Friday, November 11, 2011

Allergy Dry Eyes- TheraLife Eye Can Help

Allergy Dry Eyes

About 30 percent to 50 percent of U.S. residents have allergy symptoms.  Nearly75 percent of those allergy symptoms affect the eyes.  In other parts of the world where the weather is dry, dusty and pollution is high, this statistics may even be higher.  Allergies can trigger other problems, such as conjunctivitis - pink eye (see section on red eyes) and asthma.
Symptoms of Allergy Dry Eyes:

Symptoms of Dry Eyes and Allergy are often confused due to their similarities.  For patients with existing dry eye conditions, allergies during spring and fall where pollen count is high become even more severe.

Some of the common symptoms are:
  • Red, swollen or itchy eyes – similar to dry eye symptoms
  • Runny nose; sneezing; coughing
  • Itchy nose, mouth or throat
  • Headache from sinus congestion
  • Fatigue from lack of sleep.
Allergy in additional to dry eyes often are presented with stronger symptoms of dry; itchy; red and watery eyes.  Itchy eyes are normally a result from allergy rather than classical dry eye conditions.  Some people have both symptoms all year around.  TheraLifeâ Eye Enhanced has natural botanical ingredients that relieve both Dry Eyes and Allergy Eyes.

Causes of AllergyDry Eye

Most allergens (agents that elicit allergy symptoms) are in the air, where they come in contact with your eyes and nose. Airborne allergens include pollen, mold, dust and pet dander (cats and dogs in particular).  Some allergens like dust mites are embedded into carpets, drapery, bedding and window visors.  In that case, the allergens are triggering allergy and dry eyes all year round. 

Conventional Treatments for Allergy Dry Eyes:
o   The most common treatment for allergy is anti-histamines for quick relief.   However anti-histamines cause dehydration, sleepiness, sometimes dizziness, and often are the dry eye causes.

o   Decongestant eye drops-, which constricts blood vessels in your eye to take the red out.  Long-term use can cause your eyes to become dependent on these eye drops, and when you stop, the blood vessels become even larger, making red eyes worse.

o   Non-steroidal anti-inflammatory drops can sooth allergy eyes (e.g. Patanol).  Its effect is longer term than anti-histamines.  It is effective in treating allergy eyes, but not dry eyes.

o   Prescription steroidal eye drops provide quick relief.  However, long term use have been associated with side effects such as increased inner eye pressure (intraocular pressure) leading to glaucoma and damage to optic nerve. Steroids also have been known to cause cataracts. Prescription steroid eye drops are normally used for very severe cases and no longer than one month.

1. TheraLife
â Eye Enhanced?

TheraLife Eye Enhanced 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 relief symptoms of Allergy Eyes as well as Dry Eyes.  For more information, see TheraLife Dry Eye Benefits below:

2.  Allergy medications- we recommend Claritin – a mast cell stabilizer. 
3.  Use a Hepa filter air cleaner
4. 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:

Winter Dry Eyes- Relief from TheraLife Eye

Winter Dry Eyes- My Eyes are So Dry, They Hurt!

For some people, this only happens in the winter when force hot air furnaces and heaters are turned on.  The heaters create hot dry air movement that allows tears to evaporate quickly.  Sometimes, increase water intake, use artificial tears, nothing seems to help.  Very annoying! 

For those who already have dry eyes, the dry eye condition seems to be worse as soon as the heat is on at home or at work.

What Can I Do to Relief Winter Dry Eyes?

  1. Use a humidifier in the central heating system – this will require frequent cleaning to ensure bacteria and other organisms do not grow in the water reservoir.
  2. Use a humidifier near your desk or inside an office
  3. Drink at least 8 glasses of water
  4. Sit away from a hot air vent
  5. Do not use artificial tears often, it only make your eyes feel drier.  Artificial tears tend to wash away the key tear thickening components -mucin and lipids and make your tear evaporate easier. 
  6. Try TheraLife Eye Enhanced to help stimulate and produce tears naturally from your own eyes. 

