Tweet
Anyone tried this? is this in any artificial tears?
http://dry.org/petrolatum.html
http://dry.org/petrolatum.html
Treating evaporative dry eye and blepharitis with petrolatum next to the eye
Warning and disclaimer
The method described here has not been shown to be safe or effective in an extended clinical trial series. You should not try this method without the approval of your physician. This site's author assumes no responsibility for anybody's use of the method described here.
Theoretical background
The tear film has three layers.
Next to the eyeball is a mucin layer.
Atop that is an aqueous layer (tears).
Floating on that is a lipid (fatty, oily) layer, which acts to prevent evaporation of the aqueous layer.
In Sjogren's Syndrome, dry eye results from deficiencies both in the tear film and the lipid layer. That is, the problem is not only that Sjogren's patients make insufficient tears, but that their lipid layer is inadequate, and therefore tears evaporate faster than they should.
Donald MacKeen, PhD (an SSF board member) has discovered that if petrolatum is placed next to the eye, some of it will gradually migrate into the eye in a time-release fashion. He calls this movement "supracutaneous".
A 1999 study published in the British Journal of Ophthalmology, New treatment of dry eye: the effect of calcium ointment through eyelid skin delivery, by Tsubota K, Monden Y, Yagi Y, Goto E, Shimmura S
measured MacKeen's supracutaneous effect, and found it to begin within ten minutes of application, peak at 30 minutes, and taper down to 20% of peak after about three hours.
found petrolatum next to the eye to be effective in reducing evaporation rate and blink rates in patients.
found a petrolatum-based calcium carbonate ointment to be more effective than plain petrolatum in reducing corneal staining.
Practical method -- one person's experience
During daytime, I apply a moderate amount of petrolatum to both upper and lower eyelids, using a cleaned finger or a cotton tip applicator. I smear it from the outer corner of the eye across upper and lower lids, just outside the lashes. Following a helpful tip from a California petrolatum user, I now during daytime apply it mostly to the upper lid. This has a cosmetically preferable effect, giving less of a weepy look, but does not seem to reduce the effectiveness. The amount I am using now is about the size of two large grains of rice, per eye. This is roughly double the amount used in the Tsubota study cited above, in which the ointment was applied only to the lower lid.
I wipe off the petrolatum (with facial or toilet tissue) and reapply fresh when it seems to lose its effectiveness, which is normally at roughly one to three hour intervals.
At bedtime, I use about three times as much petrolatum, again on lower and upper lids.
In the middle of the night I wipe off petrolatum and reapply next to the eyes.
I found petrolatum for sale in a tube marked "100% pure petroleum jelly" and "White petrolatum, USP". In the United States, Vaseline is a popular brand of petrolatum. Note though that most products with the Vaseline brand are NOT pure petrolatum, and would be inadvisable for use near the eye.
I use a dedicated tube of petrolatum for my next-to-eye purpose, in order to keep it clean.
Results reported by one person
Subjectively, I find the petrolatum markedly reduces the burning sensation. This in turn reduces reflex tearing.
I find much less need for artificial tears.
I find that I no longer need to wear goggles all day.
My ophthalmologist can now get a clear (not cloudy) fluid out of my meibomian glands by squeezing them during an examination. When I only treated the lower lid, only the lower-lid meibomian glands looked good by this measure. When I changed to treating both upper and lower lids, both lower- and upper-lid meibomian glands yielded the nice clear stuff.
I apparently no longer need to use the other measures I had previously been taking to combat blepharitis:
warm compresses for 10 minutes per day
doxycycline 100mg/day
My lid hygiene routine now is just a brief wipe with warm wet washcloth, and a wipe of the lid margin.
Appearance-wise, I do look a little bit shiny around the eyes -- but not totally bizarre I think. Definitely less bizarre than goggles.
Frequently asked questions
Q: Nighttime ointments (Lacrilube, Refresh PM, etc) contain petrolatum. Is this the same thing you're talking about?
A:No. Nighttime ointments are intended to be squirted inside the eyelids, in large enough quantity to lubricate the eye, in effect replacing the normal 3-layer tear film with something more like packing the eyeball in grease. While using these ointments in the eye, vision is typically distorted. In contrast, applying petrolatum next to the eye adds just a small amount of lipid, enough to control evaporation but not enough to affect vision.
Q:Could I apply a nighttime ointment next to my eye and get the same results?
A:I have tried that and have found it is less effective than pure petrolatum. I think the reason is that the mineral oil that is added to the nighttime ointments make it spread too fast and too thinly to be effective when applied next to the eye.
