Thursday, June 8, 2017

Sjogren's Treatment & Diagnosis, What Your Eye Doctors Should Know.


Sjogren's Treatments & Diagnosis- What the Eye Doctors Should Know.


Diagnosis of Sjogren's disease can be ambiguous and difficult.  It is helpful if the patient goes into the doctor's offices know some of the basic tests that are available to accurately diagnose this condition. which is the objective of this blog post.

Sjogren syndrome is one of the most common rheumatological diseases. Primary symptoms are dry eye, dry mouth.  

On average, it takes 7 years to diagnose Sjogrens Disease

Sjogrens is a chronic, slowly progressive autoimmune disease that affects the  moisture producing glands- eyes, mouth, lungs, vaginal areas.  Sjogrens is a clinical condition of aqueous tear deficiency combined with dry mouth. The syndrome is classified as primary Sjogrens in people without an another autoimmune disease, and secondary Sjogrens in people who have a confirmed autoimmune disease such as  rheumatoid arthritis, thyroiditis, Raynaud’s, Lupus, and more.  It affects primarily females, sometimes males of all age and races.

According to the National Institute of Neurological Disorders and Stroke (NINDS), between 1 and 4 million people in the United States have Sjogrens.

Although the hallmark symptoms are dry eyes and dry mouth, Sjogrens may also cause dysfunction of other organs such as the kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas, and the central nervous system. Patients may also experience extreme fatigue and joint pain and have a higher risk of developing lymphoma.


Diagnosis

The following tests are commonly used to determine the presence of Sjogrens in addition to the person's report of symptoms and health history.

Common blood tests include:

• Complete blood cell count often shows anemia.
• Serum erythrocyte sedimentation rate and C-reactive protein are indicators of inflammation and are frequently elevated in patients with Sjogrens.
• Serum immunoglobulins are antibodies are usually elevated in Sjogrens.
• Serum antinuclear antibody is elevated in approximately 90% of patients with Sjogrens and other immune diseases.
• Serum rheumatoid factor is present in about 60% of patients with Sjogrens, as well as with RA.
• Serum Sjögren antibodies (Ro/SS-A and La/SS-B) are more specific for SS but can also be detected in people with other autoimmune diseases,  Having a negative serology does not mean one do not have the disorder.
Lip biopsy is the best single test to establish a diagnosis of Sjogren syndrome. While this is the most definitive test, performing it is not absolutely necessary from a clinical standpoint. Patients with Sjogren syndrome are essentially treated symptomatically and observed for the development of other rheumatic disorders or lymphoma. This can be initiated without performing a biopsy. If the diagnosis is in doubt or if a definitive diagnosis is needed, then this is the best test.

Management of Sjogrens Syndrome

Goals of ophthalmic management of Sjogren syndrome are: to relieve symptoms, to promote healing of the ocular surface, and to prevent complications such as persistent corneal ulcers.

The treatment of dry eyes depends on the severity of eye dryness, which is graded according to degree of symptoms, conjunctival injection and staining, corneal damage, tear quality, and lid involvement.

Drugs often prescribed for Sjogren’s patients include;

1. Immunosuppressive drugs- e.g. Plaquenil, methotrexate – these drugs often have side effects that affect vital body organs such as liver, kidney, retina, and more.
2.  Dry mouth  –  drugs such Salagen, Evoxac to stimulate salivary gland function.
3.  Dry Eye- traditional modalities include eye drops, eye gels, and prescription eye drop.  Often dry eye symptoms persists.  Learn more about TheraLife Autoimmune Dry Eye formula below.
4.  Dental care is important as those affected are prone to cavities.

Conclusion

Sjogrens can damage vital organs of the body with symptoms that may remain stable, worsen, or go into remission. Some people may experience only the mild symptoms of dry eyes and mouth, while others go through cycles of good health followed by severe disease. Many patients are able to treat problems symptomatically. Others are forced to cope with blurred vision, constant eye discomfort, recurrent mouth infections, swollen parotid glands, hoarseness, and difficulty in swallowing and eating. Debilitating fatigue and joint pain can seriously impair quality of life.

Abstract from Optometric Management- May, 2011

How can TheraLife Help?
TheraLife Autoimmune formula is an all natural alternative to treat both dry eye/dry mouth and fatigue.