For those who already have dry eyes and are already taking TheraLife Eye Enhanced, increase dosage during winter months for relief!  You can decrease the dosage again when spring comes in March when moisture content in the air increases.   

Thursday, September 22, 2011

How to treat Ocular Allergy, Dry Eyes, avoid Glaucoma with TheraLife Eye

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.
Why your allergist and eye doctors should work as a team.
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. Allergists and general practitioners tend to lack slit lamps, which can provide more information regarding ocular health. Optometrists and ophthalmologist are an integral care to both identify and manage ocular surface 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 kind of symptoms do allergy patients exhibit?
Patients, who have allergies, though don't know it, often have this symptom:
1.      Recurrent cold” that occurs around the same time every year,
2.      Profound Itchy- how this is different than dry eye>
Exhibit a papillary conjunctiva reaction that is not always present in patients who have dry eye – they will complain of profound itching. “You can have some level of itching with dry eye, 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 patients who have very narrow angles or undiagnosed angle-closure glaucoma, building up intra-ocular pressure.

Allergy and Chronic Dry Eyes.
Many of these patients and those patients being treated for systemic allergies are at risk for concomitant dry eye, as several OTC drugs contain preservatives that put patients at risk for this condition.  During the patient exam, the eye doctor can be on the lookout for any signs of ocular dryness, via slit lamp exam.
What 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.      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.
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.

This article is a short abstract from July issue of Optometric Management.

How TheraLife Eye can help!

TheraLifeâ Eye 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.  For more information, see TheraLifeâ Dry Eye at

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.


For additional information; please visit National Eye Institute:

Don’t forget to visit us at and
Want to talk to a doctor; call toll free  1-877-917-1989 or email to

Thursday, September 1, 2011

Blepharitis- Red Crusty Dry Eyes- Causes, Symptoms and Treatments by TheraLife Eye

This story sounds familiar?  Your have been diagnosed with dry eyes, you use eye drops, warm compress, cleaning eye lids with baby shampoo, and your eyes are still red, dry, and irritable.  What else could be going on?
Red dry eyes are often caused by:
  • chronic dry eye
  • Conjunctivitis
  • Blepharitis
Chronic Dry Eye Syndrome:
Red eyes is a typical chronic dry eye syndrome, in addition to feeling dry, tired, irritated, light sensitive, sandy gritty, and sometimes watery.
Conjunctivitis is caused by viral or bacterial infection.  Bacterial conjunctivitis can be treated with antibiotic eye drops. Viral infections typically runs through a 14 day cycle and stop.  For ocular herpes, please consult your physician.  Acyclovir is often the treatment of choice for herpes.
Blepharitis is a recurring condition caused by inflammation of the eye lids.  Meibomian tear glands (produce tear thickness) is often involved.  Common causes include rosacea, dandruff, sometimes allergies, bacterial growth on the eye lids.  Typical recommendation is to use warm compress daily, clean eye lids with baby shampoo followed by gentle massage of both upper and lower eye lids.  Unfortunately, blepharitis tend to recur.  Eye lid hygiene is key.
Symptoms of blepharitis are very similar to red dry eyes - blurry vision, watery, red, tired, light sensitivity and often wake up with a crusting of eyelashes.
How can TheraLife Eye Help?
TheraLife Eye is effective in reducing inflammation and stimulates tear flow for chronic dry eye relief.  Often people with chronic dry eyes also have blepharitis.  Treating chronic dry eyes reduces the inflammation, and also helps to reduce the recurrence of blepharitis.  It is highly recommended that those who have blepharitis stay on TheraLife Eye long term to increase the rate of success.
To learn more:
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Menopause Dry Eyes Caused by Hormone Imbalance

