You walk into a party reception room and are greeted with trays of delicious hors d’oeuvres. Everyone is encouraging you to try them, but you can’t. First you need to get to the bar on the opposite side of the room so you can get a glass of water to thelp the food go down. […]

Sjögren’s Syndrome and Dry Eye. Many Canadians suffer from dry eye. There are two major causes of dry eye: decreased lacrimal tear secretion and loss of tears due to evaporation which can result in symptoms of irritation, blurring, grittiness, burning and dryness.

Dry eye is a hallmark symptom of Sjögren’s syndrome. Sjögren’s is a serious autoimmune disease that results in inflammation that damages the salivary, tear and mucous-secreting glands, resulting in dry eyes and dry mouth. The disease affects 1 in 70 Canadians, up to an estimated 430,000.  9 out 10 patients are women. On average, Sjögren’s affects people between 35 and 65 years of age, but children can also suffer. Sjögren’s can occur alone (Primary Sjögren’s syndrome) or as a compilation in rheumatoid arthritis, lupus, scleroderma or other connective tissue diseases (Secondary Sjögren’s syndrome).

The Role of Tears

The tear film is a complex structure that receives molecules from the lacrimal glands, the mucus secreting globet cells, conjunctival and corneal cells of the ocular surface as well as the oil secreting meibomian glands of the lids. In the normal eye, there is a steady stream of tears that is replenished regularly during the day with the blink.

Composition of the Tear Film

  1. The watery portion of the tears that come from the lacrimal glands and contain lubricants and special proteins that fight off infection and maintain the health of the surface cells.
  2. The mucus portion thickens the tear film and helps maintain a slippery surface so that the lids can move over the surface easily.
  3. The oils from the meibomian glands sit on the surface of the tear film to prevent evaporation.

Maintaining a normal tear film is hard work. When any of the glands or cells that supply the tears become compromised, the ocular surface sends signals of dryness, discomfort, grittiness and burning to the brain. This is the basis of dry eye disease. In Sjögren’s syndrome, most of these systems fail.

Diagnosing Dry Eye

Dry Eye is the most common presentation in eye care offices. Like many diseases, there is no one test that can determine the presence and the extent of this disease. However, optometrists and ophthalmologists can get a very good idea of what is going on by doing few tests:

  • Symptoms of Dry Eye

    • It is important that your eye care practitioner know how your eyes feel and you should discuss your symptoms during your examination.
  • Tear Flow Tests

    • Using Schirmer strips or phenol red threads to measure the flow of tears over a specified period of time allows some estimate of the function of the lacrimal gland. In Sjögren’s syndrome Schirmer testing is most often done without anaesthetic and for 5 minutes. A score of less than or equal to 5mm in at least one eye is characteristic of dry eye Sjögren’s syndrome related dry eye disease. A score of less than 10mm is characteristic of aqueous deficient dry eye.
  • Tear Stability

    • Using fluorescein dye in the eye, a practitioner can measure the amount of time it takes for your tear film to breakup or evaporate. A break up time of less than 10 seconds is considered indicative of an unstable tear film.
  • Status of the Ocular Surface

    • Your eye doctor will use dyes on the surface of your eye to determine the level of dryness. Yellow fluorescein dye is used to observe dry spots on the cornea and rose bengal or lissamine green dye highlight the dry spots on the conjunctiva. Your practitioners will grade the level of staining from a score of 9. Sjögren’s syndrome is suspected when the staining in at least one eye is 4/9 or greater.
  • Status of the Lids and Meibomian Glands

    • Your lids should be examined to see if the lash line is infected or flaking, a condition called anterior blepharitis. The meibomian glands should be observed and pressure put on them to observe how easily they secrete and whether the secretions are clear, as they should be, or milky.

At the end of all of this, your practitioners should be able to tell you whether or not you have dry eye disease, whether it is mild moderate or severe, and the most likely cause of the disease. At this point a treatment plan should be put in place.

Dry Eye Treatment Options

Treatment plans will vary depending on the degree and complexity of dry eye disease. This is where your relationship with your practitioner is so important. Most dry eye is chronic and needs regular attention. The treatments fall into 3 major categories: internal, topical and environmental.

