Oil deficiency treatment

[brd888]

Hello.
I am now fairly sure my DES is caused by a deficiency in the oil layer although I've not had a professional test due lack of availability in my area.
I am able to generate "wetness" quick easily by massaging eyelids which is why I think the oil layer is poor resulting in evaporation.

Are there specific drops just for oily layer deficiency?

Regards,
Bruce.

[Eli]

Drops for Oil Deficiency

Hi Bruce,
Yes there are some drops on the market that help delay tear evaporation caused by oil (called "lipid") deficiency. One is Soothe (Alimera Sciences), another is Refresh Endura(Allergan) and yet another is called Freshkote(Aqueous Pharma) which is available by prescription only. Its similar to Dwelle/Dakrina but notably has an added ingredient to help treat the lipid layer. I think there may be one or two others, but I'm drawing blank. Of the three mentioned, only Refresh Endura is available in a preservative-free version. I would strongly reccomend however, that you see an eye doctor for a diagnosis and treatment reccomendations.
Best regards,
Eli

[Rebecca Petris]

Are there specific drops just for oily layer deficiency?

I'm not sure there's been much evidence out there that the oil-targeted tears (Soothe, Endura, or even the compounded castor oil drops) really help much more than others - unfortunately it is not nearly so simple as "I'm deficient on oil, so let's add oil to the tear film". I'd say the vast majority of people here have MGD in some degree but we're all over the map in terms of what lubricants work best. Improving the MG function itself, though a lot of work, is probably the best route to go.

[brd888]

Downer

Thanks for replying.
One of my problems is I'm male-35, not had Laser treatment and my eye (left) looks fine - no bumps on oil glands etc and I seem to have plenty "wetness". Dr Latkany said he has very few younger male patients (ok so im no spring chicken at 35) so I can't see WHY I have this condition. Does MGD always present bumps on the oil glands in the upper eyelid?

One piece of good news is I had an email reply from a local optometrist -
"Dear Mr Dunn

It's no problem to assess what type of tear film deficiency you have. This certainly helps to determine whether other treatments eg: punctal plugs or vitamin supplements would be beneficial.

Please contact us to arrange an appointment.

Yours

Ian Jarvis"

I'm going to see him and will let youse know how I get on.

Ta
Bruce.

[Tony Barnes]

Do you have any inflammatory problems, or on any other medications?? Office environment?

Without wanting to shamelessly plug too much, our product Clarymist which addresses evaporative dry eye may be of benefit to you if, as you say your tear production seems fine.

As per Rebecca, oils alone aren't going to be of much use. The tear film has 3 "distinct" layers - mucous, aqueous and lipid. The lipid layer sits on the outside and ensures that the aqeuous doesn't evaporate.

The lipid layer itself contains at least 2 regions - the uppermost region contains more normal oils, hydrophobic molecules that act as the external barrier, but below that there is a polar layer of ampiphilic phospholipids. It is the phospholipids that stabilise the lipid layer, as they keep the hydrophobic lipids and hydrophilic aqueous components at arms length so to speak. When this part of the lipid layer is disturbed, tear break up time diminishes greatly.

Clarymist uses phospholipids to repair this element. Evidence-wise theres a few peer reviewed articles that confirm that it works for evaporative dry eye sufferers, improving the condition over time (unfortunately it won't work for non-evaporative dry eye).

We've got really good distribution now, so it's not impossible that there's a healthfood shop nearby you that you could go and use the tester in (it's sprayed on closed eyes, and can be used by more than 1 person as it has a non-return pump).

If you do this, it takes a few minutes for it to start working, so don't fret if there's no "immediate" relief (some people are understably low on patience!).

Let me know if you want any more info.

[Rebecca Petris]

Does MGD always present bumps on the oil glands in the upper eye

No. I think this is why SO many people with MGD don't learn that's what they have till it's progressed very far. The signs are not necessarily obvious at all, unless a doctor gets right in there pressing on glands and seeing what if anything comes out.

[brd888]

Ahem...

Rebecca - So how do you find out if you have MGD?
I've not tried Clarymist but have seen it for sale by an Edinburgh optician - will have a go I think.

I officially have a poor tear film now - i.e. enough tears but wrong consistency. Optician was pretty good, says vision is excellent and pictures of backs of eyes taken digitally are very interesting. Health of retinas are both good.

The optician said dry eye is somewhat neglected by the health community but he asked me to try Theralife supplements.

[Rebecca Petris]

Rebecca - So how do you find out if you have MGD?

For me, it was

(a) process of elimination (I make tears, but I'm dry, therefore I make bad tears...) and

(b) my eyes respond to MGD treatment and regress when I neglect my MGDs.

[brd888]

Gunk

Rebecca,
Do you see any gunk or debris or muck after cleansing your eyelids?
Ta,
Bruce

[Rebecca Petris]

Nothing real obvious while simply cleaning lash/lid margins. When I do heat treatment, it definitely clears things out.

[dianat]

Rebecca,

Out of curiosity, do the docs tell you that you have poor oil output when pressure it applied to your lid margin?

I've been given both stories: poor output, normal output. I theorize the source of my problems to be poor oil output even though my glands are not clogged. I suspect this has always been a problem resulting in contact lens intolerance. Lasik just exacerbated the problem. (Exacerbate isn't a stong enough word, is it. )

D

[brd888]

Do you have any inflammatory problems, or on any other medications?? Office environment?

Without wanting to shamelessly plug too much, our product Clarymist which addresses evaporative dry eye may be of benefit to you if, as you say your tear production seems fine.

Tony - 1 - No inflammatory problems 2 - Yes but ruled out 3 - Office environment is too dry which makes problem worse but is not a root cause.

Please plug away - Clarymist sounds too good to be true and I bet it is. Pardon me for being a cynic. I've mail ordered some anyway - what harm in trying?? Makes sense that even the lipid layer is highly evolved - this would explain why some, I mean most, drops are so ineffective.

[Tony Barnes]

Cynicism is welcomed!! Questioning what is put in front of you is always the best way to understand a topic, and given that Clarymist tends to pose so many questions...!!

Let me know how you get on - depending where you got it from you should be able to get a refund if it doesn't help anyway

But you do sound like an ideal candidate, so fingers crossed

[Randal]

Clarymist Available in US?

Where is Clarymist available in the US?

Randal

[Tony Barnes]

It has limited availability under the brand name Tears Again - it's on the product list on here somewhere...

ah yes, here - http://www.dryeyezone.com/encycloped...omesprays.html

We had to rename it Clarymist in the UK as Tears Again was already copyrighted over here, oddly by an american company though??

EDIT: This seems to be a supplier - http://www.aclens.com/da.asp?ID=29

The bottle looks different (ours is clear), but the lid seems to be the same, which indicates it's the same patented pump, so should be the same product.