Menopause dry eye affects more than 60% of the middle age women who are either peri-menopausal, in menopause or postmenopausal.  Hormone imbalance and aging is largely to blame.  Symptoms of menopause hot flashes, insomnia, vaginal dryness, mood swings, fatigue, headaches and dry eyes.  The eyes usually feel dry, itchy, red, irritated and light sensitive.
The most common solution for dry eye remains to be eye drops-, which covers up the symptoms, and over time with frequent usage, the drops wash away the mucin, lipids and proteins that protect the eye.  The eyes become conditioned to secret less tears and become drier.
Another conventional approach is to block the eyes tear drainage system (punctal plugs) at the lower eyelids or sometimes both lower and upper eyelids.  In some cases, the drainage is permanently cauterized (closed) in order to back up tears to provide comfort.  In some cases, the plugs fall out, and the chances of eye infections increase due to poor drainage.
For moderate to severe dry eyes, very often, a prescription eye drop of cyclosporin is prescribed.  When patients have tried all these approaches and their eyes still hurt that is where TheraLife Eye Enhanced can help.

1. How TheraLife Eye Can Help
TheraLife Eye Enhanced is an all natural botanical product that stimulates the tear glands to secrete sustainable, balanced,  natural tears.  It does so by an intra-cellular mechanism called Mito-Activiation where intracellular activities of the tear glands increase and restore its normal function.  TheraLife has conducted clinical trials in patients with various dry eye and medical conditions with amazing results.  See section below, which describes the TheraLife Eye Enhanced Difference.
2. "TheraLife Menopausal Support"- All Natural, Safe and Effective
Hormone balance is vital to menopausal dry eye in women.  Menopausal dry eye is usually initiated by hormone imbalance.  For this reason, TheraLife sought for a product that will help achieve hormone balance during dry eye therapy in conjunction with TheraLife Eye Enhanced.
TheraLife Eye- Women’s Menopausal Support Formula is formulated to the exacting specifications of certified nutritionists. It contains recommended potencies of key ingredients, Black Cohosh plus soy isoflavones are combined with essential nutrients like calcium, folic acid, and B-vitamins, that have been shown to support normal hormonal levels during menopause. This synergistic blend includes standardized herbal extracts and other nutrients which, together, form a truly well-balanced and effective product for women. an all-natural, herbal supplements made with natural ingredients to provide natural menopause symptom relief including dry eyes.  These work naturally in the body to reduce hot flashes, night sweats, and other menopausal symptoms.
TheraLife Eye –Women’s Menopausal Support product has been tested to meet the highest standards. There are no known major side effects from the recommended use of TheraLife Menopausal Support.  It does not contain artificial dyes, colors, preservatives, flavors, yeast, wheat, gluten, or lactose. Our top priority is our customers' safety and satisfaction.
In addition to TheraLife Eye Enhanced, ThearaLife Eye- Women’s Menopause Support, we also recommend Primrose Oil and Fish Oil.
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Why Frequent Use of Eye Drops Make Your Eyes Drier

You have been diagnosed with chronic dry eyes. The majority of available treatments are eye drop based.  I am sure that you have tried one or all of the following:
-        Over the counter eye drops
-        Preservative free eye drops
-        Eye drops that are thicker to provide longer lasting relief such as gels
-        Eye drops that have balanced electrolytes
-        Tried  prescription cyclosporine drops
-        Tried tear thickening oily capsules
-        Used either an eye mask or thick eye gel at night.
Of all the eye drops, decongestant eye drops, such as Visine, are the worst.  Visine constricts blood vessels in your eye to take the red out. Long-term use can cause your eyes to become dependant on these eye drops, and when you stop, the blood vessels become even larger, making red eyes worse.
After all this, your eyes are still dry, irritated, red, sometimes painful, and your vision is blurred.  It is even possible to develop corneal ulcers from prolonged chronic dry eye conditions.
So why don’t drops work for my chronic dry eye?
The answers resides in our tear composition and tear secretion glands:
  1. Lacrimal Glands- This gland produces the bulk of your tear and creates tear volume
  2. Mybomian Glands- This gland secretes thickening agents (proteins, lipids, and mucin) to prevent tear evaporation and protects the eye
Our body requires that the tear volume and tear thickness be balanced and secreted evenly over time in order to provide eye comfort.  Most of the treatments listed above address either one or the other requirements, but not both:
- Eye drops – compensate for the lack of tear volume
- Oily eye capsules – compensate for the lack of tear viscosity (thickness)
The common experience with any kind of eye drops are “My eyes are dry 10 minutes after putting drops in”.  Over time, the more one uses eye drops, the drier the eyes get.  The reason is eye drops wash away the lubricating thickening agents that your Mybomian Glands produce and eventually train your eyes not to secrete tears.  It becomes a conditioning reflex.
Overuse of eye drops usually constitutes more than 4-5 times/day.   A good analogy of this would be if you washed your hands repeatedly.  The outcome?  You would have overly dry and cracked hands.  The same principle is applied to the eyes.  Strip away the natural mucin your eyes are creating with drops will eventually lead to drier eyes.
For chronic dry eyes, you need balanced, sustainable tear secretion throughout the day.  TheraLife Eye Enhanced can help!

