Goodbye, Dry Eye: Exploring Ophthalmology and Lifestyle Medicine
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Kara Wada, MD: Welcome back, everyone, to this episode of the Becoming Immune Confident podcast. We anticipate this may end up being a two part episode because I have an incredible guest today. I love bringing amazing colleagues that I've connected with, and Dr. Shilpi Pradhan is one of the best. She is a board certified ophthalmologist and a lifestyle medicine doctor.
She's also the author of two books. Goodbye, Dry Eye, which is near and dear to my heart as a Sjogren's patient. But she's also an editor, compiler, and co author of this amazing book, How Healers Heal. And she has her own practice seeing patients in Richmond, Virginia. So thank you so much, Dr. Shilpi Pradhan, for joining me this morning and bringing your expertise and knowledge and spirit to talk with me and our listeners today.
Shilpi Pradhan, MD: I'm so excited. Thank you for having me. I love your podcast and how much you share and the detailed teaching that you have. I hope I can offer your listeners some of the same energy and knowledge that you share.
Dr. Shilpi's Journey to Ophthalmology
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Kara Wada, MD: Would you mind sharing a little bit about how you, maybe how you found ophthalmology and lifestyle medicine? It's a unique combination.
Shilpi Pradhan, MD: Sure. Well in medical school, everyone is trying to find their niche and I thought I went into medical school thinking I'd be a pediatrician or a pediatric very specific heart and lung transplant surgeon. I was very ambitious. And then when I did my peds rotation and I saw beautiful children being so sick and some dying, I was like, I absolutely cannot do this. And I was completely lost and didn't know what to do. And when I found ophthalmology, I was like, 'Okay, a field where maybe nobody dies'. But that's not true. And that's sadly or happily, that's why I went into ophthalmology and there's all the other routine answers, or it's a good mix of surgery and clinic, but truly speaking, I just didn't want to deal with death Interestingly, my husband's hemonc and deals with that all the time, but I just couldn't do it and more power and support to people who can. So that's how I found ophthalmology. And since then, I've just loved it. It's fun. It's so detailed. The retina is part of the brain and the cornea is amazing. It's a part of the eye that's clear. There's so many cool things about the eye.
Kara Wada, MD: I still struggle because I have this little squeamishness about eyes. I actually was talking with someone in clinic yesterday who is studying to be a veterinarian and we shared our similar squeamishness for eyes. They really are amazing and I think maybe what I need to do, one, is to check my own biases and certainly work to not yuck someone else's yum, as I told my kids.
But really, what you just said really got that little curiosity activated of that's right, it is directly part of the brain, the cornea, all these very, really cool aspects to our physiology. That we don't get as much exposure to through our general medical school training.
The Eye as a Window to Overall Health
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Shilpi Pradhan, MD: That's true. And isn't it Shakespeare that said the eye is the window to the soul, but we use it all the time like that because it's the only place in the body you can see blood vessels, the optic nerve. For diabetic eye exams, we're looking at blood vessel health not just for vision, because if there's bleeding, aneurysms chaos going on in your eyes, I tell my patients the same thing is happening in your kidneys, in your liver, in your heart.
So it's a great marker for just knowing what's going on inside of you, but you really think about it. It's the only place we can see in vivo, in living, in real life, blood vessels and nerves and just see the inside of you.
Kara Wada, MD: Important reminder that getting our eyes checked is a vital part of our ongoing health maintenance that we should be thinking about too. Especially if we already know we're at risk for or have things like high blood pressure, diabetes or other underlying health conditions.
Unusual Eye Conditions and Diagnoses
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Shilpi Pradhan, MD: Yeah. Some of the craziest things I've diagnosed over the last 15 years would be leukemia based on an eye exam. Sent a patient with Roth spots and classic bleeding to the ER and their white count was like 112. Melanoma, of course. Metastatic cancer. There is a fun but a cult hidden condition called ocular ischemic syndrome, where you have a buildup of cholesterol in your carotid arteries, and it causes a specific pattern of bleeding in your retina. So I've diagnosed many people with that, that ended up needing surgery really rapidly. Patients with specific patterns what we call bear tracks in the retina. They almost always have polyps in their colon. So, so much the eye can tell us about the rest of the body.
