Ointment is BAD for your EYES, period

[HOSADOS]

http://http://www.dry-eye-institute.org/lectures.htm
THE IATROGENIC DRY EYE AND ITS MANAGEMENT
Frank J. Holly, Ph.D.,
Based on the Harold Stein Lecture given at the CLES Meeting, in Orlando, FL on 01/23/03. Revised on 03/31/03


Slide 23: What about Lipid Oil ?

In addition to the punctal plugs the use of ointments in the eye also belongs to this category. We have already mentioned their use to prevent nocturnal lid adherence due to lack of lubrication. Due to the importance, we repeat our warning here. Ointments consist of apolar lipids which are intensely hydrophobic. Smearing ointment over the ocular surface could not possibly improve tear film instability and the mucin layer cannot possibly mask such a large amount of lipid. Blurry vision often results. The only reason, the use of ointment at night does not result in a complete fiasco is its complete lack of polarity. It cannot spread over hydrophilic surfaces and therefore it is not a tenacious contaminant. Still, it is wise not to rely on ointments in managing dry eye symptoms as it presents another obstacle to the tear film system attempting to form a continuous tear film over the ocular surface.

While various oils often serve as lubricants in machinery, in the human body, almost exclusively aqueous macromolecular solutions serve such a purpose, such as synovial fluids in joints. The lubricant for the relative movement of the lid and the globe is also an aqueous (tear) layer. Attempting to prevent contact adhesion with heavy doses of mineral oil and other nonpolar lipids) ointments interfere with lubrication as well as with visual acuity.

[HOSADOS]

Physicians theorize that thicker gels & Ointment interfere with MG, make things WORST

http://http://www.eyeworld.org/article.php?sid=4449

Cornea-Guide our patients better gel and ointment use
by Vanessa Caceres EyeWorld Contributin Editor

Robert Latkany, M.D., founder and director, Dry Eye Clinic, New York Eye and Ear Infirmary, New York. “A lot of eye doctors are guilty of lumping all dry-eye patients together,” he said. In turn, they may recommend a gel or ointment not specific to the cause of the patient’s dry eye. Additionally, gels and ointments are often misused by patients. Here are some red flags to avoid in your patients who use gels and ointments, followed by dry-eye gel and ointment recommendations for certain conditions. Misuses

Many physicians theorize that thicker gels and ointments can interfere with meibomian glands, actually making tear-duct problems related to dry eye worse. This is especially true in patients with meibomian gland disease, although it can occur in any dry-eye patient, said Gary N. Foulks, M.D., Arthur and Virginia Keeney professor of ophthalmology, University of Louisville, Ky. “Most of these ointments are relatively messy and not good at stabilizing the tear film—they may aggravate stability,” Dr. Foulks said

Most of the ointments available are composed of petrolatum and mineral oil. “Patients’ meibomian glands are clogged, and then they’re lathering ointment on them at night,” Dr. Latkany said. “Who’s to say what that does to those ducts? Does it make matters worse? My guess is yes.”

If a patient uses a gel or ointment daily for a long time, they may avoid discovery of the root cause of their dry eye—a situation that Rebecca Petris, founder, Dry Eye Company, Silverdale, Wash., has encountered frequently when she speaks with dryeye patients. “We routinely hear from patients who are kept on ointment nightly for a long time. They’ll say ‘It finally
dawned on me that the longer I use this, the worse I feel,’” she said.

[Teri]

Thanks

Thanks for posting this. It is valuable information.

Last year, I was caught in an ointment-erosion-MGD loop where the ointment (Refresh PM or Muro 128) was the only thing that would reduce the noctural erosions, but, in turn, was making the MG more clogged and making my eyes drier. I really feel these ointments contributed to my blepharitis either developing or worsening. But I so feared the erosions....

It was also helpful to read the words "noctural lid adherence due to dryness," as this is exactly what I thought was happening. The doctors all denied that this could be the case.

Teri

[Mika]

interesting post HOSADOS.
Well I agree with you about the danger of ointment. But I am afraid to say that I am a long term user of ointment BUT with loooowww Dose. All i can say is that maybe previously it has damaged my meibomian gland perhaps because previously I was uninformed about it and overused it.

Now, I use it with a low dose and frankly, it is really helping me with my mucus and dryness. I Rarely use drops anymore -but my eyes are still dry and some days are worse than ever.
I think that if you use ointment moderately and "maintain" your eye hygiene such as steaming, warm compress, cotton-bud scrub, then its danger may be slowed or stopped...