  • Internal

    • The body is an integrated unit and therefore keeping your body healthy will maximize the health of your tears. Therefore do not smoke, eat your fruits and vegetables, increase the omega 3 fatty acids in your diet, maintain a normal weight, exercice, get enough sleep and drink plenty of water. Avoid dehydrating substance like alcohol and coffee.
  • Topical treatments

    • Using lubricants on the ocular surface regularly is the mainstay of dry eye treatment. There are numerous topical agents, both preserved and non-preserved that are helpful for dry eye patients. The rule of thumb is that if you use eye drops more than 4 times per day, it is better to use a non-preserved drop. Sometimes gels are useful especially at night. Be proactive with your drops. Use your drops regularly even if your eyes feel fine. By the time they hurt the damage may be harder to treat. If the drops are not doing enough there are other treatments that may help. Your practitioner can put plugs in the small opening of the lids called the puncta the prevent the tears from leaving the surface quickly. Also these openings can be cauterized for more permanent results. Anti-inflammatory drops such as Restasis  and topical steroids are sometimes prescribed for very severe dryness. The steroids cannot be used for long periods of time because of the complications they may cause. Finally, serum drops can be prepared by drawing your blood and taking the clear plasma part and mixing it with tear lubricants. Care of your lids is also important as inflammation of the lash line or the oil glands, called blepharitis, can cause tear evaporation. Massaging the lids and using lid scrubs and hot soaks will help to clean the lids and allow the glands to function. Applying warm compresses on the eyes a couple of times each day can make the meibomian glands secrete better and may relieve irritation and ease discomfort. The use of humidity shield glasses and Panoptyx glasses can greatly improve the symptoms. These can be made up with a prescription.
  • Environment

    • Add humidifiers wherever you can. Humidify the house and the office. In the car use only the floor vents for air conditioning and heating. Avoid drafts. Protect yourself from the wind with wrap sunglasses or humidity shield glasses. When working on a computer, raise your chai or lower the table so that your gaze is downward as this leaves less of your ocular surface exposed and reduces eye fatigue. BLINK ! The very act of blinking can help to replenish the tear film and make the meibomian glands secrete. Sometimes the simplest things are the best.

Remember that some systemic medications can cause increased dryness All of your conditions must be treated appropriately but do discuss this with your doctor. There may be alternative medications for your contition that are less drying.

Many researchers are working hard to learn more about Sjögren’s syndrome and dry eye disease. As the disease is better understood, new treatments and perhaps one day prevention will be available. For now know that your dry eyes are serious but rarely sight threatening. Do take care of your eyes with regular lubrication and a healthy lifestyle and see your eye care practitioner regularly.

Sjögren’s Syndrome

Sjögren’s (pronounced SHOW-grins) syndrome is a serious autoimmune disease that preferentially attacks and damages the salivary, tear and mucous-secreting glands, resulting in dry eyes, dry mouth, or swollen salivary glands. Hallmark symptoms of Sjögren’s is a chronic, systemic disease that can result in infllammation of the lungs, kidneys, GI system, blood vessels, liver, brain or thyroid gland. For more information go to www.sjogrenscanada.org

To learn more about Sjögren’s syndrome, please contact:

Sjögren’s Society of Canada

31 Mechanic Street, Suite 304

Paris, Ontario, N3L 1K1

1-888-558-0950

Infra-red Imaging of Meibomian Glands and Evaluation of Lipid Layer in Sjogren’s Syndrome Patients. Sjogren’s Syndrome has been defined as an autoimmune disease characterized by inflammation and destruction of sweat, salivary and tear glands.

Dry eye and Sjogren’s Syndrome occurs primarly in women, particularly during or post-menopause. Although the mechanism as to why this correlation exists is not fully understood, an underlying similarity between Sjogren’s Syndrome and menopausal women is a deficiency in androgens / hormones. The androgen-deficiency may lead to destruction of oil secreting glands (meibomian glands) in the eyelids or gland loss, leading to an increase in the evaporation of the tear film and subsequently dry eye experienced by many Sjogren’s Syndrome patients.

Meibomian glands and Dry Eyes

Meibomian glands are sebaceous oil glands located in the upper and lower eyelids. There are about 30-40 glands in the upper lid and 20-30 glands in the lower lid. Tears on the surface of the eye have two functional layers, the outermost layer composed of oils. The meibomian glands function to secrete the oils of the tears onto the surface of the eye which aids in preventing quick evaporation of the tear film and subsequent discomfort felt by the eye.

Meibomian gland dysfunction  (MGD) has been classified by the International Workshop on Meibomian Gland Dysfunction as a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct gland obstruction and / or qualitative / quantitative changes in the glandular secretion. This may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease. Meibomian gland dysfunction (MGD) has been shown to increase with age, contact lens wear, and as mentionned above, androgen deficiency. Thus, the recent findings would suggest that not only are the severe dry eye manifestations experienced in Sjogren’s syndrome due to lack of tear production, but may also be due to poor tear quality due to lack of oil layer present over the pre-ocular tear film.

Few studies have investigated meibomian gland loss in patients with Sjogren’s syndrome and to our knowledge; none have compared gland loss evaluations to the measured lipid (oil) layer thickness in thes patients. Thus, the purpose of this study was to evaluate and compare the meibomian gland drop out and the lipid layer thickness in patient with and without Sjogren’s syndrome.

