Dear Dr. Roach: I am a 74-year-old woman who loves to read the newspaper every morning. I have a problem that’s not serious, but annoying. My eyes tear up frequently during this time, causing me to wipe them. After my reading time, the problem stops. I see my ophthalmologist every year and have my vision glasses updated as needed. I am not yet a candidate for cataract surgery. Could you enlighten me about a probable cause for this irritating problem?
A.H.G.
By all means, ask your ophthalmologist at your next visit, but the most common cause I see for watery, tearing eyes are dry eyes. This apparent paradox is caused by the fact that your eyes have three different fluids. One of them, called meibum, is a long-lasting, oily material secreted by the meibomian glands, found around the edges of the eyelids near the eyelashes. This covers the eye and prevents fluid from evaporating so fast. Without this fluid, the lacrimal gland (near the temple above each eye) then has to make a lot of its watery secretions, which cause symptoms of tearing. Most commonly, the meibomian glands get clogged up by secretions becoming dry. Gently cleansing the eyelash area with warm water and baby shampoo helps many people unclog these glands. Artificial tears lubricate the eye and will reduce the symptoms of watery eyes (and maybe some eye irritation, too, that you might not have mentioned).
Dear Dr. Roach: I am about to undergo gallbladder removal due to recurring pain from gallbladder sludge. Should I be taking replacements for the bile salts that I will no longer be able to produce, and if so, what is the best type of replacement?
S.C.
Your liver makes bile salts, which are necessary for fat absorption. The gallbladder doesn’t make them at all; it just stores the bile until you eat a meal, at which point the gallbladder contracts and the bile salts are released into the small intestine to help you digest fat. Most bile salts will be reabsorbed later on at the end of the small intestine, recirculating them for reuse. In people without a gallbladder, the liver itself will continuously release bile salts into the small intestine, rather than on an as-needed basis by the gallbladder. Sometimes, the ability of the terminal ileum (the part of the intestine where bile salts are reabsorbed) gets overwhelmed, and bile acids enter the colon, causing diarrhea. This is very common in the first few weeks after gallbladder surgery, but the small intestine usually “learns” to absorb more bile salts. The colon also learns to live with bile salts, and the diarrhea mostly goes away. However, some people continue to have diarrhea after surgery, and medication to restrain bile salts (such as cholestyramine) can make a huge difference. After surgery, avoiding a high-fat diet is prudent for a month or so to minimize the amount of bile needed.
Dr. Roach writes: A recent column on medications to prevent tickborne diseases in humans, similar to those used for companion animals, inspired two kinds of letters: ones that showed concern about these medicines in veterinary use, and one from a veterinarian who told me that these medicines are being evaluated for human use. I did review their safety in animals and found that the FDA notes they have been associated with “neurologic adverse reactions, including muscle tremors, ataxia and seizures in some dogs and cats.” The FDA will have to carefully consider the risks and benefits before deciding whether to approve these medicines.
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