Thursday, October 12, 2017

Rosacea and Demodex Blepharitis Are Closely Linked


Rosacea & Demodex Blepharitis Are Closely Linked

What is Rosacea? 

Rosacea is red spider veins on the face and nose, causing flushing of the face and inflammation.  Rosacea is believed to be genetically inherited and can affect the immune system.  Rosacea is considered an autoimmune disorder.


What is Demodex?

Demodex, a tiny mite that is a normal inhabitant of human facial skin, is often the cause in rosacea flare-ups just because its often found in greater numbers on the faces ofpeople with this rosacear.1, 2  New research is supporting the fact that Demodex may be the trigger that causes the symptoms and flares of Rosacea.
Demodex mites is a part of our normal microbes that we all have.  It is important to understand how it affects the flares and inflammation of people with Rosacea. 

What are Microbiomes? 

We humans need microbiomes in order to survive.  Many bacteria are necessary for a healthy gut, so we can absorb nutrients.  Taking Probiotics to stay healthy is highly recommended. 
Demodex mites are a natural part of the human microbiome, and they may serve a useful function by feeding off of dead skin cells. In fact, dead human skin cells are the largest component of household dust and, just like dust mitesDemodex folliculorum may be part of a natural cleaning system.6

The Demodex mite

Recent research has discovered that Demodex is observed to cause Rosacea as early as 1841.
A year later, a German dermatologist found Demodex-type mites in hair follicles, almost 100 years before human Demodex was first observed in the development of rosacea.7
Larget numbers of Demodex is very common in virtually all humans. In fact demodex exist in every adult over 18 years old.8   In fact two separate species of Demodex inhabit the skin of humans – D. folliculorum, which live in hair follicles primarily on the face as well as in the meibomian glands of the eyelids, and D. brevis, which live in the sebaceous glands of the skin.8,9
Demodex have often been found in 15 to 18 times greater numbers in rosacea patients than in healthy people,1,2. Medical scientists have proposed a variety of reasons about why this unusually high incidence may trigger inflammation in individuals with rosacea. A recent meta-analysis of 48 studies on Demodex found a significant association between the relative density of Demodex and the development of rosacea, suggesting that the mites may be involved in the disease process, according to Dr. Erin Lesesky, assistant professor of dermatology at Duke University.10

The debate is whether the higher incidence of Demodex is a cause or a result of rosacea, new evidence has increasingly suggested it may be the former.
In a recent key medical journal article, Dr. Fabienne Forton, a dermatologist in Brussels, Belgium, characterized the mites as a potential missing link in understanding the onset of subtype 2(papulopustular) rosacea.2 She hypothesized that skin infections and disruption of the skin barrier may set off a chain of inflammatory reactions in individuals with rosacea, noting that when the number of mites is reduced to normal through treatment the typical rosacea complaint of sensitive skin often disappears. Dr. Stanislaw Jarmuda and colleagues also found that while mite density is greater on the skin of individuals with rosacea, mites are even more dense in individuals with the bumps and pimples of papulopustular rosacea.9
Other research have shown a bacteria D. folliculorum's on the mites maybe associated with rosacea This bacterium was found to stimulate an immune response in some individuals with rosacea, This bacterium plus mites maybe true for those with ocular rosacea as well. Dr. Jianjing Li and colleagues at the Ocular Surface Center in Miami found a significant correlation between facial rosacea, infestation of the eyes with Demodex mites and reaction to B. oleronius.12
How Can TheraLife Help?

Ocular Rosacea Starter Kit- Doctors Recommended

Reduce Inflammation, treat dry eyes, strongly anti-inflammatory, hot compress to unclog oil glands, eye lid cleanser to stop demodex. 


Learn More

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Email to:  info@theralife.com

