Friday, June 7, 2013

New Research - PTSD, Anxiety, Depression result in more severe dry eye symptoms

Post-Traumatic Stress Disorder (PTSD) which is defined as an anxiety disorder which is characterized by reliving a psychologically traumatic event, long after any physical danger involved has passed, through flashbacks and nightmares. They are among the most common of mental illness problems.

Mental Illnesses present more severe dry eye symptoms, but not clinical signs.

Studies conducted in Asian populations have found that patients with anxiety and depression reported to have more dry eye symptoms when compared to a control group.1 When a geriatric Korean population was studied, the depression scores were correlated with dry eye symptoms, but not with clinical signs.2 (Complain about symptoms but actualy dry eye measurements do not indicate the extent of the severity).  Additionally, another clinical study showed a greater prevalence of dry eye symptoms and clinical measurements (clinical signs of dry eye) in Chinese individuals with depression and anxiety disorders.3

These studies indicate complaining about dry eye symptoms seem to be directly related to the extent of mental illness, not the clinical disease.  The current research study is trying to evaluate if this is true.

This current research study focuses on veterans with PTSD and depression and it's impact on dry eye symptoms and clinical signs. This study was done in Western population, in contrast to the studies mentioned previously. Patients were recruited from the Miami Veterans Affairs Eye Clinic. The authors compared dry eye symptoms using the Dry Eye Questionnaire 5 [DEQ5] to tear film indicators obtained by clinical examination.  DEQ5 measures how severe the symptoms are based on what the individual experience.
The results showed that the DEQ5 scores were higher in the PTSD and depression sub-groups compared to the control group without mental illness. A higher number of patients in the PTSD and depression groups had severe dry eye symptoms and showed a DEQ5 score of ≥12. No significant differences in tear film tests and MGD evaluation were found among the three groups which is similar to some of the Asian studies. However, statistical analysis indicated that a PTSD diagnosis and use of certain medication (selective serotonin reuptake inhibitors) were significantly associated with severe symptoms of dryness.   

Another words, if they are on drugs, the symptoms seem to be more severe. 

This study suggests that the dry eye symptoms noted in veterans should be carefully evaluated as it involves different factors and extends beyond tear dysfunction.

This brief extract is from Current Eye Res. Jan. 2011.,  Vol. 36, pages 1-7.

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1. Li M, Gong L, Sun X, Chapin WJ. Anxiety and depression in patients with dry eye syndrome. Curr Eye Res. Jan 2011;36(1):1-7.
2. Kim KW, Han SB, Han ER, et al. Association between depression and dry eye disease in an elderly population. Invest Ophthalmol Vis Sci. 2011;52(11):7954-7958.
3. Wen W, Wu Y, Chen Y, et al. Dry eye disease in patients with depressive and anxiety disorders in Shanghai. Cornea. Jun 2012;31(6):686-692.

Tuesday, June 4, 2013

How to diagnose dry eyes with meibomian gland dysfunction?

eye check up
Meibomian Gland Dysfunction statistics vary widely from 33% to 62%. Dry eyes with Meibomian Gland Dysfunction, especially with Ocular Rosacea are one of the most difficulty dry eyes to treat.  TheraLife can help.

Meibomian gland secretions proteins, lipids and mucin which play an integral role in preventing evaporative dry eyes.  Insufficient production of these lipids can result in accelerated tear film breakup (Tear Breakup Test)and cornea damage, even when production of the aqueous component of the tear film ( Lacrimal Gland) remains normal. Since meibomian gland dysfunction often occurs concomitantly with insufficient tears in dry eye disease, assessment of dry eye syndrome often involved diagnosis of meibomian gland dysfunction.

Assessment of the Meibomian Glands

To evaluate people for meibomian gland dysfunction,  first start by exam­ining the quality of the meibomian gland secretions. In a healthy eye, the meibum is a very thin, clear liquid that expresses easily when pressure is applied to the eyelid. When patients start to develop meibomian gland disease, however, the meibomian gland secretions become thicker, maybe yellowish and the glands change in appearance. 

The first observable change is an increase in the viscosity of the meibum, which makes expressing the glands more difficult. As meibomian gland dysfunction progresses, the meibum also becomes increasingly opaque. At this stage, the meibum is still relatively thin—although not as thin as in the healthy eye—but it now appears cloudy rather than clear .

As meibomian gland dysfunction progresses, granule-like clumps begin to appear in the meibum, and eventually the meibum becomes so viscous that it is the consistency of paste. At this stage, one can still express the glands by pressing on the eyelids, but the secretions come out as a solid lumps rather than a liquid.

In addition to changes in the consistency and appearance of the meibum, the appearance of the glands themselves can indicate meibomian gland dysfunction. Look for signs of inflammation along the eyelid margin—either swelling of the lid margin or small dilated blood vessels close to the surface.

Alwasy check for facial rosacea during the exam because meibomian gland disease is more common in people with rosacea and sebaceous gland dysfunction. 

Medications such as retinoic acid (Accutane®) can obliterate meibomian glands and contribute to meibomian gland dysfunction.

Note:  Meibhomian Gland Dysfunction in dry eyes are difficult to treat because clogging of the meibomian glands tend to recur.  Keeping the glands open using hot compresses is key to success. 

healthyeyebuttonHow TheraLife Can Help?
TheraLife Eye is formulated with strong anti-inflammatory ingredients and restore normal functions to your tear secretion glands to get balnaced, sustainable tears. .  It is the only formula that scientifically focuses on intra-cellular restoration. 
Typical recovery time for Meibomian Gland Dysfunction dry eye using TheraLife Eye range from 1-3 months.

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