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Dry Eye Syndrome
What is the Cause? Is there a Cure?

Created 3/8/2004 - Updated 2/11/2009

 

 

 

2-11-2009 UPDATE: I'm doing fine! I have had very few dry eye symptoms for years. I found that two tablespoons of Barleans Flax seed oil (refrigerated kind) fixes the problem for me. It takes about 3 days before the anti-inflamatory action of the flax seed oil kicks in. There are many different causes of dry eyes, but this is what worked for me. Because flax tastes bad, I put it in a shake each morning: 3 grams of good powdered vitamin C, frozen blueberries, protein powder, two bananas, some green tea extract, and a few other goodies (all organic so you don't get pesticide residue problems). Also, I reduced my computer eye strain by getting some computer glasses that are a weaker perscription than my normal walking around and driving glasses. Dry eye problems may actually be caused by an eyelash parasite called Demodex.One person who wrote to me cured his dry eyes entirely using a tea tree oil eyelid scrub for several weeks.  Read this including the cautions and consult your doctor. I've been using a tea tree oil face scrub for a few weeks now. I do still have mild dry eyes with very dry air blowing all night from a heater or from prolonged cigarette exposure. If the simple things above don't work for you, read the rest of this article and see this info about lacritin too.

Best of luck! - Xeno




PROBLEM: Like up to 60 million other people in the US, I have dry eyes. This condition can lead to scarring of the cornea and vision loss. I wake up each morning with dry eyes. On bad days my eyes burn and sting during the day. I've had red eyelids (diagnosed blepheritis) and I've done computer work for over 10 years.

PROGNOSIS: My Ophthalmologist says my case is currently mild ( I have good days and bad) and there is no known cure. I've found some relief with the ideas on this page.

CAUSES: Dry eyes are caused by one or more of the following: 1) physical stress ( for example, from computer work), 2) poor nutrition, 3) a hormone problem, 4) a neurological disorder or damage, 5) immune system malfunctions, 6) an allergic reaction, 7) a virus, and/or 8) the toxic effects of pollution.

WHAT TO DO: Read this article so you understand the various causes of Dry Eyes. Then, work with your doctor to try the different ideas below until you find what works for you. Never give up.

INDEX

Basic Questions: HMO Ophthalmologist | Diagnosis / Recommendation | Dry Eyes, Why At Night? | Pain | Anatomy: The Tear Glands and Tear Film | Physical Problems: Meibomian Gland Disfunction | Computers and Dry Eyes | Computer Use Tips | Dry Air | Humidifier | Warm Washcloth | Eye Exercises | Immune System problems: Colostrum Results | Autologus Serum | Allergic Reactions: Sugar | Toxic Fats | Caffeine | Smoking | Decongestants | Nutrition: Flaxseed oil | vitamin E | Fish Oils | Tuna Fish | DHA | Leafy Greens | Hormone Problems: Hormone Replacement Therapy | Estrogens | Androgens | Increasing Androgens w/out Drugs | Tests | Neurological Problems: Neural Arc | Drops and drugs: Restasis | Physical Actions: Punctal Plugs | A Virus? | Pollution: Pollution and Dry Eyes | Dioxin | Time Line | Reader comments | References

Basic Questions

The HMO Ophthalmologist

I asked my HMO ophthalmologist, "Has anyone come to you with dry eyes who later got rid of the problem?"

Answer: "No."

My mission was clear. I'd be the first. 

She said I'd be surprised at how this problem is increasing. We talked a bit and she said that as a scientist I know more about it than she does. I obviously don't know enough, because I haven't solved my own problem yet. Ophthalmologists are aware of university research, but the clinical setting is different. She has heard about hormone connections, for example, but is unable to order any hormone tests because she would not know how to interpret the results.

 

Hope: Times My Doctors Were Wong

Doctors can often know what is wrong with us better than we know ourselves, but not always. With scientific curiosity and experimentation I've already cured myself of several things my doctors said I would live with for the rest of my life! Here are the "incurable" things I've beaten (or were mis-diagnosed) so far:

1. back problems (exercise, eat right, get a better bed!)
2. cavities including the need for a root canal (info here)
3. gastric reflux (stop sugar, red spagetti sauce & caffine, loosen belt, stop stomach acid drugs, sleep slightly elevated.)
4. asthma (caused in my case by air pollution and stomach acid coming up and causing shortness of breath. Exercise, take vitamin c daily, drink enough water)
5. " panic attacks " (caused, again in my case, by stomach acid coming up and getting in my lungs causing shortness of breath, plus the shakes and some heart irregularities as a side effect of the stomach acid drugs, and sleep deprivation from being a workaholic. I've been under much more mental stress subsequently, to the point of not being able to sleep for three days straight, but never did my misdiagnosed 'panic' symptoms re-appear. Regular moderate exercise is important here too.)