TheraLife® Eye Enhanced works by increasing intracellular metabolism (Mito-Activation), which enables us to stimulate the all the tear glands (mybomian and lacrimal glands) to secret its own balanced tears naturally and overcome the key issue in chronic dry eye syndrome.

Learn more:  click here

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Friday, August 5, 2011

Conjunctivits or Blepharitis- Causes, Symptoms and Treatment from TheraLife

So your eyes are red, they hurt.  How do you know if you have conjunctivitis or blepharitis?  Read on!

A.     Conjuctivitis versus Blepharitis- the Difference!

Conjunctivitis is inflammation of the clear membrane that lines the eye. Conjunctivitis is caused most commonly by infection from viruses (e.g. Herpes) or bacteria, or by an allergic reaction, though other causes exist, such as overexposure to sun, wind, smog, chlorine, or contact lens solution. Pinkeye is the common name for conjunctivitis. Blepharitis is inflammation of the eyelid; most commonly, it is caused by a bacterial infection.  It can spread from person to person, and is considered contagious.  If treatment is delayed, it may cause corneal inflammation and loss of eye sight.

What are the symptoms?

Conjunctivitis and blepharitis may cause mild discomfort with tearing, itching, burning, light sensitivity, and thickening of the eyelids. They may also produce a crust or discharge, occasionally causing the eyelids to stick together during sleep. The eyes and eyelids may become red, but usually there is no blurring or change in vision.

Other therapies

Individuals with diagnosed conjunctivitis should avoid irritants, such as contact lenses or allergy-causing agents.

Vitamins that may be helpful

Vitamin A deficiency has been reported in people with chronic conjunctivitis. It is unknown whether vitamin A supplementation can prevent conjunctivitis or help people who already have the condition. Note that high dose Vit. A can be toxic.  TheraLife uses beta-carotene- not Vit. A in the capsules.  Beta-Carotene is converted into Vit. A in your liver, only to the extent that your body requires.  The rest is secreted into the urine.  Therefore, beta-carotene is not toxic.

Home Remedies for Conjunctivitis

Several herbs have been traditionally used to treat eye inflammation. Examples include calendula, eyebright, chamomile and comfrey.  Be ware that none of these herbs has been studied for use in conjunctivitis or blepharitis. As any preparation placed on the eye must be kept sterile, topical use of these herbs in the eyes should only be done under the supervision of an experienced healthcare professional. Goldenseal and Oregon grape contain the antibacterial constituent known as berberine. While topical use of berberine in eye drops has been clinically studied for eye infections,2 the use of the whole herbs has not been studied for conjunctivitis or blepharitis.
B. Blepharitis Blepharitis is a common condition that causes inflammation of the eyelids. It can affect the inside or outside of the eyelids. The condition can be difficult to manage because it tends to recur.

Complication from blepharitis include:
: A red tender bump on the eyelid that is caused by an acute infection of the oil glands of the eyelid.
:  This condition can follow the development of a stye.  It is a usually painless firm lump cause by inflammation of the oil glands of the eyelid. Chalazion can be painful and red if there is also an infection. Problem with tear film: abnormal or decreased oil secretions that are part of the tear film can result in excess tearing or dry eye.  Because tears are necessary to keep the cornea healthy, tear film problems can make  people more at risk for corneal infections.

