciting makes it difficult to read the article. Citations at the end of paragraphs are sufficient. BlackCab  ( TALK ) 21:34, 11 February 2016 (UTC)
 * What a waste of time. Some zealot went and reinstated them. The result is an article that is far more difficult to read than it need be. BlackCab  ( TALK ) 02:27, 12 February 2016 (UTC)

Unsourced text
This section includes unsourced text that has been removed from the article. --Amit 16:16, 18 September 2007 (UTC)

Causes

 * Research indicates that approximately 80 per cent of dry eye cases are due to a deficient or disrupted lipid layer, which leads to abnormally fast evaporation of protective tears and subsequent irritation. The lipid layer is the outside layer of the tear film which helps prevent the evaporation of the tears.

Other research indicates the film does not evaporate but suffers de-wetting caused by a hydrophobic ocular surface - ref Frank Holly Phd —Preceding unsigned comment added by 92.233.165.60 (talk) 21:12, 31 May 2008 (UTC)

Clarymist
I'm moving all of the info about Clarymist from the article to this page. This is because of several reasons, namely:
 * 1) No third-party references exist for these claims, and Wikipedia shouldn't serve as a basis for product advertisement.
 * 2) Looking at the research study in detail, a large portion of the reported reduction in symptoms can be attributed simply to using a placebo.

It seems more than a bit unusual that a product for dry eyes would work even when sprayed with the eyes closed. I had to try it out for myself though to be sure. I did, and it did not have any effect, irrespective of whether it was sprayed with eyes closed or open. The text removed is below. --Amit 01:08, 29 September 2007 (UTC)


 * A recent placebo controlled study at Aston University indicated that up to an hour after appliation of Clarymist, the lipid layer was found to significantly increase in thickness. Up to 30 minutes after application, over 50 per cent of subjects reported that eyes subjected to Clarymist were also more comfortable. These findings are shortly to be presented at an eye care conference.


 * Clarymist is a natural soy lecithin spray treatment that attempts to treat the cause rather than the symptoms of dry eye. Clarymist works by stabilising the tear’s lipid layer, thus helping to prevent abnormally fast evaporation which is one of the causes of dry eye.


 * Clinical trials of 382 subjects showed that 89 percent reported a reduction in dry eye symptoms as a result of using Clarymist.


 * Unlike drops and gels, Clarymist is sprayed onto closed eyes and can be used when wearing contact lenses. Clarymist has not been shown to produce any adverse side effects.

Clarymist is designed to help people who have dry eye and although trials have shown it to benefit people without dry eye the perceived effects are less marked. If you don't have dry eye then it doesn't surprise me that you didn't find it had any affect. Many people find it difficult to believe that this spray can have any effect when sprayed on to the closed eye. When I'm working with patients who have dry eye it can be difficult to persuade them to even try Clarymist because they immediately think it can't possibly work. However, its my experience in clinical practice, that those patients who have lipid dysfunction dry eye do often get benefit from this spray and tell me that their symptoms are much reduced. Once sprayed on the closed eye the solution works its way along the eye lashes and the lid margins and then into the eye. Enough will enter the eye in this way to improve the tear film for many people with lipid dysfunction dry eye. This is a recognised method of applying eye medication and is often used in procedures for the detection of eye diseases. Frank45 09:20, 4 October 2007 (UTC)