Q:Aren't you worried about using petrolatum that is not labeled "sterile"?
A:If I could find a source for sterile petrolatum I would use it. Since I have not found that yet, I take comfort in the fact that fats and oils don't support microbe populations in the way that aqueous solutions do.
Further detailed thoughts and speculations
If the anecdotal reports of good meibomian gland functioning hold true, then we have to wonder about the mechanism by which this treament helps keep the meibomian glands working right. Some possiblities I have come up with are:
Perhaps the petrolatum creeps down into the meibomian gland openings and directly acts as a "thinner", thus keeping the meibomian gland ducts from clogging.
Perhaps the petrolatum works by slowing evaporation, thus breaking the vicious cycle in which dry eye leads to blepharitis which leads to dry eye.
On the question "Will we ever know if this is safe and effective?"
because petrolatum is unpatentable, cheap, and widely available, there is no financial incentive for investors to fund a clinical trial to establish that it is safe and effective for dry eye. Unless a nonprofit or governmental agency conducts a study, then at best we will get evidence of this method's safety and efficacy when it is used, as it was in the Tsubota study mentioned above, as the control in a study.
Donald MacKeen has patented the use of petrolatum-based preparations as a time-release mechanism for delivering drugs to the eye. I think this holds great promise, and that it may attract some funding for studies of various drugs delivered in this way. Those studies should give further information about the long-term safety of using petrolatum next to the eye (although they may be carried out on non-dry-eye populations and therefore may have nothing to say about effectivenss for dry eye).
What is the mechanism for supracutaneous movement of petrolatum?
MacKeen's patent application suggests it has something to do with a scissoring action during blinking.
What I have seen suggests to me that the petrolatum creeps in all directions from where it is placed on the skin, and will creep between the lashes and across the eyelid margin and into the eye. Of course it also creeps down onto the cheeks and up toward the eyebrows, where it does no good and no harm. It appears to also creep up the lashes and off the ends of them, where it forms dangling threads of petrolatum. These observations beg the further question, what causes the creeping? I don't have an answer to that. Whatever it is, the creeping is stronger than gravity; if you put a dot of petrolatum on your cheek and then wait half an hour, the cheek gets shiny not only below but also above the dot.
Warning and disclaimer
The method described here has not been shown to be safe or effective in an extended clinical trial series. You should not try this method without the approval of your physician. This site's author assumes no responsibility for anybody's use of the method described here.
Theoretical background
The tear film has three layers.
Next to the eyeball is a mucin layer.
Atop that is an aqueous layer (tears).
Floating on that is a lipid (fatty, oily) layer, which acts to prevent evaporation of the aqueous layer.
In Sjogren's Syndrome, dry eye results from deficiencies both in the tear film and the lipid layer. That is, the problem is not only that Sjogren's patients make insufficient tears, but that their lipid layer is inadequate, and therefore tears evaporate faster than they should.
Donald MacKeen, PhD (an SSF board member) has discovered that if petrolatum is placed next to the eye, some of it will gradually migrate into the eye in a time-release fashion. He calls this movement "supracutaneous".
A 1999 study published in the British Journal of Ophthalmology, New treatment of dry eye: the effect of calcium ointment through eyelid skin delivery, by Tsubota K, Monden Y, Yagi Y, Goto E, Shimmura S
measured MacKeen's supracutaneous effect, and found it to begin within ten minutes of application, peak at 30 minutes, and taper down to 20% of peak after about three hours.
found petrolatum next to the eye to be effective in reducing evaporation rate and blink rates in patients.
found a petrolatum-based calcium carbonate ointment to be more effective than plain petrolatum in reducing corneal staining.
Practical method -- one person's experience
During daytime, I apply a moderate amount of petrolatum to both upper and lower eyelids, using a cleaned finger or a cotton tip applicator. I smear it from the outer corner of the eye across upper and lower lids, just outside the lashes. Following a helpful tip from a California petrolatum user, I now during daytime apply it mostly to the upper lid. This has a cosmetically preferable effect, giving less of a weepy look, but does not seem to reduce the effectiveness. The amount I am using now is about the size of two large grains of rice, per eye. This is roughly double the amount used in the Tsubota study cited above, in which the ointment was applied only to the lower lid.
I wipe off the petrolatum (with facial or toilet tissue) and reapply fresh when it seems to lose its effectiveness, which is normally at roughly one to three hour intervals.
At bedtime, I use about three times as much petrolatum, again on lower and upper lids.
