Am I missing possible treatments?

[ringo]

Thanks for your feedback little mermaid,

I know I am sloppy on the references, I will try to do a better job next time! apreciate your reading my long post


Dani

[Rebecca Petris]

Dani:

Are you saying that all inflammatory dry eye conditions (mg-related or no) are essentially autoimmune?

Am I correct in distilling your reply to mean "yes"?

[ringo]

autoimmunity is present in all chronic self-perpetuating inflammation as in dry eye it is evidenced by the perpetual deployment and infiltration of T-lymphocytes without the presence of actual trauma or infection.Autoimmune does not mean it involves the entire immune system throughout the body-- in the case of idiopathic dry eye this autoimmunity is sometimes localized (not the case of dry eye in Sjogren's or other autoimune disease that work throughout the body including the eye).

[rhad]

I agree with you on this one Ringo, partially. I believe that MGD is a malfunction of the immune system, it's the inflammation that causes the "Thick wax-like oil composition". it's the inflammation that makes you wonder at times, why no oil at all comes from the gland.

I think that the basic knowledge of this disease in the medical field should be that this disease is in fact caused by inflammation...that's where the irritation comes from...I believe it's nothing more than an immune system malfunction. all inflammation comes from the immune system...I think what were dealing with is a chronic low-level inflammation originating from the immune system.

as for warm compresses, I think it's a big No-No! They only cause the Blood vessels to dialate...causing further irritation and increased inflammation. The eyelids are already "dialated" from the chronic low level inflammation already present. we don't want to increase that with hot or warm compresses. cold compresses make more sense....When Getting a Vaccination, many Doctors now advise that you should put Ice on the site of Injection, in case you have a reaction to the vaccine(from your immune system). the ice will help reduce the possible damage that could occur, associated with possible inflammation that could occur from your immune system reacting to the vaccinations... this is just one example

rhad

[ringo]

I agree with you on this one Ringo, partially. I believe that MGD is a malfunction of the immune system, it's the inflammation that causes the "Thick wax-like oil composition". it's the inflammation that makes you wonder at times, why no oil at all comes from the gland.

I think that the basic knowledge of this disease in the medical field should be that this disease is in fact caused by inflammation...that's where the irritation comes from...I believe it's nothing more than an immune system malfunction. all inflammation comes from the immune system...I think what were dealing with is a chronic low-level inflammation originating from the immune system.

as for warm compresses, I think it's a big No-No! They only cause the Blood vessels to dialate...causing further irritation and increased inflammation. The eyelids are already "dialated" from the chronic low level inflammation already present. we don't want to increase that with hot or warm compresses. cold compresses make more sense....When Getting a Vaccination, many Doctors now advise that you should put Ice on the site of Injection, in case you have a reaction to the vaccine(from your immune system). the ice will help reduce the possible damage that could occur, associated with possible inflammation that could occur from your immune system reacting to the vaccinations... this is just one example

rhad

Dear Rhad,

Thank you for replying and reading my long posts

I absolutely agree with you regarding the hot compresses-- it is only logical that inflammation and heat do not go together. Symptomatic relief is probably achieved in some patients but that is only very short-lived-- in fact less than an hour in most, which makes it necessary to repeat the massages adn compresses more than once a day.

I can only strongly agree with you that this increases the already present irritation and inflammation.
I like your example with the vaccine. Cold indeed slows down the immune attack on tissues. Even with a simple trauma, ice pack is advised on the bruise and never anything hot. The ice pack reuces the swelling and inflammation. A heat compress would actually worsen things.

But if peple insist on using hot compresses and that makes them better, I would not try to convince anyone aotherwise. I only stated the reasons behind my opinion on the subject.

Regards,
Dani

[Rebecca Petris]

Dear Rhad,
But if peple insist on using hot compresses and that makes them better, I would not try to convince anyone aotherwise.

Dani, I hope I'm misinterpreting you but this comes across as rather condescending?

