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:
Stye
: A red tender bump on the eyelid that is caused by an acute infection of the oil glands of the eyelid.
Chalazion
:  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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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 www.IOVS.org.

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.

Diagnostics
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:
TheraLife Eye is an all natural oral formula that treats from inside out!  It is uniquely formulated to restore normal cell functions to tear secretion glands intra-cellularly for sustainable, long lasting relief.  Clinically proven to work for 80% of first time users.

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