Thursday, July 28, 2011

New Treatments for Blepharitis and Dry Eyes- Meibomian Gland Deficiency

New Treatments for Blepharitis- “Meibomian Gland Deficiency- Optometric Management,
April, 2011.

Majority (75%) of patients with Blepharitis also has chronic dry eye syndrome.  The symptoms often feel similar.  Blepharitis tends to recur, where as chronic dry eye symptoms can be treated with TheraLife Eye.  Customers with Blepharitis often has rosacea on the face, nose, flaky skin, dandruff, or certain bacterial or bugs 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

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.

Two newly described therapies for MGD include

            o  Gland Probing

            o  Intense Pulsed Light (IPL).

Gland Probing
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. 
Intense Pulse Light (IPL)
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?

Blepharitis tends to recur, where as chronic dry eye symptoms can be treated with TheraLife Eye.  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. 
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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

Contact Lens Dry Eye

Contact lenses can provide a great improvement over eyeglasses for people who are bothered by the cosmetic appearance of eyeglasses or the limitation to activities that they pose. However, wearing contact lenses can cause Dry Eye. Some people have worn contact lenses for years and developed Dry Eye; some never could wear contact lenses due to a pre-existing Dry Eye condition. This condition is typically caused by not secreting enough tears, or the tear quality is poor – not thick enough which increase the rate of evaporation. 

There are 2 types of contact lenses: Soft and Rigid Gas Permeable Lenses
Dry Eyes and Soft Contact Lenses
Soft contact lenses are made from hydrophilic (likes water) plastics that contain water. In fact, the more water a soft contact lens contains, the more prone it is to losing its water. Therefore, as water evaporates from the front surface of the lens while being worn, it absorbs water from your own natural tears, causing you to have dry eye symptoms. Your eyes may feel tired, red, sandy gritty feeling, vision becomes blurry, and sometimes pain. Most people at this point reaches for artificial tears, or wash their contact lenses several times a day to get rid of the debris (mucous) that forms on the inside of the contact lenses. For some, using artificial tears become a routine procedure, sometimes as often as once an hour. But the eyes still feel dry. Soon this condition worsens and wearing contact lenses become unbearable.

Environmental factors may also cause dry eyes such as dry heat from a furnace; an air vent from air conditioner; being near smokers, and wind from being outdoors. However, for long term contact lens wearers, there is another reason for developing dry eyes. The continual rubbing of the lens across the surface of the cornea, may result in sloughing off of the microscopic hairlike structures that exist on the outermost layer of the cornea to assist in keeping the tear film stable. Years and years of gently chaffing these fine structures can result in poor tear film stability resulting in Dry Eyes.

Dry Eye and Rigid Gas Permeable Lenses
Rigid Gas Permeable Lenses usually gives the user more visual acuity (see sharper images). Rigid Gas Permeable Lenses are manufactured from polymeric materials that are hydrophobic (do not contain any water all). In addition, it tends to repel tear film which is water based. The challenge of Rigid Gas Permeable Contact Lenses is to specially formulate them to enhance their wetting characteristics so that they are compatible with the tear film. Even with these formulations, their surfaces are more prone to drying and creating dry eye symptoms. The problem of mechanically chaffing the fine structures that attract the tear film and make it stable is even greater with Rigid Gas Permeable Lenses because of the stiffness of the lens…it is rigid.
Suggestions to improve Dry Eyes

There are simple things we can do to facilitate the relief of Dry Eyes such as: sit away from an air vent; drink at least 8 glasses of water per day; exercise; wear wrap around sun glasses while outdoors; avoid draft and wind; go to an eye physician to select a contact lens material that may be more suitable. Doctors sometimes put in a punctal plug in the tear ducts in order to retain more tears. Artificial tears do help temporarily. Prolonged use of artificial tears train the eyes to secret even less tears and the Dry Eye condition worsens.

An alternative is to try an oral system that help your tear glands secret your own tears naturally throughout the day. TheraLife Eye capsules are formulated to be taken orally. It is unique because it targets tear secretion through intra-cellular mechanisms (internal cell functions). Once the person have been on TheraLife Eye and feel relief, they can also bring the capsules with them when doing outdoors activities being exposed to sun and wind. Simply take a few more capsules in addition to the regular dosage when eyes feel dry again. Usually the relief comes within 20-30 minutes. Give TheraLife Eye a try.

Computer Dry Eyes- Causes, Symptoms, Treatment and Tips for Relief

You have been on the computer for hours! Your eyes are soar! They hurt!

You are already using eye drops- feels like you have to put them in every 10 minutes!.

Here are some simple suggestions to help relief dry eyes:

  1.  Remember to blink often – program onto your computer to remind you to blink

  2. Avoid bright fluorescent lights – wear a baseball cap to shield your eyes

  3. Rest your eyes 5 minutes every hour- look out the window at a far away place to relax your eyes.

Other tips include:

1. Drink plenty of water - we recommend at least 8 glasses per day. Fruit juices are fine. Avoid caffeine from coffee or soda. Drink de-caffeinated coffee as an alternative

2. Exercise – at least three to four times per week. The more the better! Exercises improve circulation and help deliver blood and nutrients to the eye.

3. Use humidifiers -either single portable units next to your desk or install it for your central air system. This is most helpful in winter or if you live in a dry, high altitude climate.  Be sure to clean it often in order not to build up bacteria in the humidifier.

4. Wear wrap around sunglasses outdoors – dry eyes are often light and wind sensitive.

5. Avoid frequent use of eye drops- do you put eye drops in your eyes, and they feel dry again in 10 minutes? Eye drops wash away mucin, proteins and lipids that thicken your tears to prevent fast evaporation. Long-term use can condition your eyes not to secret tears and exacerbate the dry eye condition.

6. Wear eye goggles at night - your eyelids maybe partially open during sleep – to test this, tape 2 wet cotton balls onto your eyes for one night and see if your dry eye condition improved when you wake up. If yes, you can buy a goggle to wear at night that contains moisture pads. We recommend TranquilEyes from

7. Use warm compress over your eyes- to improve circulation and allow you to relax. For more information.

8. Get enough sleep!

9. Computer use -schedule frequent breaks and take your eyes away from the computer and look out the window every hour. 

How TheraLife Eye can Help!

Learn a new approach to treating Dry Eyes- by stimulating tear glands to secrete balanced, sustainable, natural tears from TheraLife.