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Demodex references

1. Jarmuda S, O’Reilly N, Zaba R, et al. Potential role of Demodex mites and bacteria in the induction of rosacea. J Med Microbiol 2012;61:1504-1510.
2. Forton FMN. Papulopustular rosacea, skin immunity and Demodex: pityriasis folliculorum as a missing link. J Eur Acad Dermatol Venereol2012;26:19–28.
3. NIH Human Microbiome Project defines normal bacterial makeup of the body. National Institutes of Health June 13, 2012.
4. Marantz Henig R. Fat factors. New York Times Aug. 123, 2006.
5. Ackerman J. How bacterial affect our bodies protect our health. Scientific American May 15, 2012, pp.
6. House dust mite. Wikipedia Accessed 11/25/14.
7. Rusiecka-Ziółkowska J, Nokiel M, Fleischer M. Demodex – an old pathogen or a new one? Adv Clin Exp Med 2014;23:295–298.
8. Thoemmes MS, Fergus DJ, Urban J, Trautwein M, Dunn RR (2014) Ubiquity and diversity of human-associated Demodex mites. Public Library of Science One 9(8):e106265. Doi:10.1371/journal.pone.0106265.
9. Jarmuda S, O’Reilly N, Zaba R, et al. Potential role of Demodex mites and bacteria in the induction of rosacea. J Medical Microbiol2012;61:1504-1510.
10. Zhao YE, Wu LP, Peng Y, et al. Retrospective analysis of association between Demodex infestation and rosacea. Arch Dermatol2010;146(8):896-902.
11. Erbagci Z, Ozgoztaosi O. The significance of Demodex folliculorumdensity in rosacea. Int J Dermatol 1998;37:421-425.
12. Li J, O’Reilly N, Sheha H, et al. Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with facial rosacea. Ophthalmology 2010;117:870-877.
13. Demodex surfaces again at summer AAD meeting. National Rosacea Society Weblog Accessed 11/25/14.

Wednesday, October 4, 2017

How I Relieved My Chronic Dry Eyes from LASIK

 

How I Relieved My Chronic Dry Eyes from LASIK

This is my personal story.  I had chronic dry eyes and blepharitis.  

Why LASIK Gives You Dry Eyes?

It has been known LASIK surgery for vision correction can induce severe dry eyes even after many years. 

This is because cutting of the cornea resulted in uneven cornea surfaces, especially if the person has dry eyes to begin with.  The friction of an uneven cornea creates inflammation every time you blink.  Inflammation shuts down the tear secretion glands, creating more dry eyes.  This becomes a vicious cycle of inflammation and dry eyes.

What is Blepharitis? 


Blepharitis is a condition caused by inflammation of the conjunctiva or meibomian- this should not be confused with Meibomian Gland Dysfunction where Meibomian Glands may be clogged.  Most Blepharitis conditions are caused by inflammation from dry eyes.

TheraLife Eye relief dry eyes and blepharitis by restoring normal cell functions to tear secretion glands and reduce inflammation to achieve long lasting relief.

Here is my personal story:

"I hesitated to order these pills because of the cost and disappointment with other products. I'm so glad I gave this a try. I had dry eyes before LASIK surgery in 2007 and was still told I was a good candidate. After LASIK, two eye doctors diagnosed me with chronic blepharitis and age-related dry eye syndrome. I was miserable and all I could think of was how dry, red and painful my eyes were ALL THE TIME! I was on prescription eye drops that is suppose to reduce inflammation and on an antibiotic drop called Azasite. Both are very expensive. I started with the recommended four capsules of Theralife Enhanced twice a day. I took the pills after meals and reducing the dosage to two pills a day after my symptoms were gone. I still can't believe I have such total relief and I am so grateful for Theralife Enhanced. I very rarely use the lubricating eye drops I relied on before."
CL  Ohio

Theralife Can Help 

TheraLife Eye capsules relief dry eyes and blepharitis by restoring normal cell functions to tear secretion glands and reduce inflammation.  Relief your dry eyes with your own tears, no more drops.  
 

TheraLife Eye to relief dry eyes

Omega 3 Fish Oil - provide lubrication and anti-inflammatory

Hot Compress - to unclog meibomian oil glands

Eye Lid Cleanser for lid hygiene.



 Call and talk to a doctor toll free
1-877-917-1989 US & Canada
Send email inquiry to  info@theralife.com
 
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Thursday, September 28, 2017

What Causes Watery Eyes?

What Causes Watery Eyes?


There are two major reasons for watering eyes - blocked tear ducts or over  production of tears. 

Majority of the watery eyes are caused by DRY EYES.
  • Blocked tear ducts – Infants sometimes are born with watery eyes. This problem goes away shortly as the tear ducts develop.

    A common cause of watery eyes in adults is blocked tear ducts, or ducts that are too narrow. Narrowed tear ducts usually is from swelling (inflammation) such as dry eyes.

    If a person's tear ducts are narrowed or blocked their tears can not drain and thus, build up in the tear sac. Stagnant tears in the tear sac increase the risk of eye infections.  The eye will start to  produce a sticky liquid, making the problem worse.