Causes of Blepharitis

Blepharitis occurs in two forms

Anterior Blepharitis affects the outside front of the eyelid. Where the eyelashes are attached.  The two most common causes of anterior blepharitis are bacteria (Staphylococcus) and scalp dandruff.

Posterior Blepharitis affects the inner eyelid (the moist part that makes contact with the eye0 and is cause by problems with the oil (meibomian) glands in this part of the tyelid.  Two skin disorders can cause this form of blepharitis:  acne rosacea, which leads to red and inflamed skin, and scalp dandruff (seborrheic dermatitis).

Symptoms of Blepharitis:
Symtpoms of either form of blepharitis include a foreign body or burning sensation,excessive tearing, itching, sensitivity to light (photophobia), red and swollen eyelids, redness of the eye, blurring vision, frothy tears, dry eye or crusting of the eyelashes on awakening.

How is Blepharitis Treated?
Treatment for both forms of blepharitis involves keeping the lids clean and free of crusts.  Warm compresses should be applied to the lid to loosen the crusts, followed by a light scrubbing of the eyelid with a cotton swab and a mixture of water and baby shampoo.  Because blepharitis rarely goes away completely, most patients must maintain an eyelid hygiene routine for life.

If the blepharitis is severe, an eye care prossional my also prescribe antibiotics or steroid eye drops.  Note that steroid eye drops can only be used for up to one month- it does have undesirable side effects such as liver damage. When scalp dandruff is present, a dandruff shampoo for the hair is recommended as well.  In addition to the warm compresses, patients with posterior blepharitis will need to massage their eyelids to clean the oil accumulated in the glands.  Patients who also have acne rosacea should have that condition treated at the same time.

How can TheraLife Help?

Blepharitis and Chronic Dry Eye goes hand in hand. Use TheraLife Eye to treat Chronic Dry Eyes, and reduces inflammation. Blepharitis tend to recur and require daily due diligence to keep your eyelids clean and keep it at bay.

TheraLife Eye is clinically proven to be effective in chronic dry eye relief in 80% of the first time users.  It works to restore normal cell functions to your tear secretion glands intra-cellularly.  Call us today!
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Wednesday, August 3, 2011

New Research in Dry Eyes- Leading to New Approaches for Diagnosis and Treatment of Chronic Dry Eye Syndrome

“The more we learn about dry eye, the more we need to understand”.
Today’s eye doctors are faced with a great deal of uncertainty. The more we learn about dry eye syndrome, the more we need to understand. In addition, corporate mergers, acquisitions and new companies all have altered the clinical and research landscape in ocular surface disease (OSD). Options for treatment are actually getting more restricted due to domination by prescription drugs which increased the cost of dry eye treatment in recent years by many folds.

What do we know about tear film and mucin?
Some of the new research in dry eye has a paradigm-shifting in our understanding of dry eye disorder. Take, for example, the tear film. Once thought to be 7µm in thickness and three layers thick (mucin, aqueous and lipid), it is now generally accepted the tear film is 3µm-to-4µm thick, and there are two layers: a mucin-aqueous gradient “gel” and a lipid layer. Taken at face value, the comparative differences do not seem that dramatic. However, what changed is our ability to accurately measure tear film thickness with interferometric techniques, which have been confirmed with anterior segment OCT. In addition, we now have a better understanding of mucins—MUC 16 is not a membrane-bound mucin and thus, is mobile and capable of forming a gradient in the aqueous layer. This allows the formation of “crusty” build up on eye lids.
The role of mucin in the health and disease of the ocular surface is still do not fully understood, but incremental yet logical steps forward in our knowledge of mucin biology will ultimately provide that answer.