Androgen
I don't have time to work on this now, especially with Wikipedia's rules about citations. But maybe someone else would like to get all the citations to back up the following. David Sullivan at Harvard Medical School's Eye Institute has done some work over the last several years that shows that androgen therapy helps with dry eye. Allergan currently has some androgen eye drops in clinical trials. I heard Sullivan speak at a scientific meeting (where my job was to write up the proceedings, write, not just transcribe) and his ideas were good. Basically, dry eye is more common in older women than men. He thinks it is because as women go through menopause, testosterone levels drop (little known fact), which leads to dry eye. Androgens control the viscosity of the oils in the skin oil glands and similar ones that protect the cornea as well. Men's testosterone levels generally being higher to begin with, it's less of a problem for them--oil stays thin,not too thick to stream over the eye and prevent fluid from evaporating. I'm happy to provide my write up of the meeting proceedings, which were published in 2002 and constitute a respectable secondary source (though not, ironically, if I write the material here myself). Here's the title "Proceedings of the 3rd annual conference on Sex and Gene Expression" I'll check my watchlist to see if anyone asks for it. Also, there was a recent article in the LA Times in which Sullivan's work was mentioned. Eperotao 17:01, 17 March 2007 (UTC)


 * Actually, as this is comparatively short, I'm just going to post it here. This IS copyrighted by the Society for Women's Health Research, but I'm hoping I'm not violating any laws by allowing people interested in dry eye to read it, since the organization's mission is to help people with health problems. Please do not plagiarize this for the entry. This is a summary of a talk given by Harvard eye researcher David Sullivan in 2002. He was given an opportunity to read and correct this, so it can be considered accurate.


 * (I have removed the content with a copyright claim. The closest equivalent by the author I could find was ) --Arcadian 02:58, 29 July 2007 (UTC)

Neutrality of section on Restasis
Tell me, does that bit about "Restasis" sound too advirtisementy? (it was added 11 March 2006 by 67.87.254.63)


 * I don't know if that bit should be deleted but for the claim, it should certainly be backed by sources. —The preceding unsigned comment was added by Seunghun (talk)


 * A bit, but it's true. I added a source.-AED 05:47, 10 April 2006 (UTC)


 * I added a little bit about the mechanism of action of the Restasis... I wanted to include some history on cyclosporine, i.e. that it was discovered in 1972, that it has historically been known for it's use in preventing solid organ transplant rejection...but couldn't really find a good spot or way to incorporate it.  Maybe that can be added once the topic has been pulled out to it's own article.  --Kfanciulli 01:38, 2 May 2007 (UTC)


 * The relevant article Ciclosporin has existed since 11:38, 27 November 2002 (UTC).   — Jeff G. (talk&#124;contribs) 05:54, 5 August 2009 (UTC)

Fish Oils / Omega 3 / Alpha Lineolic Acid
Hi chaps, I've renamed the 'omega 3' subsection as 'fish oils' as the study cited by Miljanovic et al examined used questions on sea food consumption as a surrogate for omega-3 intake. Cross sectional surveys are open to confounding and it would be safer to report the study findings rather than the authors inferences. I've also amended my typo regarding the Arch Ophth study Nernst (talk) 18:13, 6 May 2008 (UTC)

Changing article title to "dry eyes" or "dry eye syndrome"
Has anybody thought of changing the page title to Dry eyes or Dry eye syndrome. Most people (vets and optoms included) are unlikely to put 'keratoconjuncitivitis sicca' in to google. This is a good article and shouldn't be hidden. It's quite a big change and I'd be reluctant to make it without some feedback. —Preceding unsigned comment added by 78.146.186.66 (talk) 14:24, 9 May 2008 (UTC)
 * Both terms already redirect to this article. Delicious carbuncle (talk) 16:07, 9 May 2008 (UTC)


 * I understand the concern, but Wikipedia policy requires that the article title should be the scientific or recognized medical name rather than the lay term. For more information, see naming conventions for medicine related articles. As such, I don't see how the article title can be changed.

Restastis
Thanks for the further contributions to this section. I do think some further improvements need to be made -

"It is the only prescription product approved for chronic dry eyes.[5]" Reference is 3 years out of date and refers only to the US. While it is commendable to avoid weasel words, it is impossible to have complete confidence in this statement

"Approved by the U.S. Food and Drug Administration in 2002 for this indication[5], the drug decreases inflammation[6] on the eye surface." Tautalogy / clumsy. By eye surface does the article mean conjuncitva/sclera/cornea ?