How does TheraLife Autoimmune Formula Work?
  • Intracelluar stimulation of tear and salivary glands
  • Regulate immune system to reduce flares
What is in TheraLife Autoimmune Formula?
  • Immunomodulators - to help modulate and normalize the immune system
  • Anti-inflammatories - to reduce irritation and inflammation of the tear, salivery glands, eye surface, eyelids, and joints
  • Anti-fatigue agents - to stimulate circulation and boost energy
Learn more
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REFERENCES
1. Phelan D. Sjögren syndrome. 2009. http://emedicine.medscape.com/article/809290-overview.
2. Sommers MS, Johnson SA, Beery TA. Diseases and Disorders: A Nursing Therapeutics Manual. Philadelphia,PA: F.A. Davis; 2007.
3. Yanoff M, Duker JS, eds. Ophthalmology, 3rd ed. Elsevier, 2009.
4. Invernizzi P, Battezzati PM, Crosignani A, et al. Antibody to carbonic anhydrase II is present in primary biliary cirrhosis (PBC) irrespective of antimitochondrial antibody status. Clin Exp Immunol. Dec 1998; 114(3):448-54.
5. D'Arbonneau F, Ansart S, Le Berre R, et al. Thyroid dysfunction in primary Sjögren's syndrome: a long-term follow-up study. Arthritis Rheum. Dec 15 2003;49(6):804-9.
6. National Institute of Neurological Disorders and Stroke (NINDS) http://www.ninds.nih.gov/disorders/sjogrens/sjogrens.htm. Accessed May 10, 2010.
7. Fox R, Michelson P, Wallace DJ. Sjögren syndrome. In: Wallace DJ, Hahn BH, eds. Dubois’ Lupus Erythematosus. 7th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2007.
8. Sjögren’s Syndrome Foundation. http://www.sjogrens.org.
9. Daniels TE. Labial salivary gland biopsy in Sjögren's syndrome. Assessment as a diagnostic criterion in 362 suspected cases. Arthritis Rheum. Feb 1984; 27(2):147-56.
10. Tabbara K, Wagoner MD: Diagnosis and management of dry eye syndrome. In New Drugs in Ophthalmology. Edited by Smolin G. Boston: Little, Brown and Company. Cited in: Ophthalmol Clin 1996, 36:61–75.
11. Management and therapy of dry eye disease: report of the Management and Therapy Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. Apr 2007;5(2):163-78.
12. Behrens A, Doyle JJ, Stern L, Chuck RS, McDonnell PJ, Azar DT, et al. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea. Sep 2006;25(8):900-907.
13. Kruszka P, O’Brian RJ. Diagnosis and management of Sjögren syndrome. Am Fam Physician. 2009; 79(6):465-470.
14. Wallace DJ. The Lupus Book: A Guide for Patients and Their Families. New York, NY: Oxford UniversityPress; 2008. 
 15. Pullen, RL, Hall DA. Sjogren syndrome: More than dry eyes. Nursing. 2010; 40(8): 36-41.

Friday, June 2, 2017

New Treatments for Watery Dry Eyes

New Treatments for Watery Dry Eyes

Watery Dry Eye Story - This is what we hear

"I have watering eyes - tears flowing down my cheeks. My doctor diagnosed it as dry eyes, prescribes all kinds of eye drops – they don’t help. What is going on?"

Symptoms of Watery Dry Eyes


The symptoms of watering eyes can be tearing, dry, burning, sandy gritty, red, and sensitive to light.  Yes, you have all kinds of tears running down your face, but your eye doctor can tell by staining that you have dry eyes.

About 50% of the cases, watering eyes are cause by dry eyes.
Watery eyes occur when there is too much tear production or poor drainage of the tear duct . The causes for Watery Eyes often include:
  • Clogged meibomian glands- located on the upper and lower eye lids. Your doctor may chose to use laser (LipiFlow) or probes to unclog them.  Meibomian gland secrete lubricants to thicken tears. Tear not thick causes evaporative dry eyes.
  • Blepharitis- inflammation of the eye lid. Read other blog posting on blepharitis at this site.
  • Allergies and hay fever
  • Conjunctivitis – pink eye
  • Chronic sinusitis
  • Radiation therapy.
  • Medications

Why you have watering eyes?