Today’s Patients Are More Informed, and Demand Better Answers!
Today, both science and marketing plays important roles in clinical care. Very different than 15 years ago before the internet boom. Direct-to-consumer marketing, the Internet and education all result in increased awareness of disease states by both patients and clinicians. Patients today are more knowledgeable, and demand more information to make their own decisions. Doctors are influenced by supportive science for therapeutics, clinician practice patterns, education and peers. Doctors are trained a certain way in medical schools, and tend to stay with the way they were taught- slow to change. However, today’s patients demand more. Patients in this case, can be a great asset and advocate to their doctors -provide them with more options!

What is Ocular Surface Disease?
Ocular Surface Disease is composed a family of conditions impacting the front of the eye and associated adnexa. Terms such as blepharitis, meibomian gland disease or dysfunction (MGD), keratoconjunctivitis sicca, meibomitis, and meibomian keratoconjunctivitis, among others, led to the concept of dry eye disease and no less than 10 different classification schemes for some component of dry eye or blepharitis through the years.

How to Diagnose Dry Eye?
The problem is there is no single accepted diagnostic test for dry eye and the tests we do use often correlate poorly with symptoms. It is suggested that doctors ask a series of questions in addition to some of the more accepted conventional tests for dry eyes:
  • Schirmer’s Test –to measure tear volume
  • Tear Breakup Test- to determine tear viscosity
Your eye doctors should: 

1. Ask about symptoms. Have the patient describe in his/her own words how his/her eyes feel, when they feel the worst and how it is impacting his/her life. Record this information, and refer to it at follow-up visits. Note current treatments, including frequency of application.

2. Look at the lids. Twenty years ago, we looked at the lids, but at some point, we stopped. Start to express the meibomian glands- squeeze fluid out. If you see a blocked gland on slit-lamp evaluation in symptomatic patients with quiet lids, you will be surprised by what you find. Be patient—press, move laterally, press, move back, re-press. Look at the quality of the secretions, and record your description.
3. Stain. Most practitioners use fluorescein to assess tear break-up and staining of the cornea. Wait at least one minute before fully evaluating corneal staining. Believe me, you will see more. Then, use lissamine green, and again, wait a minute or two before you observe the ocular surface. This dye takes time to color mucin and devitalized cells. A band-like pattern across the inferior third of the cornea usually means either incomplete blink or possible MGD. A new product, Fluramene (Noble Vision Group), can do the job of both staining agents with one drop.

4. Follow up. This takes valuable chair time, but is worth it in the long run. Recently, there has been a lot of discussion among clinicians with dry eye clinics about the best time to follow-up on a dry eye or MGD patient.
Data suggest that dry eye patients are not overly compliant with therapy—the drop-off from prescribed or non-prescribed treatments is usually four-to-six weeks. Therefore, a six-week follow-up may be the best way to keep your patient on track, and at this appointment, discuss improvements as well as changes to the treatment regimen. Get Your Doctor to Take Time for You Your doctor should take time to do the proper medical exam and provide sufficient information for you why certain decisions are made.
We hear all too often that the doctors are doing the minimal, do not take time to explain to the patients what is going on with their debilitating dry eye conditions – leading to much frustrations on both patients and doctors.

Source: Some of this information is extracted from an article Dr. Kelly Nichols wrote for Optometric Management, July 2011.
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Clinically Proven- 80% Success with First Time Users.  Doctors Recommended!

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Latest Research in Dry Eyes -Diagnostics, Efficacy, Economics and More!

n the area of dry eye research. A lot of work has been done by some of the brightest minds in both optometry and ophthalmology, and one of the best places to discover the latest developments in dry eye is at the annual Association of Research in Vision and Ophthalmology (ARVO) meeting.  This is a summary of what is being discussed in the ARVO abstracts published in the journal Investigative Ophthalmology and Visual Science. The information can also be found online at

Alternative Treatments
1. Acupuncture
Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicine, acupuncture aims to restore and maintain health through the stimulation of specific points on the body. The procedure has been touted as a treatment for low back pain, lung cancer and Attension Deficiet Disorder. Thus it seems logical to investigate if there is any benefit in dry eye disease. A team of researchers from the U.S. Army performed acupuncture on seventeen volunteers with dry eye and found "there was no significant improvement in the measured clinical indicators of dry eye after acupuncture treatment.

