Can someone explain a in a little more detail how Dwelle works?

[mflores22]

I have searched in this forum and on the internet for more specific information about Dr. Holly's drops. Unfortunately, I haven't found anything that tells me exactly what they do. So the drops have high oncotic pressure that promotes ocular healing. Um, this really doesn't do anything for me. What is it about high oncotic pressure that promotes healing? And what part of the eye/tearfilm is being healed by the drops? What types of dry eye patients will benefit from the drops?

I'm sorry if this information is somewhere and I just haven't found it.

[shoebox]

I asked myself the same question and googled high oncotic pressure and found something to the effect that it helps the "hydrophobic" parts of the eye surface (I think of that as spots that don't accept moisture) heal or absorb moisture to create a more stable tear film on the eye surface.
Everyone can please correct me where I am wrong!

[liz56]

Okay, I'd like to try!

Hi,

I'm really just learning this myself, so please, bear with me, as I practice putting this into language.

(Dr. Holly and those who are more knowledgeable than I, please correct my essay response, if I am off base!)

The way that I understand it is that a high oncotic eye drop intervenes in the process of osmosis-- the balancing of liquid in tissue-- when too much liquid is allowed into the tissue. Think of swelling, our ordinary word for "edema." How is one to get the swelling to go down, especially when the tissue is not outer skin but rather one's blood vessels or the tissue in someone's eye? Dr. Holly discovered, and I hope that I am not misrepresenting this(!), that certain substances (dextran or polymers) help to balance out that swollen tissue effectively, because they exert a high oncotic pressure in the tissue. Thus, where osmosis has failed and the swelling increases, the molecules dissolved in the tissue from the high oncotic drop are too large to flow in and continue the swelling. So, they dissolve in the tissue and keep it at a normal level and from swelling.

Dr. Holly explains it well in the following article:


Vitamins and Polymers in the Treatment of Ocular Surface Disease

Dr. Holly also explains this idea in his discussion of treating microcystic edema (swelling in the epithelium) in the following thread:

http://www.dryeyezone.com/talk/showthread.php?t=4908

Dr. Gary Foulks also explains the principle in "New Tools for Treating Corneal Dystrophy," which appears in _Review of Ophthalmology_ (9/1/2005)

Preventing Erosions Nonsurgically

Dehydrex, a nonsurgical treatment for recurrent corneal erosions, is currently in clinical trials as an orphan drug for possible approval by the U.S. Food and Drug Administration. Dehydrex is a colloidal solution, slightly hyperosmotic to the corneal stroma, that removes fluid from epithelial cells on the corneal surface. Its molecular structure can’t penetrate into injured cells, so its effect is maintained even on damaged or abnormal epithelium.

Gary Foulks, MD, Arthur and Virginia Keeney Professor of Ophthalmology at the University of Louisville School of Medicine, has worked with Dehydrex for more than 20 years. “We conducted a large open-label study and two randomized, masked trials involving about 120 patients when I was at Duke University,” he says. The results of his early studies were published in 1981.1

“When you have a corneal erosion, you’ve broken the underlying hemidesmesomes and anchoring fibrils that hold the epithelial cells in place,” he explains. “If the epithelium heals over but hasn’t attached to the underlying cornea, any fluid that accumulates in the basal or subbasal epithelial layer will interfere with the reformation of those attachments. At night when the eyelid is closed, the fluid can build up, lifting the epithelial cells from the surface. In the morning, the eyelid abrades the cells and erosion results.”

[Rojzen]

bravissimo!

Liz56: Your incredibly smart summary of the effects of high oncotic pressure has not only improved my understanding of why high oncotic pressure heals, but also helped me understand what I've suspected intuitively: That even when a patient does not have a diagnosis of corneal erosions, the optimal therapy for corneal erosions (high oncotic drops) is likely to work to stabilize the patient's tear film. . .I'm tentatively concluding that all of us with dry eye have some degree of at-least-subclinical erosion, to a degree sufficient to damage tear film stability, as a result of incomplete wetting and defecient wettability. . .and that accordingly, if we treat ourselves as erosion cases, we are likely to benefit greatly.

[liz56]

Hi, Rojzen!

Rojzen, what you said about tear film stability is consistent with what Dr. Holly said about how Dwelle and Dakrina work in that article from the Dry Eye Institute posted above. In that, he says that there are two ways for eyes to become dry-- from an uneven corneal surface, due to injury, corneal dystrophy, or corneal defect, which causes the tear film to not spread evenly, which, in turn, causes dry spots, or it is from dry eyes that do not make enough tears, which leads to spotty coverage, which damages the surface of the epithelium and makes it uneven. I think this is why Dr. Foulks
in the article above says that the Dehydrex solution to recurrent corneal erosions is also a good treatment for dry eye.

Thanks, Rojzen, for helping me to think through this; you are so helpful in getting me comfortable using these new terms. As a person who probably has both problems, it is so helpful to be on this board with you and everyone who offers good advice for treating dry eye and corneal dystrophies. Dr. Holly's drops do just the weird and delicate thing that I need-- they dry the back end of my epithelium and lubricate the out front end. That's why I am so impressed with these drops and see Doctor Holly as being utterly brilliant!

--Liz

[mflores22]

Thanks!

Thanks for your replies, that are all great!

I have another question, if the idea behind Dwelle is to repair tissue by exerting pressure on swollen tissue on the eye, then wouldn't using hypotonic drops like Thera Tears swell these tissues that are already inflamed? Just a thought.

On a side note, in my right eye, the eye that I have problems with, the cornea looks 'blotchy' (for lack of a better word), not glassy and smooth like my left eye. My problem eye looks like there are parts of the cornea that are not level with the other parts of my eye. Could these be erosions? I always assumed it was the mucous layer of my eye that had depleted because of my dry eye.

[liz56]

Thanks for your replies, that are all great!

I have another question, if the idea behind Dwelle is to repair tissue by exerting pressure on swollen tissue on the eye, then wouldn't using hypotonic drops like Thera Tears swell these tissues that are already inflamed? Just a thought.

On a side note, in my right eye, the eye that I have problems with, the cornea looks 'blotchy' (for lack of a better word), not glassy and smooth like my left eye. My problem eye looks like there are parts of the cornea that are not level with the other parts of my eye. Could these be erosions? I always assumed it was the mucous layer of my eye that had depleted because of my dry eye.

Hi, Mflores22.

Hypotonic would let more moisture into the tissue. That is why doctors prescribe Muro 12 5% drops or ointment for recurrent corneal erosions and corneal edema. It is hypertonic. I have a terrible time with Thera Tears, because it makes me feel like I just cried my eyes out. It's good for helping me to open my eyes in the morning, because it is so watery. However, when I tried to use it during the day, I could not. There may be some people with other conditions for whom it works great, however.

There is no way to tell with the naked eye, usually, if people are having erosions. I'd see a doctor quickly if the surface of the cornea looks odd just from a normal view with no slit lamp.

--Liz

[Terri]

On a side note, in my right eye, the eye that I have problems with, the cornea looks 'blotchy' (for lack of a better word), not glassy and smooth like my left eye. My problem eye looks like there are parts of the cornea that are not level with the other parts of my eye. Could these be erosions? I always assumed it was the mucous layer of my eye that had depleted because of my dry eye.

I don't have erosions, but I had ocular surface damage that sounds very much like what you describe. Dwelle worked wonders for me, restoring the glassy, smooth surface to my eye within the first couple of weeks of use.

[mflores22]

Gracias again!

Thanks for all your replies. You've convinced me to give Dwelle another shot, and based on what I've read, I really think it can help me.