Lipid Layer Thickness Evaluation

The tear film lipid layer thickness was measured for each participant using the Keeler Tearscope Plus (Broomall, USA). During evaluation, the lipid layer of for each participant would reflect a certain pattern back to the examiner. From the reflected pattern, the examiner was able to determine the thickness of the lipid layer.

Non-Invasive Tear Break-Up Time

The non-invasive tear break-up time was measured using the Atlas Corneal Topographer (Oberkochen, Germany). Tear break-up time measures how quickly the tear film evaporates off of the surface of the eye. Each participant was asked to look at the center of the concentric ring pattern displayed on the instrument screen. The ring pattern was reflected off of the participant’s tear film and viewed by the experimenter on a screen. The participant was instructed to blink 3 consecutive times and then asked to hold their eyes open for as long as they could or until the researcher asked the participant to blink. The time elapsed between the last blink and first sign of distortion occurring of the ring pattern or subsequent blink was recorded as the non-invasive tear break-up time. This was repeated a number of 3 times for each eye.

Meibography

Meibomian gland loss was analyzed using an infrared camera system. Multiple images were taken of the upper and lower eyelids of both eyes for each participant. Gland loss-out was first evaluated subjectively using a grading scale of 0-3 based on the grading system created by Arita et al. with grade 0 = no gland loss; grade 1 = areas of gland loss were less than 33% of total gland area; grade 2 = area of gland loss was between 33% and 67% of total area; grade 3 = area of gland loss was greater than 67%. Scores were for the upper and lower eyelids were summed to obtain a score for each eye.

Meibography images were also analysed using a computer software programme (ImagJ, National Institute of Health). Total area of the eyelid where glands should be present was calculated and the area that still had glands present was calculated. The gland area value was then subtracted from the total area and converted to a percent of area that had gland loss.

The investigator was not aware as to whether the participant had Sjogren’s syndrome or not during the subjective and digital analysis of gland loss.

Results

There were 10 participants without Sjogren’s syndrome enrolled in the study (3 male and 7 females) with an average age of 58.5 years. 11 participants with Sjogren’s Syndrome were enrolled (1 male and 10 females) with an average age of 56.0 years. Not one participant in the control group reported the use of artificial tear drop and all 11 participants in the Sjogren’s group reported use of artificial tear drops.

All of the participants in the Sjogren’s group had been diagnosed with Sjogren’s syndrome for at least 4 years, the earliest diagnosis in the group being 1999 and the latest being 2008. All participants also reported that dry eye symptoms preceded diagnosis with Sjogren’s syndrome.

Tear evaporation was approximately 4x quicker in the participants with Sjogren’s syndrome compared to the participants without Sjogren’s. The Lipid layer thickness was also significantly reduced in the participants with Sjogren’s compared to those without Sjogren’s syndrome.

Subjective gland loss were different for the upper right eyelid and lower left eyelid with the scores in the Sjogren’s syndrome group being higher indicating more loss of the glands. There was little difference in subjective gland loss for the lower lid of the right eye and the upper lid of the left eye. Digital grading scores showed significant difference in gland loss values between the control and Sjogren’s syndrome groups for the upper lid of the right and left eye and the lower lid of the left eye, again with the Sjogren’s group exhibiting higher degree of gland loss than the control group. There was no significant difference between the digital gland loss scores between groups in the lower right lid.

Conclusion

In this study, the participants in the Sjogren’s syndrome group presented with a significantly thinner lipid layer, with the majority of the lipid layers being relatively thinner than the group of participants without Sjogren’s syndrome. The Sjogren’s group also had a shorter non invasive tear break-up time which could be attributed to the thinner lipid layer thickness leading to quicker evaporation of the tear film.

The shorter tear break-up time and thin lipid layer thickness found in the Sjogren’s group could be further explained by the higher degree of gland loss found in the Sjogren’s syndrome group. As mentionned previously, the meibomian glands secrete the lipid layer of the tears, thus if there are fewer glands present, not as much lipid would be secreted, leading to a thinner lipid layer and short tear break-up time.

In conclusion, this study supports previous work suggesting that meibomian gland dysfunction plays an essential role in the severe dry eye experienced by patients with Sjogren’s syndrome. It also exemplifies the use of meibography for a quick and easy assessment of the degree of gland dropout in patients with Sjogren’s syndrome which could aid in a better understanding and management of the disease.

 

Souce: Connections Sjogren’s Society of Canada, 2014 Volume 8, Issue 1

April is the awareness month for Sjogren’s disease. This year, the Dry Eyes Store was present at the Sjogren’s Society of Canada annual conference held last weekend in Toronto.

A rewarding experience for those who want to learn more about this autoimmune disease

At this event, patients and individuals interested in this syndrome were able to learn about the disease, treatments and ongoing research through expert presenters in the field. In fact, participants were able to learn more about dry eye, dry mouth and arthritis pain associated with this chronic condition that is overwhelmingly experienced by women.