The traditional method is to use lissamine green staining for the diagnosis of conjunctivitis. However, this dye then to dissipate over time and becomes less effective. Common protocol for sodium fluorescein staining usually entails immediate viewing after immediate instillation, but this study showed immediate viewing of lissamine green after instillation resulted in higher mean staining grades than at the two minute time point. The study concluded that a “false staining appearance occurs upon immediate instillation of lissamine green.

Economics of Dry Eye Treatment

The rising cost of prescription medications is a concern to all patients, and doctors alike, and dry eye medications are no exception. Restasis is costly even after insurance payments to the patients.  A group from Bascom Palmer retrospectively analyzed trends in dry eye medication use and expenditures from 2001 to 2006 and found the mean expenditure per patient per year increasing from $55 in 2001 to $299 by 2006.  The group’s finding was "strongly driven by the introduction of Restasis in 2003 as 84% of prescriptions filled and 91% of expenditures in 2005-06 were related to Restasis. "The study found that women spent twice as much as men on dry eye medications ($244 versus $122) and that patients with greater than a high school education spent on average 2.5 times as much on dry eye medication as those with less than a high school education ($250 versus $100).
Another interesting study of dry eye economics came from Duke University where researchers studied punctual plug usage and reimbursement in Medicare patients. The group sought to determine whether changes in Medicare reimbursement for punctual plug insertion were associated with a decrease in the incidence of plug insertion. The group found that while the Medicare population-adjusted incidence of dry eye diagnosis increased by 28.5% in their study period of 2001-2008, first-time punctual plug insertion rates declined by 23.6%.7 The researchers also found that Medicare reimbursement for punctual plug insertion decreased 55.3% during the same time period. The authors concluded that the decline in punctual plug insertion “may be associated with the decrease in Medicare reimbursement” but in fact is more likely tied to their second reason for the reduction, “the introduction in 2003 of Restasis.”

Ocular Infections and Dry Eye

People with dry eye seem to have more ocular infections than the normal population.  A study in Australia found the “antimicrobial effects of tear proteins decrease in hyperosmolar ( low tear viscosity)  conditions leading to enhanced bacterial proliferation,” indicating that “people with hyperosmolar tears or dry eye will have decreased antibacterial defense at the ocular surface.”
Treatment Efficacy Azithromycin more effective than Doxycycline for Meibomian Gland Dysfunction and Contact Lens Dry Eyes
There are several studies concerning the use of topical azithromucin in ocular surface diseases. . Dr. Gary Foulks and his group at the University of Louisville compared the effectiveness of topical azithromucin versus oral doxycycline therapy in meibomian gland dysfunction ( Belpharitis)  Twenty-two subjects were treated with topical azithromycin solution for one month and seven subjects were treated with oral doxycycline for two months. The study concluded that while both topical azithromycin and oral doxycycline improved clinical signs and symptoms of meibomian gland dysfunction, the "response to azithromycin is more rapid and more robust than doxycycline."
Yet another study from the Ohio State University School of Optometry evaluated the efficacy of a four-week treatment with topical 1.0% azithromycin solution versus rewetting drops in patients with contact lens related dry eye. An over two-hour improvement in comfortable contact lens wear time was noted throughout the four-week study period with azithromycin solution use.

Glaucoma Therapy not related to Dry Eyes
Several studies explored the effect of topical glaucoma therapy on dry eye. A French group found tear osmolarity increased in patients treated for glaucoma or ocular hypertension (glaucoma), particularly in those using eyedrops with multiple preservatives. Another study from France found the chronic administration of eyedrops containing preservatives may decrease corneal sensitivity in patients treated with intraocular pressure lowering medications. This decrease in corneal sensitivity could explain the absence of correlation between signs and symptoms of dry eye disease in patients treated for glaucoma or ocular hypertension.
TheraLife Eye for Chronic Dry Eye Relief:
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