In the middle of the night I wipe off petrolatum and reapply next to the eyes.
I found petrolatum for sale in a tube marked "100% pure petroleum jelly" and "White petrolatum, USP". In the United States, Vaseline is a popular brand of petrolatum. Note though that most products with the Vaseline brand are NOT pure petrolatum, and would be inadvisable for use near the eye.
I use a dedicated tube of petrolatum for my next-to-eye purpose, in order to keep it clean.
Results reported by one person
Subjectively, I find the petrolatum markedly reduces the burning sensation. This in turn reduces reflex tearing.
I find much less need for artificial tears.
I find that I no longer need to wear goggles all day.
My ophthalmologist can now get a clear (not cloudy) fluid out of my meibomian glands by squeezing them during an examination. When I only treated the lower lid, only the lower-lid meibomian glands looked good by this measure. When I changed to treating both upper and lower lids, both lower- and upper-lid meibomian glands yielded the nice clear stuff.
I apparently no longer need to use the other measures I had previously been taking to combat blepharitis:
warm compresses for 10 minutes per day
doxycycline 100mg/day
My lid hygiene routine now is just a brief wipe with warm wet washcloth, and a wipe of the lid margin.
Appearance-wise, I do look a little bit shiny around the eyes -- but not totally bizarre I think. Definitely less bizarre than goggles.
Frequently asked questions
Q: Nighttime ointments (Lacrilube, Refresh PM, etc) contain petrolatum. Is this the same thing you're talking about?
A:No. Nighttime ointments are intended to be squirted inside the eyelids, in large enough quantity to lubricate the eye, in effect replacing the normal 3-layer tear film with something more like packing the eyeball in grease. While using these ointments in the eye, vision is typically distorted. In contrast, applying petrolatum next to the eye adds just a small amount of lipid, enough to control evaporation but not enough to affect vision.
Q:Could I apply a nighttime ointment next to my eye and get the same results?
A:I have tried that and have found it is less effective than pure petrolatum. I think the reason is that the mineral oil that is added to the nighttime ointments make it spread too fast and too thinly to be effective when applied next to the eye.
Q:Aren't you worried about using petrolatum that is not labeled "sterile"?
A:If I could find a source for sterile petrolatum I would use it. Since I have not found that yet, I take comfort in the fact that fats and oils don't support microbe populations in the way that aqueous solutions do.
Further detailed thoughts and speculations
If the anecdotal reports of good meibomian gland functioning hold true, then we have to wonder about the mechanism by which this treament helps keep the meibomian glands working right. Some possiblities I have come up with are:
Perhaps the petrolatum creeps down into the meibomian gland openings and directly acts as a "thinner", thus keeping the meibomian gland ducts from clogging.
Perhaps the petrolatum works by slowing evaporation, thus breaking the vicious cycle in which dry eye leads to blepharitis which leads to dry eye.
On the question "Will we ever know if this is safe and effective?"
because petrolatum is unpatentable, cheap, and widely available, there is no financial incentive for investors to fund a clinical trial to establish that it is safe and effective for dry eye. Unless a nonprofit or governmental agency conducts a study, then at best we will get evidence of this method's safety and efficacy when it is used, as it was in the Tsubota study mentioned above, as the control in a study.
Donald MacKeen has patented the use of petrolatum-based preparations as a time-release mechanism for delivering drugs to the eye. I think this holds great promise, and that it may attract some funding for studies of various drugs delivered in this way. Those studies should give further information about the long-term safety of using petrolatum next to the eye (although they may be carried out on non-dry-eye populations and therefore may have nothing to say about effectivenss for dry eye).
What is the mechanism for supracutaneous movement of petrolatum?
MacKeen's patent application suggests it has something to do with a scissoring action during blinking.
What I have seen suggests to me that the petrolatum creeps in all directions from where it is placed on the skin, and will creep between the lashes and across the eyelid margin and into the eye. Of course it also creeps down onto the cheeks and up toward the eyebrows, where it does no good and no harm. It appears to also creep up the lashes and off the ends of them, where it forms dangling threads of petrolatum. These observations beg the further question, what causes the creeping? I don't have an answer to that. Whatever it is, the creeping is stronger than gravity; if you put a dot of petrolatum on your cheek and then wait half an hour, the cheek gets shiny not only below but also above the dot.
where will DES take me next I wonder! 
yes i often think that, where will this dry eye take me next? I need to get some of this creeping vaseline
...they just improve it abit...im back to square 1 ])
Comment