I don't use compresses out of some misguided insistence. I use them on explicit medical advice that I believe to be very sound and which is supported in medical literature. AND it works for me

Not all MGD is equal. Not all inflammation is equal. There are lots of people with types of inflammation that should not use heat because it will exacerbate it. But that can't be extrapolated to everyone.

But perhaps a much more significant point is this:

With many treatments, probably ALL pharmaceutical treatments, you agree to take a step backward in order to take two forward - that's the hope at least. There are always disadvantages and side effects - which one accepts IF the real or perceived benefit exceeds them by a large enough margin. Look at the gajillions of people on Restasis struggling with burning every time they put it in - but who still take it either because it improves their tear production, or because they and their doctor believe it eventually will.

Personally, I have no side effects from daily heat treatment of which I am aware. But even if it had a moderate downside for me, I would GLADLY accept it for the sake of keeping my meibomian glands clear. Which is what heat does for me (not to say it will do it for anyone else).

EDIT: Sorry for being redundant - I just noticed Rob made the same point here many posts ago

[ringo]

Dear Rebecca,

In my original post regarding hot compresses, I explicitly stated that almost all the medications and treatments used for dry eye have potential bad side effects; so the same my go for hot compresses.

Saying that if hot compresses benefit people, they should continue using them is not condescending.
I explicity stated that this is my opinion ( shared by some doctors and patients), and I explained the logic behind this opinion. Although the logic might be compelling, I meant to say that there are people who are willing to trade off the benefit and relief against the potential adverse effect, just like I am taking this trade off with other medications that I use and they benefit me.
I am feeling really sad that you interpret my posts in a way that I never intended them. I have replied to your PM's in my inbox.

I truly and sincerely apologize to anone who might feel that I am being condescending when citing my opinion.

[indrep]

I hope everyone will take this with neutral intent that it is offered.

Inflammation on the ocular surface comes from an imbalance in the water/salt ratio of the tear film. When the salts are increased it starts the signaling pathways to the brain for inflammation. The reasons for this are long and technical and I will not go into unless requested.

So to stop the inflammation we must get more water on the ocular surface and keep it there. Warm compresses, according to the DEWS report, increases the ability of the meibomian glands to secrete lipids. Lipids regulate evaporation of the water in the tear film. While cold may make the eyes feel better it coagulates the lipids. Think of oil when cool versus when hot.

There is a product in the Dry Eye Shop that helps do this. Using it requires patience. Remember it took years, unless surgically induced, to have the severe symptoms most have. Give a true therapy time( over 80 studies) and you may be surprised at its effectiveness. I have seen Restasis scripts and punctal occlusion drop off significantly when patients tried this therapy.

Just my personal experience.

[~Lin]

Has anyone had negative reactions to dwelle? I think its causing Tessa's eyes to be redder and a little swollen, but at other times of the day her eyes are looking better than before I started her on dwelle... Maybe its an initial reaction to the drops that goes away after a bit?

I also did some experimenting with heat, and found it causes her eyes to become much redder and quite swollen so I won't be using that. Her eyes were looking really good and I put her in the bathroom with the shower on really hot to steam up the room for some moist heat. Her eyes became quite swollen after. I waited until they looked normal and tried heat on her eyes again and the same response...

[chelvis7]

Immune system is the culprit

Hi ringo,

i am 24, male, currently studying in Germany. One month before i got dry eye, i went to see a chinese doctor (acupuncture)in Germany, just to ask him about my health status. And surprisingly after holding my wrist for 2 minutes, he told me that my immune system got problem. That time i didnt take it seriously what he meant. I thought he was just bullshiting me. Then after one month, i was diagnosed with MGD. So after that i google internet to find out the relation between dry eye and immune system. To my surprise, there are disease like thyroid, Sjogren, Rheumatits, lupus. And i quickly got it all checked .Nothing was found.
And Ringo, i definitely agree with you that MGD is due to the immune system.