"Cyclosporine appears to work since the chronic inflammation of the ocular surface is mediated mainly by T-lymphocytes and cyclosporine’s proposed mechanism of action in immunosuppression is through T-lymphocyte inhibition[15] through “binding an intracellular protein that ultimately controls transcription factors required for cytokine production and T-lymphocyte maturation”.[16]" Poorly worded, repetitive and overstated. The pathogenesis is variable and still poorly understood. Most drugs ulitmately work by modification of protein transcription, what is the purpose of this statement ?

"It increases healthy tear production,[6] which may be reduced because of inflammation on the eye surface.[5] In a clinical trial involving 1,200 individuals, Restasis increased tear production in 15 percent of patients, compared with 5 percent of patients in the placebo group.[5]" Repetitive and confusing - "inflammation of the eye surface~" has already been mentioned twice in this paragraph. Clarify. Are there 'unhealthy' tears as well as healthy tears ? Surely a decrease in tear production promotes inflammation. If the pathogenisis is chicken and egg then this should be stated. What is the journal reference for the improvement in 15% of 1200 people ?

"Usually, 1 gtt (drop) of Restasis is instilled in each eye twice a day, 12 hours apart.[1] It should not be used when ??while?? wearing contact lenses,[1] or by persons ?? people ?? with eye infections[5] or hypersensitivity[5] to the ingredients. It has not been tested in people with herpes viral infections of the eye,[5] and it should not be used by anyone with a history[6] of such an infection. The most common side effect is a burning sensation.[5] Other side effects may be eye redness, discharge, watery eyes, eye pain, foreign body sensation, itching, stinging, and blurred vision.[1][5]" Does it have to be exactly 12 hours apart, is this convention or evidence based ? Of course it shoudn't be given it to people who are allergic to it. Cyclosporin has been tested on patients with HSV in the treatment of stromal keratitis (Heiligenhaus et al, Graefs '99)

I'd welcome further ideas before re-modifying this secion Nernst (talk) 10:27, 21 July 2008 (UTC)


 * The sentence about it being the only prescription drug for dry eyes can simply be started with "As of 2005," to address that issue.


 * At this time I don't have a journal reference for the 15% claim, but I imagine the result is from a study conducted by the company that sells Restatis. It is also in the product insert. The statement: "In a clinical trial involving 1,200 individuals, Restasis increased tear production in 15 percent of patients, compared with 5 percent of patients in the placebo group." is very important because it states the chance of the drug being effective.


 * The statement about 1 drop being used twice a day is again based on the info contained in the product insert. Of course it doesn't have to be exactly 12 hours apart, but that is desirable.


 * --AB (talk) 22:59, 21 July 2008 (UTC)

"As of 2005" would be one solution but its not hugely helpful to emphasise the licenced status since on and off label topical corticosteroids remain the mainstay of treatment of ocular surface disease. I've reinserted the 15% claim but it's still not ideal and it's only examining a surrogate outcome (patients want to know if there eyes will feel less dry, not if they'll produce more tears). To be honest I'd prefer to remove the whole 2nd paragraph because if you're taking the drug, you'll already have the small print and if you're not, it's not really relevant. 219.88.218.112 (talk) 07:50, 22 July 2008 (UTC)


 * Laypersons such as myself don't know about that relation between corticosteroids and ocular surface disease. Accordingly, I've now modified the sentence and added it back to the article.
 * The point about 15% is most definitely relevant. Like I said earlier, it tells you the chances of the drug being effective for you, and it helps you decide whether to consider using the drug at all. --AB (talk) 18:37, 22 July 2008 (UTC)

