Tear jerker device

[patrick]

Hi all,

I know its stupid,but i do not know how to place a link here on these boards.
But i read a very interesting article yesterday about a tear jerking device currently being developed at the stanford University. In my opinion this sounds very promising!
It is the second time i read something about this device. First time was in may 2014.
Both articles can be found if you google 'tear jerking device'. I am very curious what other members here think about it.
If someone here is able to open a topic and place the link of the article in it that would be great of course!

Patrick..

[Spoon]

Presuming the additional tears are 'basal tear quality' rather than reflex tears it sounds like it has a lot of potential for people with solely aqueous deficient dry eye. Though, a few things that first come to mind are:
1. I have heard that overstimulating the lacrimal gland can inflame it and stop it functioning properly. Eye docs have observed (and I experienced myself) that in the early stages of MGD, when lacrimal gland cannot keep up with the evaporation rate due to lack of oil on the tear film it up-regulates tear production. The eyes become very watery which confuses people when they're told they have dry eye. Eventually after months of hyper-stimulation of the lacrimal gland the gland becomes inflamed and 'burns out' which is probably why MGD is so often seen with aqueous deficiency as well. However since they will be able to control the amount of stimulation perhaps it could be optimized to keep the lacrimal gland producing basal tears below the rate at which it would become 'exhausted'.
2. If you have MGD (majority of dry eye patients) then it will be a double edged sword - you would get the lubrication benefit from additional aqueous but the tears would become more salty/hyper-tonic which increases inflammation and the enduring cascade. You might be better off just using hypo-tonic artificial tears.

[patrick]

Hi spoon,

Thanks for your response.
I think you raise some very valid points although i'm not sure if they're necessarily true. of course trying to speed up the lacrimal gland and meanwhile destroying it by doing that is of course what you not want. Thats clear.
I have mgd and have become increasingly aqueous deficient over time to. This happened over a time span of nearly a decade now. I had refractive surgery in 2005. (lasek)
My theory is that i have become slightly aqueous deficient after the surgery which caused an imbalance in my tear composition and that later on caused mgd as a secunary consequense. As we all know this over time becomes a vicious circle we can't seem to escape from.
Thing is that if it could be made possible to raise your basal tear levels structurally to what can be considered 'normal' wouldn't that lower the friction between the eye lids and corneal surface in such a way that perhaps the inflammatory cycle gets interrupted? And the body is then maybe able to heal itself?
I can understand what you mean when you say that the lacrimal gland is trying to overcompensate the high evaporation rate in the early stages. I myself never experienced it, but I know it exists. i actually never heard that the lacrimal gland can get exhausted by this.
What makes you think that if you raise your basal tear levels they become more salty? Isn't it so that if the water component is larger the salt content will be more dilluted?

Already 10 years down the road with this dry eye condition and still i have so much questions and very little real knowledge.
Mainly because this condition is so very poorly understood. Even by most of the opthalmologists i met in the recent years...

[Spoon]

Hi Patrick. I was probably a little negative about it sorry. I certainly agree that the additional tears would reduce mechanical friction and that can only help for healing. The reason why I think the tears would get more salty if you had moderate-severe MGD is that the basal tears contain the salts and which are quickly concentrated because in most environments the evaporation rate is so much higher with MGD that it normally would be. However it is more complex that that, meibum reduces surface tension of the watery layer to help spread the tears and retain an even tear film thickness. With this in mind, for someone with MGD perhaps an increased basal tear secretion rate would just speed up the flow from the lacrimal gland to the punctum, giving each unit of tear less time to concentrate its salts. I'm not sure it would work like that but I do think that this device is something to look forward to for some patients. I can understand your idea of using it as a way to provide an environment for healing and I hope it works in that way, however increasing the quantity of one tear film component will never compensate for the insufficiency of another - the tears need to be balanced within normal limits.

[patrick]

Hello spoon,

No problem at all. I don't consider your opinion as negative and i appreciate your input. It is actually very okay of you to try to put things in the right perspective. I think that is what this forum is about. To share knowledge,opinions and experiences.

I see what you mean. It is probably no use trying to raise one part of the tearcomposition while other components are still insufficient. I guess its all about the right balance.

My initial thought was since my aqueous deficiency seems to get worse over time that trying to stop or reverse this would make my tears a little less 'toxic' and that could create a bit healthier environment to treat the mgd issue. Which i think is basically caused by mechanical friction due to lack of lubrication. Btw. I have my lower punctums permanently plugged,so the little amount of tears i have can't flow away through these punctums. Still my eyes feel dry almost constantly. The evaporation rate therefore must be ultra high i guess.