Ophthalmology & Optometry/dry eye


dr dovie,hope you can help me,i had dry eye and went to a optomertrist.she said my  oil glands in my eyes were not producing tears.she squeezes them and said a substance like tooth paste came out.she was not informative and did not tell me if they were infected.her treatment as 200 mg of doxycycline.no options.i am extremely reluntant to take doxycycline because of possibly of c-diff.i don't even know if this is best treatmemt.any other options instead of antbactiral meds  to help oil glands like ointments or eye    drops

Changing the tear chemistry and gland function is important for many people with dry eye. This thick paste that was expressed is not a sign of infection, it is a sign of meibomian gland dysfunction.  Taking doxycycline is a useful antibiotic, but it also works to prevent the action of a few inflammatory chemicals.  It is typically dosed fairly low for dry eye syndrome, so the concerns of c.diff are low-to-none, but this is something to talk to your doctor about.  I typically start with 100 mg twice daily, and wean down to 50 mg once daily over the course of a week or two.  

There are other options for getting the glands in better shape - warm compresses, lid massage, and something called Lipiflow treatment is becoming poplar.  This is expensive, though, as insurance doesn't cover it yet.

Good Luck!

Here is part of an abstract from a published paper on dry eye syndrome...
Doxycycline was discovered in the early 1960s. It is a semisynthetic long-acting tetracycline derivative which inhibits bacterial ribosomes in a wide variety of micro-organisms. In subantimicrobial doses it is also effective as primary treatment for rosacea and sterile corneal ulceration.36,37 Previous studies using experimental dry eye models demonstrated that doxycycline was efficacious in decreasing gelatinolytic activity in the ocular surface epithelia, as well as decreasing levels of MMP-9 mRNA transcripts, and preventing experimental dry eye-induced increase in IL-1 and TNF-α.38 Doxycycline also improves corneal surface regularity and barrier function.39

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John M. Dovie, OD, FAAO


As a residency-trained Fellow of the American Academy of Optometry I am able to answer most questions regarding eye and vision health. Anything is welcome, ranging from dry or allergy eyes, bifocal contact lenses, or thoughts on LASIK surgery. As I am not a surgeon, detail-oriented surgical-related questions may be better answered by an ophthalmologist.


Selected to participate in the PCO residency program in Philadelphia at The Eye Institute, where I worked OD and MD specialists gaining invaluable experience in various clinics including glaucoma, cornea and cataract, oculo-plastics, retinal disease, neuro-ophthalmic disease, primary care, emergency medicine, and special populations. Have practiced and trained in numerous settings including hospital, academic, retail and private practice. I earned my Fellowship in the American Academy of Optometry (FAAO). There are currently only about 3000 active fellows worldwide, and there are only about 70 Fellows in the state of Virginia. I currently own and operate my own optometric practice/clinic.

American Academy of Optometry, American Optometric Association (Contact Lens/Cornea Section member since 2001), Southwest Virginia Optometric Association, Virginia Tech Alumni Association

“Nyctalopia as the Presenting Sign of Vitamin A Deficiency: A Late Complication of Gastric Bypass Surgery.” Clinical Case Study Poster presented at The American Academy of Optometry Denver, Colorado, December 2006, co-authored with Bradley Lane, OD.
“The Importance of Considering Paranasal Sinus Mucocele as a Differential Diagnosis in Diplopia.” Clinical Case Study Poster presented at The American Academy of Optometry San Diego, California, December 2005, co-authored with Kelly Malloy, OD, FAAO and Cherie Farkash, OD.
“Acute Onset of Halos and Glare: Bilateral Keratitis—An Atypical Presentation of Amiodarone Keratopathy.” Clinical Case Study Poster presented at The American Academy of Optometry Tampa, Florida December 2004. Also Presented to New Jersey Academy of Optometry, Neptune, New Jersey March 2005.
“The Opportunity for an Optometrist to Save a Life.” Clinical Case Study and Grand Rounds Presentation presented at The Pennsylvania College of Optometry, Philadelphia, Pennsylvania, September 2004.
“Corneal whorls cause wonder.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 10/15/2006.
“Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.” Co-authored with Andrew Gurwood, OD, FAAO. Published February, 2006, Optometry.
“Pondering the posterior polka-dots.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 5/15/2005.
Professional Involvement:
“AION: Amiodarone-Induced or Anterior Ischemic Optic Neuropathy?” Participated as a peer-review referee for Expert Review of Ophthalmology (London, UK); refereed 10/2006.

Bachelor of Science, Cum Laude, Virginia Tech. Bachelor of Science, Pennsylvania College of Optometry. Doctorate (OD), Pennsylvania College of Optometry Residency, Pennsylvania College of Optometry Fellow of the American Academy of Optometry

Awards and Honors
Winner, First Place, "Best Beside Manner" by Our Health Magazine: 2012, 2013, 2014 Winner, First Place, "Best Eye Doctor" by The Roanoke Times: 2013, 2014 Recognized as a Fellow of the American Academy of Optometry, December, 2006 Recipient of the Onofrey G. Rybachok Memorial Scholarship, 2000-2001 Member: The Golden Key International Honor Society Member: The National Biological Honor Society Member: The National Honor Society Eagle Scout awarded 1994

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