One of the major causes of over tear production is Dry Eye Syndrome. Since you may have had dry eyes for a long time, left untreated, your brain started to secrete reflux tears, the type of tears you cry with which is of poor quality. 

Dry Eye causes the eyes to become irritable; inflamed which stimulates the body to produce “Reflex Tears” which is of poor quality. Eye drops adds more fluid to wash away the lubricant that your eyes produce naturally to make the eyes even drier.

How is Dry Eye Syndrome diagnosed?

One of the main tests for tearing is to check whether the eyes are too dry. There are 3 key tests your eye doctors do to test for dry eyes:

1. Fluorescent stains – to observe condition of your cornea.

2. Shirmer’s Test or Zone Quick t- measure the amount of tears.  In case of watering eyes, this cannot be used.

3. Tear Viscosity – using a fluorescent dye and a stop watch to see how fast your tear disperse- an indication of how thick your tears are to prevent evaporation.  This test again cannot be used in watering eyes.

If you doctor has already diagnosed you with chronic dry eyes, then you need to treat the dry eyes first before over tearing will stop.

How Can TheraLife Help?

TheraLife offers a chronic dry eye solution that treats from inside out. TheraLife Eye stimulates your own tear secretion glands to secrete balanced and thick tears to relief chronic dry eye. Watery eyes due to dry eye is harder to treat than chronic dry eye.  TheraLife Eye will treat the dry eyes first, then your brain will stop crying.

Most effective approach - TheraLife Eye + Fish Oil + Hot Compress (twice a day, 10 minutes each time) + daily eye lid cleaning. 

Just so you have the correct expectations - it takes 3 months to stop your eyes from crying.  You have already suffered enough- drops has not worked so far.  Be patient, you will stop crying.  This is our guarantee. 


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Can Stress Cause Dry Eyes? TheraLife Can Help

Can Stress Cause Dry Eyes?  TheraLife Can Help


Workplace stress can cause changes in your body, your emotions , and induce chronic dry eyes. On the other hand, if you already have dry eyes, dry eye symptoms become worse when you are stressed.

Dry Eye Symptoms include but not limited to

  • Dry Eyes
  • Headaches
  • Fatigue – feeling tired
  • Stiff Neck and Shoulder Pain
  • Back Pain
  • Sweaty Palms and Feet
  • Upset stomach
  • Depression

Chronic Dry Eye and Stress

Chronic stress can be debilitation.  When left untreated can lead to serious long term illnesses and decreased immune systems.  Some of these examples are:
  • chronic dry eye syndrome
  • heart diseases
  • chronic muscle pains
  • changes in hormone levels that lead to low fertility
  • weakening lung functions leading to catching colds and flu’s more easily,
  • asthma
  • obstructive lung diseases
  • worsening of skin problems like acne, eczema and psoriasis
Relationship between stress and dry eyes are well documented.  We can understand this phenomena from how stress affects the circulatory system (How Does Stress Affect the Circulatory System. By Adrian Whittle). Stress causes the blood to produce hormones that increase the blood flow (increase blood pressure) and make blood thicker (causing strokes). As the heart is working harder, the micro-circulation of blood to the extremities such as skin, legs, and arms are decreased.

This decrease in blood supply may also include the brain and eyes. Eyes being connected to the brain already has a delicate blood circulation balance. Under stress, blood supply to the brain and eyes are both compromised, causing dry eyes.  Left untreated, this condition can become chronic. 

References: 
Learn more from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446543/pdf/11211637.pdf
http://www.hse.gov.uk/stress/
http://www.stress.org/job.htm

How can TheraLife Help?

Theralife has 2 products that can help. TheraLife Eye and TheraLife Fatigue.
TheraLife Eye EnhancedTheraLife Eye works by stimulating the tear secretion to achieve balanced, sustainable tears from inside out. Learn more.
TheraLife FatigueTheraLife Fatigue delivers more oxygen to the brain, promotes alertness without caffeine, stay focused at work, and be able to sleep better at night. Learn more!

Which product is best for me?
 For those who have an existing dry eye condition and are already using TheraLife Eye Enhanced - try to increase the dosage. For those who would like to try TheraLife Eye Enhanced for Dry Eye, click here for additional information.
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