Understanding and Managing Dry Eyes
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Kara Wada, MD: And you have a special passion in sharing information about dry eye, which is something that I deal with and I know is quite common. Let's talk a little bit more about, about dry eye. What what causes it and hop in.
Sure well, I think we all have dry eyes. My dry eyes started in my mid 20s and I'm in my mid 40s now. So, dry eyes been a part of my life and I didn't think that I would become a dry eye specialist over the years, but I just want to keep improving my own body and my eyes and my functioning. And that's led me down this path of buying machines to help dry eyes and learning more and more about dry eyes and then to write this book, Goodbye, Dry Eye. So here is my book, which you can find on Amazon or Barnes and Nobles or wherever the websites.
And you have a Kindle version too for those of us that use that. That's where I have mine.
Shilpi Pradhan, MD: So I wrote it to be very approachable for the layperson and not medically based because you know there's a dry eye workshop that puts out a 400 page research progress report every 10 years last published in 2017. I'm not trying to recreate that amazing piece of research. I'm just trying to pull out things that I see in clinic that tell me what is the cause of this patient's dry eye and how can I get them better and some reasons why patients may fail therapy and just some tips and we can go through those that I put in the book to try to help patients get better and if they're not getting the help that they
Symptoms of Dry Eyes
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Kara Wada, MD: So, maybe let's talk about how dry eye can look and feel, because I think there are some misconceptions or things that I frequently am talking to patients about that surprised me, too.
Shilpi Pradhan, MD: Do you want to share some of those?
Kara Wada, MD: Well, certainly our eyes can feel dry or gritty but I think a lot of patients that I see will come in thinking they have allergies that are affect, that are affecting their eyes. And their allergy testing is actually negative. And so then one of the things that I think about or ask about is dry eye.
So I think, I guess where I was thinking was this overlap in how people may have some itching or some watering that's caused by dry eye, which just seems odd at first thought. Yeah.
Shilpi Pradhan, MD: I think it's funny you said that because my chapters are outlined exactly like that. Doc, my eyes burn. My eyes feel dry. Doc, my eyes are sandy gritty. Doc, my eyelashes are crusty. Doc, my eyes are watery. So I just go through all of the different symptoms that you may be having and you mentioned allergy. I think that's a very interesting.
One, there are some things that where you see it in the eyes, even if the allergy testing is negative and treatment with I can see allergic inflammation and it looks different than other kinds of inflammation and treating that can help dry eyes. So basic, like you mentioned, blurry vision, dry, sandy, gritty is like one a normal version.
Then there's the extreme where patients are painful and they can't even open their eyes. They're so light sensitive. They have to sit with sunglasses in a dark room and that's a severe neuropathic dry eye on the spectrum.
And then there's the watery patients and watering is an interesting dry eye because it can be mechanical. It can literally be, they're rubbing their eyes so much, the eyelid position isn't proper. So the tear flow isn't down into the tear ducts. If the tear ducts are blocked, if they have a sinus infection or they're making too much water. So either they're not draining the water properly or they're making too much water from irritation.
People can get little rocks that grow inside their eyelids from a dysfunctional oil glands. And then the rocks can cause irritation, sandy, gritty feeling and cause watering and then allergy, like you mentioned, for sure, but there's so many causes. I've seen patients with embedded eyelashes that are causing, you just have to go see your doctor, right?
Embedded eyelashes in the conjunctiva, embedded concretions, embedded eyelashes in the tear duct. I'm like, just there's so many things I've seen. I've seen embedded metal that was there for years. I'm like, how long have you have been there? And I take it out and they feel better. So, it's so interesting. Every day I see something different.
Kara Wada, MD: Yeah, and getting to this idea of figuring out when we can the root cause, because if you are able to pluck out an ingrown hair. Well, goodness, of course that inflammation is going to resolve, in a lot of ways. It's like the princess and the pea. Yeah, but a real life physiologic version.