Often invisible from the outside, the symptoms are sometimes very debilitating. Personally, it was a very personal rewarding experience and an incredible business opportunity for the Dry Eye Store to publicize its products.

Success of our products

As mentioned earlier, Sjogren’s disease very often brings dryness symptoms into the body as it affects the different glands and mucous membranes responsible for secreting fluids. It is for this reason that the common symptoms are dryness of the mouth and eyes.

Our products, specially designed to help relieve dry eye symptoms were a huge success during our presence at this event. Indeed, several patients were very happy to be able to try our moisture chamber glasses specifically designed for dry eyes. Some have said they have been looking for this type of eyewear for years and have never been able to find them in traditional eye shop. At the Dry Eyes Store we have the widest selection of dry eye glasses for all budgets.

The Ziena Verona, Ziena Oasis and Verbena Liberty Sport glasses and sunglasses are without surprises the models that have been the most popular. These glasses help protect your eyes without shamefully sacrificing your look.

lunettes pour yeux secs pour sjogren

Glasses made to relieve dry eye associated with Sjogren’s syndrome.

A lady bought a pair of glasses in the morning and continued to attend the conference wearing her new glasses. She returned at the end of the day thanking me many times that she had not known such relief for a long time. That’s why I find it so rewarding to operate the Dry Eye Store. We make a difference in the lives of many people who often feel abandoned and misunderstood.

Meetings with interesting people

Apart from the patients who visited our booth, I also had the privilege of meeting health professionals such as rheumatologists, ophthalmologists and optometrists. They were also very impressed by the glasses we sell and have shown a serious interest in incorporating certain models into their practices.

Dry eye associated with Sjogren’s syndrome

Sjogren syndrome is defined as an autoimmune disease that is characterized by inflammation and destruction of the salivary and lacrimal glands. The resulting dryness of the eye is often very severe, chronic and debilitating. That’s why these people need glasses like the ones we have to create mechanical protection around the eyes and promote a more humid environment for the eyeball.

Sjögren's Society of Canada annual event

Sjögren’s Society of Canada annual event

If you have dry eyes, with or without Sjogren’s syndrome, we believe that our glasses can help reduce your dry eye symptoms and restore your quality of life. I am perfectly aware that buying glasses online is not easy, but you will not find these glasses at your local glasses shop.

The glasses Ziena Verona, Ziena Oasis and Verbena Liberty Sport are specially designed for the female face. If you are a man, the model Ziena Nereus is more suitable in your case. All these glasses can receive your prescription glasses.

Thank you to the Sjögren’s Society of Canada for trusting us and inviting us to their annual event. We are proud and honored to have been able to attend and help, in our own way, to relieve those who suffer from dry eye.

I would also like to thank everyone who came to visit our booth and who helped make this day a success!

 

Another perspective on the Dry Eye Syndrom with the aim of improving the treatment of MGD (Meibomian Gland Dysfunction), DES (Dry Eye Syndrome) and CDE (Chronical Dry Eye)

Eyelids could not slide accross my eye ball without scratching it

I will start right at the beginning of my journey: I am a long-term patient myself of MGD (Meibomian Gland Dysfunction) which leads to the DES (Dry Eye Syndrom) and CDE (Chronical Dry Eye) respectively. It all started a couple years ago when I my eyelids could not slide across my eye ball without scratching it. It basically felt like you put on your windscreen wiper on your car when it does not rain – it’s really not a good feeling to have.

Inflammation of my eyelid margin

Back than it was combined it was inflammation of my eyelid margin which even worsened the situation. At that point, I have not heard of any of the technical terms associated with it like those above or blepharitis, ocular rosacea or things like that. Back then I was just really annoyed by the symptoms which included the typical dryness, redness, itchiness, irritation, watery eyes and just pure eye pain. (Maybe you will recognize yourself if you read through it or know someone with a similar story.)
After that my multi-year story started where I tried to cure, improve and even „hack” the symptoms and especially (root) causes on every level I could:
1) Nutrition (e.g. by eating more omega-3 containing food like avocado, salmon, (wal)nuts but also more probiotics – and also supporting this with supplements )
2) Psychology (e.g. with meditation)
3) Physiology (e.g. going to the sauna; using the Blephasteam goggles; doing eyelid margin hygiene; getting LipiFlow treatment; now currently in the process of setting up my IPL (Intense Pulsed Light) treatment during summer)
4) Medication (e.g. using eye drops like Lacrycon or Optava)
5) Alternative medicine (e.g. TCM (Traditional Chinese Medicine), i.e. acupuncture or drinking TCM herb mixtures as a tee)
It can seem intimidating at the beginning to see that so many levers exist to improve the MGD/DES/CDE and all its symptoms. But I perceived it as good news: if there are so many levers to pull it also means that if you pull all levers at once you will see positive effects pretty soon.
Of course, at the beginning I learned the various root causes step by steps by visiting many different eye experts, by reading articles on the internet, by following „bio hackers” (e.g. Dave Asprey – if you don’t know him yet, make sure to check out his blog), books, scientifical papers (e.g. on PubMed), reading in dozens of forums and Facebook groups on the internet and so on.