Regardless of background, input is always appreciated but context is important and it is less helpful to modify sections in isolation. This article works best when it provides an overview of options and ideas. Professionals can provide more detail and up to date research to individuals where it's needed. I'm as guilty as anyone of selective editing but don't really have the time or expertise to go over the whole thing. There are lots of general review are out there for anyone inclined to improve the article further (see below). Evidence from manufacturers should always be treated with caution and in a complex disease like this, outcomes like tear production are less useful than perceived improvement or willingness to recommed the product (98% in one study). Remember, many people with dry eyes will get reflex tearing! http://www.ajmc.com/article.cfm?ID=10265 http://www.ajmc.com/article.cfm?ID=10266 If we're keeping the side effects section, then we should probably include the risk of cancer at high doses of cyclosporin. —Preceding unsigned comment added by Nernst (talk • contribs) 11:41, 23 July 2008 (UTC)


 * I disagree that the purpose of an article is only to provide an overview of options and ideas. As we know, there isn't a lack of space here. If any section becomes too large, it can always be split into a separate article. What may be excessive details to one reader may be important information for another. Accordingly, I don't mind the inclusion of the risk of cancer. As for evidence from manufacturers, I agree that it should always be treated cautiously. --AB (talk) 19:34, 24 July 2008 (UTC)

Good point and fair enough. The article is still readable and that's the main thing. I think what I'm trying to say is that we shouldn't get bogged down in detail and miss the wood from the trees. If we do talk about one treatment we should do it in the context of the other therapies. I managed to track down a review that includes FDA licencing info and have accordingly removed the "only licenced treatment" bit (again, sorry) on the basis that it can be misleading if it makes people think that other treatments are not safe or have not been FDA approved. Management and therapy of dry eye disease: report of the Management and Therapy Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5:163-178. http://www.tearfilm.org/dewsreport/. 139.80.144.99 (talk) 04:59, 25 July 2008 (UTC) P.S. I'm not even going to get started on that/those on the basis that if we start debating pronouns my brain will melt —Preceding unsigned comment added by 139.80.144.99 (talk) 05:01, 25 July 2008 (UTC)  P.P.S. Has anyone thought of merging artificial tears in to this article ?


 * There is absolutely no reason to merge artificial tears into this article. By the way, your recent edits to the article introduced some errors which I've now fixed. The display of many of the references was damaged, and there were a couple of spelling and punctuation errors. --AB (talk) 06:00, 25 July 2008 (UTC)

Thanks for doing that. I suppose there is enough information on artificial tears to justify another entry given that Lemp devotes 20 paragraphs to it but we should probably include a bit more within this article as well. I'll try and add a bit more later this week. Nernst (talk) 04:25, 27 July 2008 (UTC)

Adding Lacrisert
I'm trying to add Lacrisert to the medications section and it keeps on getting removed for being too advertorial. Can someone help with this? It's an approved drug and has a full page on wikipedia. All of the info is right from the fda approved info. Not sure how this is different than the Restasis info. Thank you. --Astanger (talk) 21:14, 1 February 2010 (UTC)
 * The article on artificial tears is more specific for mention of a product such as Lacrisert. Note that the artificial tears article already briefly mentions Lacrisert in the Usage section. Restasis in contrast is not an artificial tear product. --IO Device (talk) 01:30, 2 February 2010 (UTC)

Makes sense but shouldn't it also be in the dry eye section. It is an approved product for dry eye. Is there something we can put in the dry eye/medications section? --Astanger (talk) 20:34, 2 February 2010 (UTC)
 * I suspect anything that is put in the dry eye article about Lacrisert will be removed. If you like, you can add a royalty free personally created image of Lacrisert in the Usage section of the artificial tears article. This will give it more exposure there. --IO Device (talk) 00:29, 6 February 2010 (UTC)

On adding Lacrisert: a question
Maybe I'm missing something here, but Lacrisert does not have "a full page on Wikipedia" as stated above, but is only a redirect to hydroxypropyl cellulose. Given that fact, today's addition of a section labeled "Lacrisert" and repeating that name 10 times seems inappropriate, should it remain? The section was added by user User:RCWAMS, and is the same content added 17 February by User:AMSRCW, who received a warning for product promotion at the time. --CliffC (talk) 20:45, 10 March 2010 (UTC)
 * I've removed it and started an SPI case here. Delicious carbuncle (talk) 21:51, 10 March 2010 (UTC)