    Narrow drainage channels on the insides of the eyes can become blocked due to swelling or scarring from dry eye syndrome.
  • Over-production of tears - irritated eyes can produce more tears because the body is trying to rinse away the irritant. Some examples of irritants that can cause watery eyes include:
    • Dry Eyes- irritated, red, gritty, light sensitive, tired.
    • Chemicals, such as fumes, and even onions
    • Allergic conjunctivitis
    • Eye infections
    • Injury to the eye, such as a scratch or a bit of dirt
    • Trichiasis - inward-growing eyelashes, often caused by marginal entropion (the eye lid turns in at the edges towards the eye) which causes irritation.
    • Ectropion - this is when the lower eyelid turns outwards
The tears of some patients have a high fat (lipid) content. This may cause uneven spread of liquid across the eye, leaving dry patches which become painful, irritated and cause the eye to produce more tears.  This is what happens in chronic dry eyes.

Theralife Can Help
Doctors Recommended for Watery Dry Eyes.  

To stop watery dry eyes, relief dry eyes first, then your eyes will stop watering .  This will take 3 months on TheraLife Eye capsules. 

TheraLife Eye is not an eye drop.  It is a capsule that relief dry eyes from within to get balanced, sustainable tear production.  Eye drops simply add more fluid to your eyes that are already watery- making your eyes drier and drier.   Watery eyes do recover by using TheraLife Eye.  Start your relief today.

Learn more 




Call and talk to a doctor today toll free 1-877-917-1989 US/Canada.  International (650) 949-6080
email:info@theralife.com
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Why Allergy Medications Can Lead to Dry Eyes & Glaucoma

 

 Allergy Medications Can Lead to Dry Eyes and Glaucoma.

Incidence of Allergy


The number of people has allergies or asthma is one in five!

Allergy patients can present themselves with itchy, red, watery and dry eyes. They often complain of having a constant cold.  Chronic dry eye is often associated with ocular allergy.  Want to know what medications are prescribed and how the doctors diagnose ocular allergies and more?  Read on - - - -

Allergy in the United States is very common and is considered a systemic condition that is treatable.  About one third of the patients who has allergies are not aware they have this condition.  Patients who suspect they suffer from allergies usually first visit their family practitioner, who may refer them to an allergist. These patients often end up taking an oral systemic medication, and treatment often leads to chronic dry eye, glaucoma and more eye issues.

Allergy Medications Affects Eyes


Although allergy also affects the eyes, systemic antihistamines are partially effective at alleviating ocular symptoms (e.g. itching and redness), and they have also been shown to contribute to secondary dry eye problems.

Many of your optometrists or ophthalmologists can refer you to an allergist. They should work as an integral team for this wide spread problem.

What are the Symptoms of Allergies


People, who have allergies often have these symptoms:
  1. Recurrent cold” that occurs around the same time every year,
  2. Profound Itchy- how this is different than dry eye.
    Dry eyes can have itching,m but its hallmarks are more the foreign body sensation, grittiness, discomfort and reflex tearing. And usually with allergy, there is more redness in the eye.”
  3. Lower lids may reveal dark half circles. This swelling and discoloration is indicative of allergy.
  4. Constantly rubbing nose up and down.    

Allergy and Glaucoma:


Allergists are aware that some allergy medications can cause the pupil to dilate and prompt angle-closure attacks in people who have very narrow angles or undiagnosed angle-closure glaucoma, building up intra-ocular pressure.

Allergy and Chronic Dry Eyes.

People being treated for chronic allergies are at risk for concomitant dry eye, as several OTC drugs contain preservatives that put patients at risk for this condition.  During the eye esamination, the eye doctor can be on the lookout for any signs of ocular dryness, via slit lamp exam.

Her is a list of  Prescription Medications are used to treat Allergy?