The Role of Lifestyle in Eye H ealth
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Shilpi Pradhan, MD: I think that's where lifestyle medicine interests me a lot more bringing that in, is it does talk about root causes, right? And there's a, I wrote a whole section in my dry eye book about the lifestyle medicine factors that can cause dry eye, that people sometimes pay attention to but sometimes they don't and if you treat the root cause, we're going to get better, longer term relief than just throwing a medication on or just using artificial tears as a lubricant, but not treating the root cause.
Kara Wada, MD: Could you share just a couple of those?
Shilpi Pradhan, MD: Sure. Great. My biggest one would be sleep. Patients are not sleeping enough or they're not having proper sleep hygiene before their bedtime routine. So they're like watching on their phones or watching TV up until the moment they fall asleep and they're like falling asleep with their glasses on or with their phone in their hand and
Kara Wada, MD: Or heaven forbid those contacts in.
Shilpi Pradhan, MD: Oh my gosh, I'm glad you mentioned that. That is the worst thing you can do, sleep in your contact lenses. Thank you for bringing that up, but, so, we want from sleep, from lifestyle medicine, we know we want proper sleep hygiene, 30 minutes to an hour before, wind down, do your meditation, do your gratitude journal ,turn off all electronic devices 30 minutes before sleeping and that just helps sleep so much.
If patients are on their devices they may sleep with their eyes partially open. I've seen patients who were drinking, not even a lot, just one drink, but super close to bedtime. And that impairs that person, not everyone in particular, to just not sleep with their eyes closed. And they've come in at least three times with corneal abrasions from just sleeping with their eyes open. I know it's terrible. Is it just drinking maybe earlier in the day or avoiding alcohol altogether? But if that's a risk factor for you just little simple things can, and then they wake up so much better.
Another big one for sleep in our older patients wearing a CPAP is that air forces the eyelids open while they're sleeping. So wearing an eye mask or their specialized eye masks that I love from iECO, they are a silicone, like swimming goggles, but much, much bigger, like a silicone wrap around that will just block all the air.
I know it's one more thing on your face to sleep with, but it makes such a huge difference for my patients with a CPAP mask for sleeping. And treating the sleep apnea is important with the CPAP. Don't stop wearing your mask because that increases your risk of glaucoma and other diseases well proven correlation, not causation, but so anyway, there's a little tips about sleep.
Practical Tips for Eye Care and Hygiene
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Kara Wada, MD: I think one of the other things that I've noticed too. Humans being humans, like every, once in a very blue moon, cause I don't wear eye makeup all that often anymore, but certainly when I was younger, I would notice if I didn't wash my face and take makeup off before bed that, not only did you wake up with raccoon eyes, but having more issues with eye irritation. And in hindsight, it probably was a little bit of a flare up of dry eye symptoms, too.
Shilpi Pradhan, MD: That's a great point. You must take off your eye makeup before sleeping. And another one would be to change your eye makeup every three to six months. Think about it like your toothbrush. You don't want to be using makeup that's super old because that can have germs and bacteria that's growing in there for a long time. One related topic would be demodex blepharitis.
Kara Wada, MD: I talk with patients about this, but I always tread carefully because of kind of that squeamish factor, too. So a little bit of a warning for those listening.
Shilpi Pradhan, MD: Yeah. Well, I see demodex every day and it's a huge cause of dry eyes and treating the demodex or just regular blepharitis can be a huge improvement in dry eye symptoms, and which, what that means is just crusty eyelashes, which can be a combo from skin bacteria or this little mite that lives in people's eyelashes, but there are treatments and there is definitely a hope to get rid of it and get your dry eyes feeling better. There's actually a new treatment that was FDA approved about a month ago that I'm seeing good results.
Kara Wada, MD: I liken these little critters that live in and on us, we already know are pretty familiar and I think we're comfortable with the idea that we have a lot of bacteria but also, have virus, fungi and little mites too, as it as the case may be, it's I talk about them similar to dust mites. They're part of our environment and we can try to calm them down, get them back into their place in the ecosystem and not taking over.