Regarding the SPI - RCWAMS/AMSRCW is another company that works with AStanger and took over trying to get Lacrisert added. I work with AStanger and would like to continue the discussion on how to get Lacrisert added. Please advise. WillAb (talk) 23:17, 31 March 2010 (UTC)
 * You can see my replies above dated 2 and 6 February 2010. --IO Device (talk) 11:33, 1 April 2010 (UTC)

IO Device - regarding your comment dated 6/Feb, please explain why you suspect anything Lacrisert-related put in the dry eye article will be removed? Since the drug indication is for dry eye syndrome, I'm not clear why it would be removed (other than being too advertorial, which I can work on). Thank you. WillAb (talk) 00:27, 5 April 2010 (UTC)


 * In Wikipedia, information is to be included within the most specific article for that information. The article on artificial tears is a more specific place for Lacrisert. Note, by the way, that Lacrisert is already mentioned, albeit in brief, in that article. No particular artificial tear (or similar) product deserves mention in the current article. --IO Device (talk) 00:43, 5 April 2010 (UTC)

OK - I would like to update the information on Lacrisert in the artificial tears article with the following. Before I go and actually upload it, wanted to float it by you for any red flags before I reference/link it. You can ignore the terms in parentheses; those are just placeholders for citations. Thanks. Update: A formulation of hydroxypropyl cellulose is manufactured by Aton Pharma under the trade name Lacrisert. Approved by the U.S. Food and Drug Administration, it has been used as a dry eye therapy for over 25 years.(DOF) Lacrisert is indicated for patients with moderate to severe dry eye syndromes, including keratoconjunctivitis sicca; for patients who remain symptomatic after therapy with artificial tear solutions; and patients with exposure keratitis, decreased corneal sensitivity, and recurrent corneal erosions.(PI) Lacrisert helps to retain tears (Katz 1978) by maintaining tear film on the surface of the eye longer. (PI)

Lacrisert does not contain any preservatives and is supplied as a single-dose insert that is placed in the lower lid of each eye, every morning.(PI) The insert dissolves within minutes of insertion and can be used in contact wearers. Side effects include temporary blurring of vision, eye discomfort or irritation, increased sensitivity to light, eyelid swelling, and eye redness.(PI) —Preceding unsigned comment added by WillAb (talk • contribs) 12:11, 6 April 2010 (UTC)


 * That seems like far too much information. I suggest what be mentioned is only how Lacrisert is different and special. As for mention of side effects, try to put any Lacrisert specific ones in the existing section on side effects. After you update the article, others can edit it as would be relevant. You can also add a picture assuming that you can obtain one with an acceptable license. --IO Device (talk) 15:36, 6 April 2010 (UTC)


 * I agree with IO Device as to how much information should be included. Since we're talking about changing artificial tears and not this article, I suggest the discussion be moved over there so those watching that article can participate.  --CliffC (talk) 20:35, 6 April 2010 (UTC)


 * Continue here. --IO Device (talk) 00:35, 7 April 2010 (UTC)

"Symptoms" format
If this many symptoms must be added, I highly suggest they be entered in a LIST FORMAT. —Preceding unsigned comment added by Lindendoss (talk • contribs) 18:08, 21 September 2010 (UTC)
 * A normal list would waste horizontal space due to incomplete use of the available line width. This will greatly increase the amount of vertical space used. The current paragraph format allows the entire line width to be used. --IO Device (talk) 01:00, 22 September 2010 (UTC)

Contact lenses can induce dry eye.
It makes sense then one way to prevent the condition is to avoid contact lenses, no? 66.108.223.179 (talk) 13:49, 7 May 2011 (UTC)


