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Q: I was recently diagnosed with dry eyes. But my eyes seem to be watery all the time. How do you explain this?

A: Usually, people with dry eyes have too few tears. But as strange as it may sound, dry eyes can also be watery. Tears are a mixture of oil, mucous and water. Dry eyes will water if there is not enough oil or mucous in the mixture.

As we age, our tear production slows. If your lacrimal glands don’t make as many tears, you’ll have a problem with the quantity of tears.

If some of the other glands slow, such as those that produce oil, you’ll have a problem with the quality of tears, since you need all three tear components for the tear film.

You need the right amount and mixture of tears to avoid eye problems. A healthy film of tears cleans and protects your cornea and helps preserve your vision.

In addition to aging, the natural loss of tears can be made worse by a number of things, including:

• Environment. Low humidity can dry out your eyes as well as your skin. Air pollutants and allergens can cause inflammation, which decreases tear production. These may also cause your eyes to produce “reflex tears” that are too watery to lubricate the cornea properly.
• Reduced blinking. Blinking stimulates tear production and spreads the tear film evenly over the cornea. But we tend to blink less as we get older. Moreover, driving, reading, working at a computer, or any other activity that causes you to blink less often can lead to dry eyes.
• Medications. Dry eyes can be a side effect of a wide range of drugs, including antihistamines, anti-anxiety agents, antidepressants and diuretics.
• Eye surgery. Lasik, the laser procedure performed on the cornea to improve vision, can affect the eye’s ability to produce tears for as long as six months after surgery.

For people who make enough tears but have dry eye symptoms, warm compresses and gentle eye massage can stimulate the oil glands on the lid margins.

If you aren’t making enough tears, the first approach is usually to replace the tears. There are several eyedrops labeled “artificial tears” that closely resemble the composition of normal tears.

For more severe cases, your eye doctor may recommend prescription drops, such as those containing cyclosporine (Restasis) or lifitegrast (Xiidra). There’s even an in-office procedure to block tear drainage by inserting plugs into the tear drainage ducts.

— Dr. Howard LeWine, an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School.

Q: Why are nuts now considered an important part of a healthy diet?

A: Indeed the consensus has changed about nuts. For a long time, the high fat content of nuts gave them a reputation of a food to be avoided.

Not anymore. Multiple studies have shown that certain fats common in nuts — mono- and polyunsaturated fats and omega-3 fatty acids — actually reduce the risk of cardiovascular disease.

The FDA now allows nut producers to claim that a diet that includes one ounce of nuts daily can reduce your risk of heart disease.

Nuts have the potential to:

• Improve cholesterol profiles. The unsaturated fat in nuts helps to lower LDL (bad) cholesterol and raise HDL (good) cholesterol.
• Prevent arrhythmias. One type of unsaturated fat — omega-3 fatty acids — appears to prevent the development of erratic heart rhythms.
• Reduce blood clotting. There is some evidence that omega-3s may work much the same way as aspirin does to keep blood from clotting.
• Relax blood vessels. Nuts are rich in arginine, an amino acid needed to make a molecule called nitric oxide that relaxes constricted blood vessels and eases blood flow.
• Raise levels of glucagon-like peptide 1. This hormone helps to control glucose levels and to lower insulin levels in people with prediabetes.
• Contribute to satiety. Nuts are rich in fat, fiber and protein, all of which are more likely than foods high in carbohydrates to make you feel full. Perhaps that’s why people who eat nuts regularly are less likely to be obese.

Like other healthy foods, nuts can be stripped of many of their nutrients during processing, so raw nuts are your best choice. Also, blanched peanuts and almonds can lose beneficial antioxidants and phytochemicals when their skins are removed.

The general recommendation is to aim for 1.5 ounces of nuts or seeds per day. They make great snacks. You can spread them (buy all-natural nut or seed butters or grind the nuts yourself), or scatter seeds and chopped nuts to add flavor and texture to salads, sandwiches, yogurts and breakfast cereals.

— Dr. Howard LeWine

Q: Why do I sometimes get congested in one nostril?

A:

Many people don’t realize that every four to six hours, one side of the nose becomes more congested, and the other side decongests. They switch back and forth in a normal cycle.

If one side is more obstructed to begin with, from a deviated septum or swelling of the soft tissue structures, it will be more noticeable when that side decongests.

Here are other reasons for congestion in one nostril:

• Side sleeping. People also experience stuffiness in the nostril that faces down when they sleep on their side.
• Deviated septum. If you have blockage that is continuous, it could be a result of a deviated septum.
• Inflammation and nasal polyps. There are people who have chronic inflammation and nasal polyps. In rare cases, this can be due to a tumor, but these are uncommon. Chronic and persistent obstruction on one side should be evaluated by a doctor and probably an ENT (otolaryngologist).
• Foreign objects in the nose. In small children, blockage in one nostril might be due to a foreign body that they put in their nose. If you see thick drainage or pus coming out, it’s time to call your doctor.

— Dr. Michael Benninger, chairman of the Head and Neck Institute at the Cleveland Clinic and professor of surgery at the College of Medicine of Case Western Reserve University.

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