[rukapuka]

This is a very important piece of information. I discontinued using the ointments once i read ur port, Thank u!
But what abt the semi-liquid lubricants[either gel or liquigel]? Is that risky too?

[HOSADOS]

I stopped using ointment forever (unless I really need to use a drug that come only in Ointment and I have no choice). Having said that, I found that using tiny amount of oil together with some eye drops (instilling eye drop right after) is much better, but it's MUCH better not to use it at all !!!

What I do, is that every 2-3 hours more or less depending on the relative humidity and my dryness, I express and squeeze my Mieibomain glands for 2-4 minutes, to have some does of fresh and natural lipid oil kicking in, and then I instill eye drops. This works very well, as the tears stabilize and wettabily and moister sustain longer. For me this works best.

Until Thu last week, I was using Ointment Steroid for about a week, to be more precise Maxitrol that contains steroid and two anti -biotic agents, and also Opti-last which anti alergic and preserved with BAK !!! Yeh, all the BAD stuff together. I must confess that I knew it was WRONG, but eventually, I gave up to the Ophthalmologist order, to show him that I try to get better, and to negate his arguement that I don't want to heal since I'm not using drugs...I had the same issue with the Ophthalmologist I saw before and the one before and so on...they didn't believe that I said it is BAD stuff and that I have sound science backing it up.

This week, was one of the most horrible weeks I had for quite some time over the last months...my eyes got EXTREMELY dry and my TBUT deteriorated. Even now, after a few days free from this stuff my Meibomain Glands are still not functioning as they were before taking this stuff. After that, I emailed the Ophthalmologist the research articles I've just posted here and showed him what happened and he was SEMI convinced. Alright he said, this is not good for you, but might still work for other...this is the problem, they just don't get it ! I say, every healthy person try those stuff would see his TBUT decrease, eyes get red and dry, however, only with severe moderate DES/MGD one could really suffer as this is quite noticable. For others, it 's not much that they pay attention. I also noticed that Ointment make not feeling the eye or pain sometime, and this explain why many think it's helpful and missing the bad stuff, I think.

Anyway, this incident, was enought for me to get the confidence that my body is actually my science lab and the experiment I do on myself are the most trutable source for me. I also realize that I must read and do research on my own, and consult with other patients, since not all Ophthalmologists, doctors and speicialists could be trusted.

[HOSADOS]

This is a very important piece of information. I discontinued using the ointments once i read ur port, Thank u!
But what abt the semi-liquid lubricants[either gel or liquigel]? Is that risky too?

Personally, I'm a fan of Dr. Holly, and his word of wisdom coincide with my persoanl experience so far. So he argues that gel and ointment and any high viscosity drops are not good. Those he seek a more technical and scientific explanation are welcone to go through Dr. Holly's 10 fallacies in his Q&A forum, I think he relate to that issue in more details when he discuss why low viscosity enhance lubrication.

http://www.dry-eye-institute.org/lectures.htm

he other misconception that still lurks in the mind of eye care professionals and artificial tear manufacturers is that high viscosity results in long retention time and therefore it is advantageous. Indeed, preparations that are 300 times more viscous than aqueous tear are still used in post-lasik eyes. Needless to say such a formulation is unable to form a lubricating layer between the lid and globe and if it did, it would contribute considerably to the epithelial surface damage

The most important parameter, the wetting synergistic polymer combination is found in all four artificial tears. They all also have low viscosity to enhance lid lubrication and decrease shear forces at the vulnerable ocular and tarsal surfaces.

[eva]

Hello all

I am not a doctor nor an expert - however I do know the root cause of my dry eyes - Sjogren's Syndrome.

I live in Toronto and there is a large downtown hospital with a "Sjogren team" - called the Sjogren Clinic. Looks at the disease from every angle - it just so happens that my personal problem is only dry eyes ("only" is enough thank you)

The head ophtomologist and his team recommend the use of Lacrilube (vaseline like preservative free substance) and preservative free drops during the day.

They also give patients Restasis which is not available in Canada but I was able to get it, like other patients through the SS Clinic (I stopped it after a year to see if I'd get worse since I didn't notice much improvement except at the beginning but nothing after that) - I've been off it for months and there is no adverse effect. Hopefully I will never need it again, because I am vigilant with the drops and the Lacrilube.

So personally, I find it hard to believe that all the doctors at the clinic recommend a substance that could be counter-productive and harmful but like I said I am not an expert.