So my conclusion is that: The cure is simple. Get the immune system work again, u got MGD solved. Thats it.Warm or cold compress relieve the discomfort just for a while, but will never ever cure it

[rhad]

Hi ringo,

i am 24, male, currently studying in Germany. One month before i got dry eye, i went to see a chinese doctor (acupuncture)in Germany, just to ask him about my health status. And surprisingly after holding my wrist for 2 minutes, he told me that my immune system got problem. That time i didnt take it seriously what he meant. I thought he was just bullshiting me. Then after one month, i was diagnosed with MGD. So after that i google internet to find out the relation between dry eye and immune system. To my surprise, there are disease like thyroid, Sjogren, Rheumatits, lupus. And i quickly got it all checked .Nothing was found.
And Ringo, i definitely agree with you that MGD is due to the immune system.

So my conclusion is that: The cure is simple. Get the immune system work again, u got MGD solved. Thats it.Warm or cold compress relieve the discomfort just for a while, but will never ever cure it

exactly! I agree.

[Britta]

A compromise

I had done warm/hot compresses and lid massage for a couple of months until I was finally diagnoses with ocular rosacea. This was when I stopped the eye spa, even though it had always given me some relief. I only continued careful hygienic measures. However, after some days my eyes signaled they missed the procedure. As a compromise I now do the following: I just take a cup of boiled water, warm a q-tip in it and do a soft massage with that warmed up q-tip. Doing that my vision still gets blurred and any burning sensation disappears for some time. This may not be enough to open severely clogged glands but it does not aggravate the inflammation in my eyes either.

[ringo]

Dear Lyn,

Like I have mentioned in previous posts, personally I am not in favor of applying heat to inflamed eyes. You could use a lukewarm wahscloth to clean your dog's eyes, but exposing them to actual heat treatments might make them wrose, the way you described.
Please do check these websites, they are concise and informative and focus on the treatment options section; it does not vary much from the human regimens, but there are important considerations regarding animals

http://www.vetinfo.com/canine-dry-eye.html
http://www.thepawblog.com/canine-dry-eye-kcs/
http://www.marvistavet.com/html/body_kcs__dry_eye_.html

It is amazing how people and animals are treated with the same things... and how similar the disease etiology and nature is.
Please let us now if that helped...

Dani

Has anyone had negative reactions to dwelle? I think its causing Tessa's eyes to be redder and a little swollen, but at other times of the day her eyes are looking better than before I started her on dwelle... Maybe its an initial reaction to the drops that goes away after a bit?

I also did some experimenting with heat, and found it causes her eyes to become much redder and quite swollen so I won't be using that. Her eyes were looking really good and I put her in the bathroom with the shower on really hot to steam up the room for some moist heat. Her eyes became quite swollen after. I waited until they looked normal and tried heat on her eyes again and the same response...

[ringo]

Dear Indrep,

I suppose that the theory you speak about below (salt/water ratio on the eye surface), relates to tear osmolarity. Could you please elaborate on this theory? I am not familiar with it.

Please try to understand what I am about to say below as my personal concern,not as criticism, and as an expression of my personal opinion. Thank you in advance for your understanding.

I would be very cautious when promoting certain treatment (heat application products for dry eye) as universally applicable to all kinds and levels of severity of dry eye.

For example,heat application would not help someone with aqueous deficiency induced dry eye,whose meiboian glands have not been involved in the inflammation yet,
but inflammation is present on the ocular surface due to non-evoparative aqueous deficiency
(my case initially, later on as the inflammation wasnt tackled, it involved the meiboian glands as well).

You say that to stop the inflammation, we must get more water in the eye, adn keep it there. You propose to do that by releasing lipids into the tear film through application of hot compresses.
I have to say that it will be close to impossible to resolve a severe dry eye inflammation by the method you are proposing as universally working in every case.
More lipids occasionally released in the tear film(especially in aqueously deficient dry eye and compromised by inflammation corneal surface)cannot target inflammation in any way, even if they prevent existing scarce tears from evaporating temporarily.