Dry Eye Treatments

It took a long time, costed a lot of money and was really frustrating at times since I always had the feeling that I could collect all the valuable „actionable insights” only drop-by-drop and step-by-step without there being a source where I could learn everything at once. Until I learned about most of the treatment options and causes it took around 2 years (and I was a pretty obsessive researcher on that topic to be honest — at some point my eye specialists / doctors told me they could skip their conference visits because I already told them everything about the new scientific breakthroughs and treatment options :-). Along this way, I also tried every possible treatment option and continuously optimized along all these five categories I mentioned above.
As of now, I can say that I cured around 90% of the dry eye syndrome with the help of many information sources, experts and doctors. (Thank you for your support if you read this!). I am still learning and studying the topic since I still have the aim of hacking this medical condition to end up of curing 100% of the symptoms (which is currently not possible).
I feel pretty lucky to be able to afford and also get access to all these sources of support, information and expertise here in Switzerland — that’s why I thought to myself: with all this experience, what’s the best way of passing on those silver bullets to my fellow DES-patients?

Dry Eye Survey

Therefore I have created a short online-survey via SurveyMonkey to really understand what hurdles others had or still have to overcome — you can find it here:
It’s only 10 questions, so it will not take no more than 5 minutes to complete – promised :-) I would be eternally grateful if you could participate and tell me about your struggles and opinions.
Of course, if you have any questions, extra input, feel the need to discuss certain points etc. please reach out to me by leaving a comment below or send me an email ( info@augenfrieden.de ) where I will reply to every message personally.
Thank you in advance & looking forward to hearing back from you!
Best regards
Jerry

What are dry eyes ? What is eye dryness ? Dr. Ashley O’Dwyer is explaining it in a very clear and simple way in this video.

 

What is eye dryness ? What does it mean ?

If you’re blinking and your vision is changing upon the blink, a lot of that’s due to that tear film. When you blink, the tears are spread across your eye and if that’s out of whack then your eyes can be considered dry. So if anything affects those three layers of your tear film, your eyes are considered dry. Another thing you’ll feel is discomfort or a gritty feeling.

What is going on with the eye when you’ve got eye dryness ?

When your eyes are dry and you’re getting these problems, what’s going on with the eye ? When you look at the eye, over coating the front part of your eyes is the tears. Most people think of the tears is just kind of a liquid layer but it’s actually made of three different parts.

  • A mucin layer which helps cling the tears to your eyes off of the cornea.
  • An aqueous layer or the liquid layer
  • A lipid layer, which is kind of like an oily substance

That last layer (lipid layer) helps the liquid to stay on your eyes and prevents it from evaporating very quickly. So when you have a nice oily layer (lipid layer) on the top, the tears stays stuck on your eyes and they stay nice and hydrated.

Tear film layers and eye dryness

So when you have any of those layers that are not doing their job or they’re or they’re off or too high or too low, your eyes are gonna feel dry. The main two layers that we will focus on are the aqueous and the lipid layer.

Aqueous layer

Let’s start with the aqueous layer ! This layer of the tear film is produced by the lacrimal glands. They are located right up of the eyes. When one of your eyes feel dry, you get a signal to your brain and then to your lacrimal glands that tells your eye to produce more of this liquid to keep it nice, coated and hydrated. In a lot of times, people get really watery eyes and it’s actually eye dryness ! This seems counterintuitive because there’s a lot of water then why would your eyes feel dry ?

Well what happens is when your eyes feel dry, you get that signal to produce more tears and you keep producing tears quicker than they can even drain so then they keep watering. Watery eyes is often a very big sign of dryness. What also can happen is due to inflammation either in the lacrimal gland or the eye and you get a decrease of secretion of that aqueous layer.

Oily / Lipid layer

The lipid layer of the tear film is produced by the meibomian glands located in the eyelids. When they’re working properly, whenever you blink, they secrete a lipid and keeps a nice amount of oil at the front of your eyes and that helps to control tears evaporation. If for any reason, you don’t have enough of this oil being secreted, your tears are flying off your eyes very quickly and so you have to keep producing more tears to keep your eyes feel hydrated.

In an ideal world, you have the perfect amount on there so the tears stay on your eyes longer and you’re more comfortable, which is great ! What can happen is because these glands are located in the eyelid margin, makeup can kind of hinder it, keeping that on there over the day. Over time, these glands can kind of shrink up and not secrete as much oil. Reduced secretions can cause some issues as well. The good news is, is because these multiple steps, there’s a lot of things we can do for eye dryness depending on what’s going on in your eyes. The best thing for you to do is talk about this to your eye care provider and have them help you with which ones you have to kind of work on and make that better so that you can have nice comfortable vision all the time.

