What came first, the chicken or the egg?

[Flick]

Or in dry eye talk, the inflammation or the increased osmolarity?

http://www.theratears.com/documents/dryeyeround.pdf

The link above was posted earlier and it is pretty interesting. A roundtable discussion of scientists at the leading dry-eye pharmaceuticals talking about treatment and causes of dry eye. There is quite a lot of disagreement, most of which centers upon whether inflammation or increased osmolarity comes first in dry eye.

I personally believe that increased osmolarity is essentially a synonym for dry eye. If there are less tears, of course there is going to be a higher concentration of salt in the remaining tears. I don't see how this could be a cause of dry eye. It's a symptom. It's like saying that decreased tear volume is the cause of dry eye.

Therefore, I'm more inclined to believe that inflammation disrupts the neural circuit, damages the lacrimal system, lowers tear volume and therefore increases tear osmolarity. But maybe something else is the root cause, and inflammation is just another symptom. I think it's plain to see after reading this article that we aren't quite as close to discovering the cause of DES as I had hoped we were.

I was also struck by Dr. Gilbard's incessant promotion of TheraTears products. Every other sentence he spoke mentioned them. I used TheraTears drops for several months with no noticeable improvement. In fact, I found myself needing to use the drops more and more often as time went by. But whatever, it didn't work for me, that's fine. What bothers me is that these physicians get so tied in to the success of their products that they begin to ignore other things. Of course, this problem isn't unique to DES, but I think it's more concerning in DES, since there aren't nearly as many physicians out there doing research on it as compared to say cancer or heart disease.

Okay, enough of my Sunday morning philosophizing. I'd be curious to hear what others think about this link.

[kakinda]

Hi Flick, Yes Sazy did post this on the thread bellow earlier on:

http://www.dryeyezone.com/talk/showthread.php?t=1685

You'll see my comment on it too if you want... a lot of commerce to read between the lines indeed.

One further question for you: is it inflammation disrupting the neural circuit or the other way round? I'm more inclined for the latter.
In my case, the neural circuit was disrupted long before I showed sings of inflammation but hey let's hope the experts will someday really look into it from a fundamental research point of view and not a commercial one...
As i said in the other thread why not do a comparative test of their products besides this discussion... and stop wondering if hypotonic, less salty,more electrolytes, less this, more that, is better.
and carry out the reserach to answer the question...
Philosophy is somehow the art of constinuously finding ways not to really answer the question. Should research follow the same path? I hope that these pharma guys will concentrate on finding answers rather than questions.
And a simple way to do that is compare the products they so frequently mentioned in their discussion... will they do that?

Has anyone noticed that one's eye are becoming too salty? I've had that impression lately... I'm using a lot of saline rinsing for DE and allergies but then I have felt the need to find less salty drops... there's one in France called Artelac, and some like Vismed and Hyal drop (both hyaluronate).
Could those of you suffering from moderate to severe DE confirm this impression?

t.c.
K

[np1981]

Confused

In my case my eyes seemed to get dry before they became red/inflammed. But I have had plugs now and my eyes are moist most of the time, but my eyes still feel "inflammed" at times. I still wonder if there is something else going on...

[kakinda]

inflammation could be the hen in the process... it may lay an the egg later on and most likely was once a chicken... grown old...
Well, I think its an intermediate process not the causative one... but what matters is blocking the process somewhere (even if it's just a palliative solution).
Alcon (Restasis) first claimed that it increased production of tears but I believe -like most people who used cyclo that I've talke to - that less inflammation reduces the consequences or the severity of the symptoms rather than suppressing DE altogether and enable the lachrymal unit to re-function again...
that claim is abusive in my case at least.
I believe that less salty drops would make sense since we are continuously adding more salt with each drop and concentrating it due to the inscreased evaporation... and I do feel this.
But the osmolarity issue isn't only that (the salt issue) but rather to figure out how the different tear layers interact... and really intertwined but independent as well... it seems that at some level mucin and "water" do mix however, the lipid layer is mainly on top...(see the hyperosmolarity theory) these are the mechanism that needs to be understood.
At one point, everyone was talking about slightly hypotonic drops... that could make sense too, since in MGD tears become hypertonic (acid).
But in the end if think the important questions is: what makes normal tears so special? what the ingredients we need to reproduce/add for each type of DE?...
So a lot of good leads if there were to be more fundamental research...
but it sounds to me that pharmas are working the other way around, they have their well-known substances (have a look at most things in the pipeline; cyclo is an old immunomodulatory drug, doxy is one of the oldest drugs still available and the others are usually formulations previously used elsewhere) that they are hoping to prove beneficial in other diseases including DE. I'm pretty sure it's like starting a puzzle without looking for the edges/colours first and trying to fit randomly the pieces together...
Some people believe in lottery... I prefer method but I may be wrong just wanted to share my impression on current research
K
PS: I'd be glad to be proven wrong

[sazy123]

Inflammation cant be the etiology otherwise restasis or steroid drops would work for most people with dry eye, surely? for a small percentage of people it may be the etiology. Many people with dry eye have inflammation as a result of dry eyes, isnt it enivatable when your eye is starved of what it needs then on top of that your lids rub over your eyes constantly.

I also dont belive in the osmolity thoery much either, coz ive used thera tears for a while near the start of when my eyes got really bad and they never helped, now im using them again in the hope they might help this time (i had some left from last time). If the etiology is osmority then they need something better to tackle it than thera tears IMO. Coz i havent heard any raving reports from patients about it, and im sure there would be some on the dryeyezone we here success stories from lots of things but i havent heard anythinglike what Dr Gilbard is claiming from theratears. if there is anyone please corret me...

In the report all the docs keep saying that drops like thera tears or systane are more effective before the condition becomes 'chronic', in that the drops can break the cycle. But the problem I see with this is- before the dry eye become bad (i.e they have a mild form) people arnt likely to go and seek help from doctors, so they wont know about the benefit of using these drops until its too late. Or at the start of developing bad dry eye, again they might not realise the benefit. Therefore, more needs to be done for us people who have 'chronic dry eye', because we are the people who will be seeking the help. Im not being funny but the last two weeks i had another sinus flare up and during which id class my dry eye as being 'mild' i didnt even need to use artificial tears. Anway the point is people dont seek things they dont need. Unless its for contact lense wear, but even then i wouldnt go to great lenghts..

Im abit confused am I write in thinking etiology is the root cause of the disease? coz surely the cause of the disease is something like hormones considering the majority of suffers are women post menapause. I never did science so excuse me for being ignorant.. Androgen drops etc are getting closer to the true cause IMO.

[green eyes2]

I believe that hormones most likely play a part in dry eye, especially since dry eyes affect women to a much higher degree than men. When I was pregnant my dry eyes went into remission. A few weeks after my pregnancy ended it was back to painful, burning dry eyes. I know that a lot of women have the opposite happen during pregnancy and their dry eyes get worse. Even women with "normal" eyes can get dry eyes during pregnancy. Also, many postmenopausal women are affected by dry eyes. I believe hormones are most likely involved with many autoimmune diseases as well, as all primarily affect women.