What I do know is that I use what was recommended and my problems with SS is "under control" - so I guess everyone has to do what works for them.

Permanent plugs are considered a "last resort" at the Clinic - my temporary ones fell out within 24 hours. It seems that while putting plugs in keeps the moisture in, it also prevents "junk" from draining away. So once again it's an individual choice and the pros and cons have to be carefully weighed by each individual.

The only thing I am convinced about 100% that dry eyes, regardless of the cause do not respond to the same treatment for everyone - which in itself is very frustrating.

I find this site very helpful - it makes one think about various suggestions, like not using Lacrilube as an example. After considering other alternatives and knowing where the recommendation to use it came from, I decided to continue using it. No guarantees I made the right decision but then again, medicine is not an exact science.

[rubyslippers]

Does this information include Gen-Teal gel. My doctor said to use it nightly to prevent erosions. Since I have done this, I have not had an erosion in months.

[Rebecca Petris]

So personally, I find it hard to believe that all the doctors at the clinic recommend a substance that could be counter-productive and harmful

It's a fair point and an important one to address in the forums. It's not the first topic, by any means, where what's commonly espoused on the boards may fly in the face of conventional dry eye treatment.

Conventional wisdom has always said that thicker = better protection. It is my personal understanding that the scientific findings of Dr. Holly's and others' findings have clearly refuted this - and on the strength of that plus the preponderance of anecdotal reports on this board about patients doing worse with frequent ointment use, we've been very sympathetic here to a negative view of frequent use of petralatum/mineral oil ointments. Can't tell you how many people I've known personally who got better when they found something more effective than ointment.

However, we have to be careful with this because I do not want people relying on this board as their source for decision-making. For fact-finding, yes, for getting ideas to explore and things to talk to their doctor about (and occasionally challenge their doctor on) but not as the determinant factor in treatment decisions.

Regarding conventional thinking on ointments, I think that this is becoming increasingly controversial in medical circles (see recent Eyeworld article) and I am very glad that that is the case. It's been in use so long nobody's bothered to study what it really does to the cornea lately and if and when they do, I think we'll get some interesting information.

At a personal level... I used to use Lacrilube and I came to hate the stuff like poison. But where I was living at the time I had few-to-no other choices. Gotta do whatcha gotta do sometimes.

[eva]

Rebecca

Why did you hate Lacrilube and what did you switch to?

Do you think it's more irritating to people who have plugs because it can't drain? I personally started mixing it with BION Tears at night simply because it felt good.

I read that lots of people use gel at night - I use it during the day. If I use it at night, I am up at 4 a.m. putting it in again. The Lacrilube cut down makes me sleep through all nigh - so personnaly it works for me. Obviously it didn't for you.

I wonder if the needs of SS patients are different from people whose eyes are dry from other causes. What is your opinion?

thanks

eva

[clairvoyant]

Can someone please tell me what kind of moisturizer is ok for the eye lids, if all that stuff is forbidden?

A derm has reccomended one but it contains mineral oil... So I need to get the opnion from a few different ophamologists but yea... anyone have a good one they use?

[Mika]

Me, i use ointment ONLY during the day. At night I hate putting ointment in my eyes. So i Sleep without any artificial tears or ointment. But I put some saline before going to sleep.
Well, if here in mauritius there was an excellent risk-free substitute for ointment, I would have gladly jump into it.. But the 4 out of 6 artificial tears (including gel) available here are benzalkonium chloride. Only tears naturale alcon and Refresh Tears are available. So, I have no much choice except ointment...! ... but it helps

[HOSADOS]

The resean some pateints like Ointment-is that it numb the surface of the cornea

Similar to contacnt lenses effect, I suspect that ointment numbs the surface of the cornea and cause corneal desensitization (or prevent nerve activation), which would allow one to find some relief, but this is only ******g the issue.

Here's what I think happens. The delicate sensory nerves residing within the superficial cornea, (the tiny nerve fibers that sense smoke or overly chlorinated pool water), also sense very tiny changes in tear film chemistry (pH, osmolarity, etc.). These nerves automatically send the appropriate signal to the lacrimal glands: make less tears, make more tears. Loss of corneal sensation interrupts that critical tear feedback loop. Numb corneas don't send signals!

I must say, I never read this in any research, but this makes a lot of sense and probably close to what happen. I think Dr. Holly is in the best position to answer what is the exact mechanism.