Hopefully this video helped you, if you have any question about this video, feel free to send an email at the dryeyeguru@gmail.com

 

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Inflammation is the prime therapeutic target in Dry Eye. In the diagnosis and management of dry eye, we’ve reached a new level. We have a new generation of diagonostic tests for assessing specific signs of the disease, which we can then address with both new and familiar targeted treatments.

We can evaluate meibomian gland structure and function, detect markers of inflammation, assess tear film stability, and match the findings with the pertinent short and long term therapies. All of this is great news for the millions of dry eye patients whose vision and quality of life aren’t what they could be because of dry eye.

Inflammation – a major causative factor in both aqueous-deficient and evaporative dry eye – has been and will continue to be a target of therapy.

restasis multidose

restasis multidose

Restasis (cyclosporine ophthalmic emulsion 0,05%, Allergan) alone and with Lotemax (loteprednol etabonate ophthalmic suspension 0,5%, Bausch + Lomb) as recommended by the Asclepius Panel is a mainstay in dry eye treatment because it reduces inflammation. Restasis is the only therapeutic ocular medication for dry eye disease that acts on all three layers of the tear film, supporting the lipid layer with castor oil, increasing the acqueous laye, and increasing globet cell density in the mucin layer by 191%. Azithromycin or doxycycline are also frequently prescribed for dry eye patients when mitigating the signs and symptoms of meibomian gland dysfunction is the goal.

Recently approved option to treat dry eye inflammation now available

 

xiidra for dry eyes

xiidra for dry eyes

The newest prescription medication for dry eye, Xiidra (lifitegrast ophthalmic solution 5%, Shire), is a small-molecule integrin antagonist that reduces inflammation by blocking the interaction of integrin lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1), thereby disrupting T-cell activation and migration. Xiidra is FDA (and now Health Canada) approved for treatment of the signs and symptoms of dry eye disease. It was evaluated in four placebo -controlled 12 weeks trials. Each of the four studies assessed the effect of Xiidra on both the signs and symptoms of dry eye disease at baseline and weeks 2, 6 and 12. Assessment of symptoms was based on change from baseline in patient reported eye dryness score (EDS), and assessment of signs was based on the inferior corneal staining score (ICSS). In all four studies, a larger reduction in eye dryness score was observed with Xiidra at 6 and 12 weeks.

In two of the four studies, an improvement in eye dryness score was seen with Xiidra at 2 weeks. At week 12, a larger reduction in ICSS favoring Xiidra was observed in three of the four studies. Xiidra just recently became available to clinics, so time will tell how it best fits into treatment protocols.

Dry Eye related inflammation

HydroEye Dry Eye Relief

HydroEye Dry Eye Relief

We can also address dry eye related inflammation with neutraceuticals that contain omega fatty acids. We have many products to choose from, but it makes sense to recommend that our patients use an option that’s backed by solid data. A study that evaluated an omega-3 / omega-6 (gamma linoleic acid, GLA) combination, HydroEye Support for Dry Eyes (ScienceBased Health), in 38 postmenopausal women with moderate to severe dry eye. Patients received either four HydroEye softgels daily or placebo and were evaluated at baseline, 4, 12, and 24 weeks. By the end of the study, patients taking the supplements had significantly improved symptom scores compared with baseline and placebo.

HydroEye was found to dampen inflammation and maintain corneal smoothness, while these parameters worsened for those taking the placebo. A distinguishing feature of HydroEye is that it contains the unique Omega-6 fatty acid GLA. While omega-6s are often thought of as counter-productive in decreasing inflammation, GLA actually has a potent positive effect that is site-specific for the lacrimal gland and ocular surface.

Amniotic membrane treatment for Dry Eye

The last inflammation-targeting treatment that is important to mention in the context of dry eye is amniotic membrane, Prokera Slim (BioTissue), in particular. Amniotic membrane treatment has traditionnaly been used in the OR and for immediately vision-threatening conditions, such as corneal melts and infectious keratitis, but because of the attributes of Prokera Slim, it is being used more frequently in the clinic as part of dry eye therapy, as well as chemical burns, corneal abrasions, and so on.

Because the membrane used in Prokera is cryopreserved rather than dehydrated, it retains its full biologic capability to reduce inflammation and rejuvenate the ocular surface. Its ease of use and tolerability – it is placed on the eye in-office and is self-retaining – are aslo significant contributors to its increased use for dry eye. A large survey of dry eye patients treated with Prokera Slim showed that 93% felt better and 81% would request Prokera Slim if their symptoms returned.