Intranasal Corticosteroids for Ocular Allergy- Veramust ( GlaxoSmithKline)
Prescription Ocular Allergy Drugs
► Alcaftadine 0.25% (Lastacaft, Allergan) Age of use: two years +, Dosing: q.d.
► Azelastine hydrochloride 0.05% (Optivar, Meda) Age of use: three years +, Dosing: b.i.d.
► Bepotastine besilate 1.5% (Bepreve, ISTA Pharmaceuticals) Age of use: two years, + Dosing: b.i.d.
► Cromolyn sodium 4% (Opticrom, Allergan) Age of use: four years +, Dosing: q.i.d.
► Emedastine difumarate 0.05% (Emadine, Meda) Age of use: three years +, Dosing: q.i.d.
► Epinastine HCI 0.05% (Elestat, Allergan) Age of use: three years +, Dosing: b.i.d.
► Lodoxamide tromethamine 0.1% (Alomide, Alcon) Age of use: two years +, Dosing: q.i.d.
► Loteprednol etabonate 0.2% (Alrex, Bausch + Lomb) Age of use: Safety and effectiveness in children has not been established. Dosing q.i.d.
► Loteprednol etabonate 0.5% (Lotemax, Bausch + Lomb) Age of use: Safety and effectiveness in pediatric patients have not been established. Dosing: q.i.d.
► Nedocromil sodium 2% (Alocril, Allergan) Age of use: three years +, Dosing: b.i.d.
► Olopatadine hydrochloride 0.2% (Pataday, Alcon) Age of use: two years +, Dosing: q.d.
► Olopatadine hydrochloride 0.1% (Patanol, Alcon) Age of use: three years +, Dosing: b.i.d.
► Pemirolast potassium 0.1% (Alamast, Vistakon Pharmaceuticals, LLC)Age of use: three years +, Dosing: q.i.d.* Be sure to check these drugs for their individual preservative amounts. Which makes dry eye symptoms worse.
  1. 1. Spangler DL, Abelson MB, Ober A, Gomes PJ. Randomized, double-masked comparison of olopatadine ophthalmic solution, mometasone furoate monohydrate nasal spray, and fexofenadine hydrochloride tablets using the conjunctival and nasal allergen challenge models. Clin Ther. 2003 Aug;25(8): 2245-2267.
    2. Abelson MB, Welch DL. An evaluation of onset and duration of action of Patanol (olopatadine hydrochloride ophthalmic solution 0.1%) compared to Claritin (loratadine 10 mg) tablets in acute allergic conjunctivitis in the conjunctival allergen challenge model. Acta Ophthalmol Scand Suppl. 2000;(230): 60-63.
    3. Ouslter GW, Workman DA, Torkildsen GL. An open-label, investigator masked, crossover study of the ocular drying effects of two antihistamines, topical epinastine and systemic loratadine, in adult volunteers with seasonal allergic conjunctivitis. Clin Ther 2007 Apr;29(4): 611-616.
    4. Pew Internet and American Life Project. Fox S. The Social Life of Health Information, 2011. http://pewinternet.org/Reports/2011/Social-Life-of-Health-Info/Summary-of-Findings/Section-2.aspx
    5. Stewart MG. Identification and management of undiagnosed allergic rhinitis in adults and children. Clin Exp Allergy 2008;38(5):751-760.
    6. Rosenwasser LJ, Mahr T, Abelson MB, et al. A comparison of olopatadine 0.2% ophthalmic solution versus fluticasone furoate nasal spray for the treatment of allergic conjunctivitis. Allergy Asthma Proc. 2008 Nov-Dec;29(6): 644-653.


How TheraLife Eye can help!


Why TheraLifeEye Enhanced?

TheraLife Eye Enhanced treats both dry eye and ocular allergies.  You are getting 2 benefits in one pill.

TheraLife Eye is an all-natural botanical product that does not have some of the side effects of anti-histamines (dehydration, dizziness, fatigue and Dry Eyes) or drugs.  TheraLifeâ Eye Enhanced has ingredients that relieve symptoms of Allergy Eyes as well as Dry Eyes. 

To learn more, click here
For more information, see TheraLife  Dry Eye Benefits below:

1.  Allergy medications- we recommend Claritin – a mast cell stabilizer.
2.  Use a Hepa filter air cleaner

3. Leave outer clothing and shoes outside before coming into the house to avoid tracking allergens indoors.
DO NOT USE ANTIHISTAMINES – e.g. Benydryl, Claritin D

For additional information; please visit National Eye Institute:  nei.gov/

Monday, September 25, 2017

Importance of Vitamin D in Dry Eye Relief

Importance of Vitamin D in Dry Eye Relief

Recent clinical studies indicate people with Vitamin D deficiency is often associated with chronic dry eye syndrome.  

What are the symptoms of Vitamin D Deficiency?

  • Tingling fingers and toes. 
  • Tired ALL the time.
  • Horrible, deep bone aches all night long.
  •  Dry, irritated eyes. 
  • Legs falling asleep in the middle of a 60 minute workout. 
  • Random "electric zings" that shot through calf and elbow that felt like someone just flicked ice cold water droplets on the skin, although nothing was ever there. 