 * Contact lense usage over a period of several years may very well induce dry eye. Soft contact lenses seem to be worse in this regard. It is therefore logical to either avoid their prolonged long term usage, or to at least religiously use contact lenses compatible lubricating/rewetting drops for the eyes throughout the day while the lens are worn. It is not known to me if the latter will prevent the development of dry eye disease. Of course not everyone who wears soft contact lenses for years (without the aforementioned drops) develops dry eye. Personally I wore them regularly for ten years before I developed it. As such, there probably are other concomitant factors that increase one's odds of developing dry eye&mdash;these are not known to me. Publication research might yield more info. --IO Device (talk) 19:06, 7 May 2011 (UTC)


 * FWIW, newer daily-use contact lenses are much better in this regard. They stay much wetter. Nevertheless, the use of an adequate compatible preservative-free lubricant is nevertheless recommended with them.--Hyperforin (talk) 04:20, 12 February 2016 (UTC)

MEDRS
Per the notice on the top of this talk page, the guideline WP:MEDRS should be followed when selecting sources for this article. I will tag what I feel are the unsuitable references so they can be replaced at some point. Lesion ( talk ) 15:56, 14 December 2013 (UTC)

Management
Having suffered severe dry eye symptoms for years, I now use a combination of annual total punctal cauterization of all four puncta, Restasis, and synthetic vitamin A 10000 IU as retinyl palmitate daily for close to complete management of dryness symptoms, to the point where I rarely need to use lubricants, except when using contact lenses. It is not that my eyes are now more wet; they aren't, but they don't feel dry or irritated anymore. Note that vitamin A as beta carotene is not similarly effective, and a lower dose of 5000 IU is not comparably effective either. For some reason, vitamin A as cod liver oil hasn't worked for me either, only the synthetic form has, and I don't know why. Relevant scientific information about vitamin A supplementation for dry eyes is pending inclusion into the article. --IO Device (talk) 20:04, 4 June 2019 (UTC)

To supplement the above, low humidity in the winter, i.e. under 30%, can lead to severe symptoms which are easily reversed by using a humidifier which restores the humidity to 30% or higher. The symptoms can be especially severe at 15%. There isn't much extra benefit after the humidity is at least about 35%. --Acyclic (talk) 14:28, 31 March 2019 (UTC)

Code May Be Incorrect
Different information for listing of K'Sicca here

http://timdietrich.me/icd-10/cm/H16.221/ — Preceding unsigned comment added by 75.108.69.219 (talk) 21:32, 17 February 2016 (UTC)

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Contact lens clarification
Contact lenses don't cause dry eye disease afaik, but they typically do worsen the symptoms while the lens is in use. Having said that, some contacts are much more hydrating than others. --Acyclic (talk) 04:50, 17 August 2017 (UTC)
 * They result in the symptom of dry eyes  Doc James  (talk · contribs · email) 04:18, 20 August 2017 (UTC)
 * Thanks for the link. There are two conditions that have to be true for this to have a possibility of happening: (1) Modern hydrating lenses are not used, and older variants that are far less hydrating are used instead. Lenses have evolved since 2005. (2) Rewetting drops for contact lenses are not used (assuming the absence of punctal plugs or cauterization). I personally recommend Oasis Tears brand. I have no CoI with any brand. Technically I recommend RF cauterization to eliminate the dependency on these drops. --Acyclic (talk) 20:12, 20 August 2017 (UTC)
 * Do we have a newer source that comments on contact lenses? Doc James  (talk · contribs · email) 07:35, 21 August 2017 (UTC)

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Concerns reference 46. While checking the update of the Cochrane Review I did not find the contents of the sentence in the reference. I find no data in the review on epidemiology. Please advise us on this. — Preceding unsigned comment added by HMill88 (talk • contribs) 10:07, 16 September 2017 (UTC)

Fish oil
I have excised this section as it was built on unreliable (i.e. non-WP:MEDRS) sources. This was particularly unfortunate as the current science is pointing in exactly the opposite direction that Wikpedia was.. Alexbrn (talk) 10:53, 29 September 2018 (UTC)