Additional dry eye inflammation fighters on the way

While we continue to address all aspects of dry eye for our patients, we can also expect more treatments that target inflammation to become available. Many, including the immunomodulating JAK inhibitor tofacitinib (Pfizer), the small-molecule nerve growth factor MIM-D3 (Mimetogen), the interleukin-1 blockers EBI-005 (Eleven Biotherapeutics) and Anakinra (Amgen), the amino acid analog rebamipide (Otsuka Pharmaceuticals), and the chemokine thymosin beta-4 (RegeneRX), are currently in development.

By Walter O. Whitley, OD, MBA, FAAO

Dr. Whitley is director of optometric services at Virginia Eye Consultants, an optometry/ophthalmology tertiary referral center with five locations throughout the state. He is also residency program supervisor for the Salus University Pennsylvania College of Optometry.

Source: Optometric Management January 2017, p. 12-13

 


 

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Did you know that the vast majority of people with rosacea face skin also have ocular rosacea? Rosacea is a common inflammatory condition of the skin and sometimes eyelids that causes redness, pimples and swelling on the face. In the presence of ocular rosacea, the eyes and eyelids are red and uncomfortable.

rosacée et rosacée oculaire

Rosacea and ocular rosacea

Millions of people around the world suffer from some form of rosacea. Rosacea is sometimes defined as “adult acne”. People with rosacea tend to blush easily and as the condition progresses, more and more persistent patches appear on the face. Over time, blood vessels are often clearly visible on the nose, cheeks, forehead and chin. This condition often makes the skin dry and rough and sometimes even swollen. In the beginning, the redness is intermittent and it is better to consult your dermatologist at the first signs of rosacea. You should also see your ophthalmologist if you suspect eye rosacea.

Causes of rosacea

The causes of rosacea are not yet well known but it seems that various environmental factors may accentuate redness such as eating spicy foods or taking alcohol. Stress, hot baths or the use of antihypertensive drugs are also aggravating factors. Exposure to the sun or extreme temperatures also favors rosacea outbreaks.

People at risk of developing rosacea

Rosacea can affect everyone and at any age. However, rosacea most often affects white-skinned people aged 30 to 60, especially those of Celtic descent or northern Europe. Women are also more often affected than men and it would seem that there would be some hereditary links.

Treatment of rosacea

It is important to consult your doctor if you think you have facial rosacea or ocular rosacea. Do not try to treat yourself without consulting your dermatologist. Some over-the-counter products could simply make your problem worse. Your doctor may prescribe medications:

  • Topical or oral antibiotics;
  • Creams containing steroids;
  • Laser treatments;
  • Green concealer makeup;
  • Proper care and cleaning of the skin;
  • Reduced sun exposure: sunscreen, shade and wide-brimmed hat.

It should be understood that rosacea (including ocular rosacea) is often chronic and evolves over time. Just like dry eye, even if it is chronic, there are excellent ways to relieve the symptoms by adopting certain habits.

Myths and realities about rosacea

  • Myths: Rosacea only strikes people with fair skin.
    • Reality: Although more common in fair-skinned people, this condition affects all skin types.
  • Myths: Rosacea sufferers drink too much alcohol.
    • Reality: Alcohol consumption is an aggravating factor, but rosacea can also be very apparent in people who do not consume alcohol at all.
  • Myths: The nose of women with rosacea grows.
    • Reality: This symptom is rare and occurs almost exclusively in men.
  • Myths: Rosacea affects only the skin.
    • Reality: In up to 50% of cases, the eyes are affected. Ocular rosacea is characterized by red, watery eyes, frequent styes, and a sensation of irritation, dryness, or foreign body in the eye.

Ocular rosacea

If your rosacea affects your eyes, it is likely that you will experience the same symptoms that describe blepharitis and meibomian gland dysfunction. The sand grain sensation in the eyes comes from the fact that your eyes are dry and poorly lubricated. The use of hot compresses, eyelid massages and eyelid hygiene is essential to help you control your symptoms.

 

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Whether or not you have dry eye, the fact remains that an eye exam at your optometrist is still very important. It is advisable to have your eyes examined at least once a year. The sight examination performed by your optometrist can detect the potential presence of eye diseases. Optometrists do more than simply measure your visual acuity.

dry eye and eye exam

Dry eye and Eye exam

As an example, a friend recently complained of a blurred vision. He went to his optometrist to have his eyes examined. The optometrist immediately detected an eye bleed. After measuring the patient’s intraocular pressure, he immediately referred him to the hospital for emergency consultation with an ophthalmologist. This person did not even know she was suffering from glaucoma. A potentially dangerous condition for your vision if left untreated.

As already mentioned, the ophthalmologist does not just measure your visual acuity, but does a thorough eye exam to detect the possible presence of diseases that can affect your eyes. Certain systematic diseases can have a significant impact on your eye health such as diabetes, multiple sclerosis or a brain tumor. The sooner these problems are detected, the more effective the treatment will be. It is the same for dry eye. The optometrist is able to assess your dry eye and provide you with personalized advice tailored to your situation. If necessary, he refers you to the ophthalmologist.