 Clinical Research Study

This is an abstract of a recently published article 


This is an abstract from a  recent publication in Acta Opthalmol, May, 2017

Clinical study was done at Department of Ophthalmology at Hallym University Kangnam Sacred Heart Hospital in Korea


The clinical study took people with dry eyes and control. They Evaluated people with Vitamin D deficiency measured in the blood, and dry eye measurements such as Tear Breakup Test, (TBUT) Shrimer's Test ( tear volume) and Ocular Surgace Disease INdex (OSDI), plus fluorescent staining.  
 
Results indicate TBUT and Tear Volume were directly correlated with Serum Vitamine D Deficiency.  
These 2 parameters, lack of tear volume ( lacrimal gland deficiency) and TBUT ( tear not thick enough) are the key factors in chronic dry eyes.   
 

Vitamin D's Role in Health

 

This very important vitamin has many positive effects on the body, including a role in

  • reducing inflammation, 

  • reducing the risk of depression and even death from cardiovascular disease. 

     

    • It may also play a role in the prevention of Diabetes, Hypertension, Multiple Sclerosis, asthma, sleep apnea, dental caries, and allergy. 

     

    Who is at Risk 


    low vitamin D levels have also been associated with increased dry eye signs and symptoms, Those at higher risk include individuals who are homebound (or work-bound!), vegans, obese individuals, or those with reduced kidney or GI function, to name a few. It’s estimated that one in every two people are at risk for Vitamin D deficiency, and that risk increases with age.
     

Theralife Can Help 
Doctors Recommended!
TheraLife Eye is designed to revive and restore your tear functions so you can make your own tears for dry eye relief.  Read more about our customer stories.  
 Call us toll free 1-877-917-1989 US/Canada
 send email inquiries to info@theralife.com
Follow us on twitter and facebook. 
 
 
 
 
 
 
Jin KW, Ro JW, Shin YJ, Hyon JY, Wee WR, Park SG. Acta Ophthalmol. 2017 May;95(3):e230-e235.
 
References
 1. Lu X, Elizondo RA, Nielsen R, et al. Vitamin D in Tear Fluid. Invest Ophthalmol Vis Sci. 2015 Sep;56(10):5880-7.
2. Alsalem JA, Patel D, Susarla R, et al. Characterization of vitamin D production by human ocular barrier cells. Invest Ophthalmol Vis Sci. 2014 Apr 7;55(4):2140-7.
3. Yin Z, Pintea V, Lin Y, Hammock BD, Watsky MA. Vitamin D enhances corneal epithelial barrier function. Invest Ophthalmol Vis Sci. 2011 Sep 21;52(10):7359-64.
4. Reichrath J. Vitamin D and the skin: an ancient friend, revisited. Exp Dermatol. 2007 Jul;16(7):618-25.
5. Need AG, O'Loughlin PD, Horowitz M, Nordin BE. Relationship between fasting serum glucose, age, body mass index and serum 25 hydroxyvitamin D in postmenopausal women. Clin Endocrinol (Oxf). 2005 Jun;62(6):738-41.
6. Jin KW, Ro JW, Shin YJ, Hyon JY, Wee WR, Park SG. Correlation of vitamin D levels with tear film stability and secretion in patients with dry eye syndrome. Acta Ophthalmol. 2017 May;95(3):e230-e235. 

Wednesday, September 20, 2017

How To Treat Recurring Blepharitis/MGD - Chronic Dry Eyes

 How To Treat Recurring Blepharitis/MGD - Chronic Dry Eyes

This is an abstract from Optometric Management titled New Treatments for Blepharitis- “Meibomian Gland Deficiency ( MGD)

Abstract


Majority (75%) of patients with Blepharitis also has chronic dry eye syndrome.  The symptoms often feel similar.  Blepharitis tends to recur, Customers with Blepharitis often has rosacea on the face, nose, flaky skin, dandruff, or certain bacterial or mites growing on the eye lashes.  It is recommended that you wear no make up on the eyes. 

There are newer options to offer our patients who continue to suffer the effects of meibomian gland dysfunction (MGD), despite our best efforts with traditional therapies.  MGD is reported to afflict 67.2% of people over the age of 60 in the United States. Common treatments include:

1. Hot compresses 2-3 times per day.  Each time gently massage your eye lids after wards .  A hot wash cloth is not good enough.

2. Essential fatty acids – such as Omega 3 Fish Oil or Flaxseed Oil for their strong anti- inflammatory properties

3. topical and oral antibiotics

4. topical cyclosporine. 