Also you advise people to give the product/heat treatment a long time to work.
You are a moderator on this forum and therefore your claims have a very high levelof credibility.
I also highly respect and admire your effort and great contribution to the alleviation of so many people's pain and suffering.

However,what worries me (please do not take this wrongly, I am just gathering the courage to be honest),
is that urging people (in cases of serious:moderate to severe dry eye, which are many on this forum) to stick to this kind of treatment exclusively and promising it will work for sure in every case over a long time,
might make people dismiss treatment options that are absolutely necessary in their cases,
and this might lead to a deterioration of the condition which might be irreversible.
This is what happened in my case history, for example.

According to the official treatment guidelines for dry eye in the medical textbooks and manuals, even at the stage MILD TO MODERATE dry eye antiinflammatory therapy and tear stimulating therapy (like cyclosporin, doxycycline, steroids, NSADIS,secretagogues,etc). must be employed to quickly tackle and reverse the settling in vicious cycle of infllammation that leads to the higher severity levels of the disease.

Dry eye unfortunately turns out to be a relentless morbid disorder, which needs serious therapy to spare the patient unnecessary suffering and preventable worsening of the condition.

Propagating heat application not as simply an additional measure (that might not work well for some patients), but promoting it as universally applicable treatment that is bound to solve any kind/level of inflammation in the dry eye in the long term, might be counterproductive for many patients in need of more serious therapy.

I hope everyone will take this with neutral intent that it is offered.It is just an honest expression of a concern that has built over reading a lot of posts regarding the subject in this thread and others. If I choose to stay silent, I will avoid controversy and possible harsh criticism that I received before for voicing the same views, but I think we all have the right to honestly and openly share our thoughts here, and then everyone else has the right to refute, or discuss, or present their opinion on the subject.

Thank you.
Dani

Inflammation on the ocular surface comes from an imbalance in the water/salt ratio of the tear film. When the salts are increased it starts the signaling pathways to the brain for inflammation. The reasons for this are long and technical and I will not go into unless requested.

So to stop the inflammation we must get more water on the ocular surface and keep it there. Warm compresses, according to the DEWS report, increases the ability of the meibomian glands to secrete lipids. Lipids regulate evaporation of the water in the tear film. While cold may make the eyes feel better it coagulates the lipids. Think of oil when cool versus when hot.

There is a product in the Dry Eye Shop that helps do this. Using it requires patience. Remember it took years, unless surgically induced, to have the severe symptoms most have. Give a true therapy time( over 80 studies) and you may be surprised at its effectiveness. I have seen Restasis scripts and punctal occlusion drop off significantly when patients tried this therapy.

Just my personal experience.

[Rebecca Petris]

Dani,

I realize your post is directed at indrep but I'm going to step in.

Propagating heat application not as simply an additional measure (that might not work well for some patients), but promoting it as universally applicable treatment that is bound to solve any kind/level of inflammation in the dry eye in the long term, might be counterproductive for many patients in need of more serious therapy.

We get your concern about heat. But no one is promoting it as "universally applicable", nor "urged people to stick to it exclusively" nor yet "promised it will work for sure".

Furthermore, while warning others not to promote heat as a cureall (which we're not doing), you certainly have created the impression through many posts and threads that you feel cyclosporin is an appropriate universal treatment (if that is incorrect, please clarify). Cycylosporin seems to work for you and for many other people here. That's great. Yet, notwithstanding what any textbook or corporate sponsored study or guideline may say, it is far from having universal acceptance in the medical world, any more than any other treatment ever mentioned on this website is universally effective at a practical level, from artificial tears to plugs to drugs to heat to moisture chambers to sclerals to honey to Omega 3s to acupuncture to snake oil.

If I choose to stay silent, I will avoid controversy and possible harsh criticism that I received before for voicing the same views

Dani,

The criticism you received from me was NOT for voicing your views, as you well know from my PMs. I requested you to change the way you present your opinions (or other information), and I privately attempted to give you specifics about what was troubling to me and our moderator team about your posts. Apparently I haven't gotten through. I will contact you privately again.