Shilpi Pradhan, MD: So since you mentioned dust mites, I did have a patient who asked me, so if I buy those allergen covers, will that help keep my demodex out of my pillows? Because she was washing her pillows and getting treated and I looked it up and they are the same size. So I don't have any proof that would protect your pillows from getting infested with demodex, but I think it would work because the dust mites and demodex mites are the same size.
Kara Wada, MD: What a fun thought for a little research project.
Shilpi Pradhan, MD: Yes. Oh, so that's what it was. Regarding the makeup, I had a great tip told to me by a patient that I share with a lot of patients. I think I put it in my book as well, but for cleaning your eyelashes, she bought disposable mascara wands. You can get like a hundred for 10 bucks and she puts like the eyelid. the foam on the mascara wand and this cleans her lashes that way because you can get to the base of the lash much better. And then the other thing is if you do happen to have mice or crusty eyelashes and you're treating it and you want to wear makeup, you can buy a new one, use a disposable wand and not double dip. And keep your makeup clean and apply, and then obviously use a new one for the other eye. And then you can wash them with the cleansers and reuse them later.
Kara Wada, MD: This sounds like a really good idea for a little Instagram reel or a TikTok video too. We have to try to set it up in the bathroom this weekend. Yeah.
Shilpi Pradhan, MD: Yep. I tell patients this all the time. I'm pretty sure I put it in my book, but just like little tips like that, that I think would help a lot of people feel better and get better treatment rather than just cleaning with baby shampoo, which does help too, but try to get it really close to your lash base.
Kara Wada, MD: My worry always with and where I've hit the pause button a little bit with baby shampoo, and I'd love to pick your brain on this is that like things like this the typical baby shampoo have fragrance and some other things that can be irritating for folks that already have you know breaks in the skin or sensitive skin. So my question, what I've told people, and I guess it would be helpful to check with an ophthalmologist is to use like another, just gentle cleanser that they'd use on their face. Would that be sufficient still, or?
Shilpi Pradhan, MD: I guess it depends on the person and their allergens. I actually recommend eyelid cleansers specifically for cleaning your eyelashes. I'm not a huge fan of the baby shampoo either, although I think it is economical for patients who tolerate it fine. But so my favorite eyelid cleanser is one by Eyeeco. It's a company in California and they have this Tea tree oil, 1 percent concentration cleanser that I love. Another one is Lefadex that you can find on Amazon or other places. And it has coconut oil and tea tree oil. And tea tree oil does kill mites. And for some of my patients who are, like, just allergic to everything, they can actually just use plain coconut oil to clean their lashes. And it works well and takes off makeup as well.
Kara Wada, MD: We love coconut oil in the ear, nose and throat and allergy clinic too for dry noses or when the heat turns on and the nose gets like a little crusty and uncomfortable. Another option aside from Vaseline being, another great economical option too. But I always tell patients you get the benefit if you're using it for your nose, that it smells like vacation too.
So, and you may end up having a little bit, be able to smell that too if you're using it on your eyes as well.
Shilpi Pradhan, MD: So since you mentioned Vaseline, I love having patients use Vaseline for their eyelids and encrusting as well. And sometimes when my eyes are super dry, I put it not in my eyes, but on my eyelashes before sleeping and it really helps me wake up feeling much more refreshed.
Kara Wada, MD: That's great.
Shilpi Pradhan, MD: But you don't want to put it inside. You don't want to clog your oil glands, but just on the outside.
Kara Wada, MD: Yeah, even for eczema, it's a great essentially kind of seals in the moisture and helps prevent that ongoing loss. So, I get all the different terms confused, but between humectants and eczema.
Shilpi Pradhan, MD: Other thing I wanted to mention about lifestyle medicine and dry eyes would be hydration. I know it seems really basic, but patients don't drink, I don't drink enough water. Nobody drinks enough water. If you think you're drinking enough, you want to get your eight glasses of eight ounces per day and that can make a huge difference in how your eyes feel.