Dry Eyes

Advances in technology mean that some issues today are much easier to deal with than a decade ago. The biggest advances are in dry eye care and cataract removal.

Tears serve not only to lubricate the eyes but also to clean the ocular surface by removing foreign bodies. A healthy tear film reduces the risk of eye infections. The itching or burning sensation or irritation that characterizes dry eye conditions occur when the tears do not have the correct chemical composition or are insufficiently produced.

Did you know that about 80% of cases of dry eye are due to tears that no longer have the right chemical composition?

Thanks to various tests at its disposal, the optometrist is able to determine the cause of your dry eye in the vast majority of cases. For this, he uses what is called a biomicroscope and special dyes such as lissamine green to color the ocular surface. This dye, combined with a blue light, measures the quantity, quality and distribution of tears on the surface of your eye.

Following the examination, he may prescribe certain prescription drugs such as anti-inflammatory drugs, ophthalmic gels, nonsteroidal anti-inflammatory drugs, artificial tears, and so on.

If your dry eye is partly due to the work on screen, it can advise you on the wearing of protective glasses that filter blue light.

Nutritional advice for your dry eyes

Your optometrist will be able to give you nutritional advice to treat and relieve your dry eye. In general to have good eyes, it is recommended to eat foods rich in lutein and zeaxanthin. These antioxidants are found in spinach, kale and several dark green vegetables. Foods rich in lutein and zeaxanthin will help reduce your chances of developing age-related macular degeneration, a condition that causes progressive loss of central vision.

To reduce the symptoms of dry eye, it is recommended to eat foods rich in Omega-3 fatty acids, such as ground flaxseed or fish oil supplements.

Your optometrist can detect cataracts

Cataracts are formed when the lens of the eye, which is normally transparent, becomes opaque. Although painless, cataract formation blurs vision and seriously hinders night vision. In general, cataract formation occurs after the age of 60 years. It can develop in a few months or a much longer period. Untreated, cataract seriously affects the quality of life of the person affected because his vision is constantly blurred. When the optometrist detects a possible presence of cataracts, he will refer you to an ophthalmologist. He will then proceeds to ablation and implants a synthetic lens.

A complete eye health assessment at the optometrist includes the following:

  • A review of overall health status and history of eye problems
  • Assessment of visual acuity with and without corrective lenses
  • Assessment of pupillary reactions, peripheral vision and ocular muscle function
  • Measuring intraocular pressure to detect glaucoma
  • Observation of the retina and the optic nerve
  • Retinal screening test using a camera to detect diseases such as macular degeneration, glaucoma, retinal tear, diabetes, hypertension, etc.

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As many people who suffer from dry eye also report dryness of the skin, we thought to introduce an article that deals with dry skin.

sécheresse de la peau

What is dry skin?

The skin dries out due to the deterioration of the natural barrier that maintains its hydration. This can lead to more serious conditions, such as eczema.

Dry skin can become rough, flaking and chapped. Itching and irritation are often associated with drying of the skin.

Several factors contribute to the dryness of the skin. The sun, changes in seasons or temperatures, hereditary factors and the use of irritants are some examples. The skin tends to become dry in the winter months, as the outside temperature is cold and windy, while the home or office environment is dry and hot. Aging also affects the skin, causing it to gradually lose its natural moisturizing properties.

How to prevent dryness of the skin?

Prevention of dry skin requires careful care. Moisturizing your skin helps keep it healthy and radiant and youthful. Here are some measures that help promote good hydration of the skin:

  • Reduce shower time and use less hot water.
  • Do not wash more than once a day.
  • Use a soap-free body care specifically designed for dry skin. After a shower or bath, blot the water on the skin with a soft towel; avoid rubbing.
  • Apply a moisturizing or emollient agent immediately after washing to form a barrier that will keep your skin moisturized. You can reapply during the day for maximum effect.
  • Protect yourself from the drying effects of the sun by using, both winter and summer, sunscreen with a sun protection factor (SPF) of at least 30. Apply a generous layer at least 30 minutes before exposure to the sun.
  • Wear gloves when working in the garden or when using household products.
  • Use a humidifier, especially during the winter. However, be sure to clean it and keep its filters clean to prevent the spread of dust and mold.
  • In winter, protect your skin from wind and cold by dressing properly. Wearing gloves and a scarf can make a good difference.
  • Stop smoking. Smoking causes narrowing of the blood vessels, which reduces the supply of oxygen and nutrients to the skin.
  • Moisturize appropriately by drinking six to eight glasses of water or other liquids daily unless directed by your doctor.
  • Exercise regularly to improve blood circulation in your skin.

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