5. Clean eye lids - we recommend a hypochlorous acid based cleanser to prevent re-attachment of bacteria or mites.Two newly described therapies for MGD include 

            o  Gland Probing - Intraductal Meibomian Gland Probing

            o  Intense Pulsed Light (IPL).


Meibomian gland probing was proposed by Steven Maskin, MD using a 76 micron, stainless steel probe of 2- or 4 mm length to unblock glands.  He presented a case series of 25 patients diagnosed with MGD, based on lid margin or tarsal hyperemia, telangiectasia, thickening or irregularity or meibomian gland metaplasia, plus lid tenderness upon palpation; or subjective complaints such as stickiness, irritation or discomfort. Gland patency was assessed via transillumination to determine the best candidates for probing; intact or atrophied glands were avoided. After anesthesia with either tetravisc or 4% lidocaine, the 2 mm probe was passed through the gland perpendicular to the lid margin.  During the probing, there was mild resistance at the level of the orifice; more moderate resistance associated with a gritty sensation; and more severe resistance suggestive of fibrovascular tissue that was able to be penetrated with mild additional pressure.  Twenty-four of 25 patients (96%) had immediate post-probing relief, while all patients reported relief of symptoms by four months post-procedure.  Twenty patients (80%) did not need re-treatment by average follow-up of 11.2 months, while the remaining five patients (20%) required re-treatment at an average of four to six months. 


Another experimental treatment is Intense Pulsed Light (IPL), introduced by Rolando Toyos, MD. The treatment uses heat from a special flash lamp to melt the obstructions in the meibomian gland orifices.12  When originally used in dermatology for acne and rosacea patients,  IPL patients would subsequently report that their eyes felt better post treatment.  In 2003, Toyos conducted a study in which 100 patients with treatment resistant MGD were treated with IPL on the lower lid on only one side.  He reported that following treatment, the MGD was improved, both subjectively and clinically.  Dr. Toyos claims that when the light is absorbed by the blood vessels, the heat that is generated melts the secretions and opens the glands, decreasing the inflammatory cytokines, and allows for easier expression and improvement of tear film stability.  There’s also some evidence that IPL decreases parasites on the eyelash margin that can cause meibomian gland problems.  It usually takes three to four treatments over the course of four months, with maintenance treatments required every six to twelve months.
As the number of dry eye patients in our practices continues to grow, newer and more innovative methods of diagnosis and management will enable us to treat more of these patients more efficaciously.

Why TheraLife Eye?

Combination of Theralife Eye and Eye Lid Cleansing, Omega 3 Fish Oil will allow you to recover from this disorder. 

 Underlying cause of Blepahritis is often chronic dry eyes.  Blepharitis tends to recur.  Typical signs of Blepharitis is inflamed eye lids, red eyes, tired, irritated.  TheraLife Eye stimulates both the Lacrimal gland for tear secretion, and meibomian gland to secrete balanced tears that lasts all day long.  Combination with effective eye lid cleansing will get rid of this condition.  


Call us toll free: 1-877-917-1989 US and Canada.  International (650) 949-6080   email to   :info@theralife.com

REFERENCES

1. Bron AJ, Tiffany JM. The contribution of meibomian disease to dry eye. Ocul Surf. 2004 Apr;2(2):149-65.
2. Pinna A, Piccinini P, Carta F. Effect of oral linoleic and gamma-linolenic acid on meibomian gland dysfunction. Cornea. 2007 Apr;26(3):260-4.
3. Foulks GN, Borchman D, Yappert M, et al. Topical azithromycin therapy for meibomian gland dysfunction: clinical response and lipid alterations. Cornea.2010 Jul;29(7):781-8.
4. Luchs J. Efficacy of topical azithromycin ophthalmic solution 1% in the treatment of posterior blepharitis. Adv Ther. 2008;25:858-70.
5. Dougherty JM, McCulley JP, Silvany RE, Meyer DR. The role of tetracycline in chronic blepharitis. Inhibition of lipase production in staphylococci. Invest Ophthalmol Vis Sci. 1991 Oct;32(11):2970-5.
6. Ralph RA. Tetracyclines and the treatment of corneal stromal ulceration: a review. Cornea. 2000 May;19(3):274-7.
7. Stone DU, Chodosh J. Oral tetracyclines for ocular rosacea: an evidence based review of the literature. Cornea. 2004 Jan;23(1):106-9.
8. Yoo SE, Lee DC, Chang MH. The effect of low-dose doxycycline therapy in chronic