Kara Wada, MD: Absolutely. And so much of our eyes, but also many of us, like I've noticed my hydration really affects my like my digestion as well. And our skin, everything, so all the good reasons to get that habit or that behavior habituated.
The Impact of Diet on Eye Health
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Shilpi Pradhan, MD: Agree. And I know, about inflammation but diet is, I talk about diet briefly because diet is huge in lifestyle medicine as and just eating less processed foods decreases inflammation in your body. Processed food increase inflammation in your body and that includes your eyes. And so just trying to stay away and from processed foods and eating a whole food more plant predominant diet can help your dry eyes as well. And I'm super gluten intolerant and over the last five to six years where I've committed to being a hundred percent gluten free. Whereas, I dabbled with it before that. It has made a huge difference in how my eyes feel and they're just a lot less dry being gluten free.
Kara Wada, MD: That's really interesting because I have a few patients that has well several that have gone on to be diagnosed with celiac. So that you know makes absolute sense but also in the gluten intolerant group, too who have noticed significant differences in their nose and sinus symptoms as well.
There is a study that one of our colleagues who's active on Instagram just posted this morning that I already texted our fellows about because I want to pull it up and read the whole article, but just looking more at how our body's responses. To foods may be driving inflammation and in this particular study it looked at food allergy tests that were "positive".
So they had elevated levels, but these patients didn't have true allergy so they had elevated levels, but they ate the foods. They didn't have an anaphylactic reaction and looked at that in regards to cardiovascular risk. So I've just seen the little clip of the abstract, but I'm excited to read and look at this expanding paradigm that we have about we know this little narrow window of physiology of the IgE or food, antibody causing allergy, but how else might our bodies be responding to foods in a not helpful way? Be curious.
Shilpi Pradhan, MD: That's exciting. I truly believe food is the source of a lot of our problems. And if we can change that behavior, we can help ourselves so much more.
Kara Wada, MD: And I think one of the big reasons that we talk so much about having a plant forward diet, eating a wide variety of plants is it's really helping reinforce those good gut bugs that you had mentioned that then are pumping out anti inflammatory signals and helping keep everything in a little bit better balance.
Yeah. Well, this has been awesome. Would you mind sharing again information about your book, where we can find it? We'll make sure to have all the links on the show page. But I'm sure that a lot of folks are going to want to go pick it up.
Shilpi Pradhan, MD: Thank you so much. Absolutely. I wanted to, since you mentioned sinuses, I wanted to share one more story. I had a patient who had narrow angles and then we did her laser to treat the narrow angles and then she could smell again. It was amazing. But then she developed sinus infections about a year later where she couldn't just get rid of them.
And she had been in antibiotics for three rounds. Then she actually had sinus surgery to try to get rid of the sinus infection. I'm not really sure what the surgery entailed. And then she came to see me and she was, just for her annual exam. And I was like, can you please please just go dairy-free for one month.
Like just try it because I know in some patients, dairy can cause a lot of sinus inflammation. And she called me, we had a like a phone call visit set up a month later and I was like, 'How are you doing? You've been living in pain for a year. Did going dairy free help you at all?' And she was like, 'It's amazing.'
After two weeks, I have been pain free and I have not had another sinus infection. And she has stayed dairy free for the last year and a half now. And it's, so our diet can cause so much and changing it. Even one little thing can help so much. So, thanks for letting me share that last little story.
Kara Wada, MD: Sometimes the juice is worth the squeeze when we make those big changes.
Shilpi Pradhan, MD: And then my book, Goodbye Dry Eye is available on anywhere you buy books. Mostly Amazon, barnesandnobles.com. I think it's on target.com as well. I would love to help more people and thank you for letting me be here and share my message so we can help patients and do simple things that might help their dry eyes significantly.
Kara Wada, MD: Thank you so much, Dr. Shilpi. And all the listeners, you're going to have to stay tuned because we're going to have a whole nother episode talking even more about the role of lifestyle medicine together and Dr. Shilpi's other books. So stay tuned.
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