So, Dry Eye Syndrome is said by experts to be incurable, but I don't buy it.


Diagnosis / Recommendation

ACTION: See an opthamologist and get a diagnosis.

Tear Strips Test Results after 5 minutes

9/15/2005 : Shiermer's test shows 24 in the left eye, 5 in the right.
2/24/2004 : Shiermer's test shows 11 in the left eye, 5 in the right.

I'm certain I was told the reading was 3 in the right eye on the day of the test, but when I called 3/26/04, she said my lower number was a 5, not a 3. So, my left eye improved, and my right either hasn't gotten any worse or has improved in the last year. I don;t recall having the numing drops put in last year like I did this year, but perhaps I did.

Fluorescein Dye Test Results after 5 minutes

2/24/2004: Eye exam shows my tear film breaks up rapidly which indicates my oil glands aren't producing enough or the right kinds of oils for my tear film. The Fluorescein dye showed the doc that my tear film does break up quickly. Rapid tear break-up time (the time for dry spots to occur on the cornea) indicates dry eye syndrome.
9/15/2005: Fluorescein Dye test shows far fewer dry spots this time than last year. The doctor commented that both eyes looked much better.

Other tests

Results pending.

Last year I was told that my eyes aren't dry enough to warrant tests for any other disease. This year in 2005, although my doc wouldn't try making tears from my blood (due to the ease of contamination of such a solution she said) I did get some blood tests this time around for Sjorgren's, rheumatoid arthritis, and diabetes. I'll let you know how that goes. I really hope I don't have any of them, but it will be great to know for certain.

Ophthalmologist's Recommendation 2005:

- Punctal plugs. No way. Not me. I'm focusing on the cause, not on patching the symptoms.

ACTION: soak eyes and massage eyelids several times per day with warm washcloth to fight the blepharitis. Okay, I'll try to do that more.

 

Ophthalmologist's Recommendation 2004:

ACTION: Use over the counter antibiotic ointment ( erythromycin - slight eye irritant, ointment goes on lids, not in eyes - 48 ) for blepharitis several times per day

ACTION: soak eyes and massage eyelids several times per day with warm washcloth.

The idea is to give the tear film a chance to build back up. Tears naturally contain enzymes that neutralize the microorganisms that colonize the eye. The warmth increases the blood flow around your eyes which may help for several reasons. 

Dry Eyes, Why At Night?

Before I went to the HMO ophthalmologist, I asked my optometrist why my eyes are dry only at night. He didn't know.

Here is one answer I found: Tears are produced when we blink. People normally blink about every six seconds. This physical action replenishes the tear film. 14 We don't blink at night, so the eyes of people with this condition dry out more then. This sounds like an answer, but it isn't, because for most of my life, I have not had dry eyes. I've slept for many years without dry eyes. ( I tested the possibility that I've started sleeping with my eyes partially open. Nice try, but ... Nope. )

Is any fluid produced at night with our eyes closed? Yes. When you close your eyes, reflex tears production stops or greatly slows, but there is a slower flow constantly secreted and removed fluid which, unlike day tears, is extremely rich in natural antibodies (sIgA) which fight infection.  71 This high concentration of antibodies at night leads to inflammation and triggers the problem immune system response that results in dry eyes at night.  

Interesting. My recurring nightly symptoms of Dry Eye Syndrome (DES) point to an immune system controlled inflammation response.


Pain

This condition can be a drag. One person writes, "Due to the fact that there are an enormous amount of nerve endings in the cornea, a dry eye condition can be enormously painful. Even reports of suicide driven by this pain have been recorded."

There are plenty of happy blind people out there, but I'm not aiming to be one of them. The goal of this search is to find a cure for this problem, not just relief for the symptoms.

What is happening?

I'm still trying to digest the amazingly complexity of the eye and of healthy tear formation. It involves coordination of muscles, nerves, hormones and your body's immune system.

Dry eye is also known as KCS or keratoconjuctivitis sicca. KCS is an autoimmune inflammatory process. The term "kerato" indicates the cornea. The "conjunctiva" is the thin, transparent tissue that covers the outer surface of the eye. The "itis" means inflamation, in this case, vascular engorement (blood vessels filling with blood causing red eye), and some degree of stromal edema (tissue swelling). The "stroma" is the connective tissue framework of an organ, gland, or other structure. The term "edema" indicates is an excessive accumulation of watery fluid. Finally, "sicca" is Latin for dry or thirsty. So, KCS is literally a dry and inflamed tear film, cornea and surrounding eye tissue.

We do know that the amount of circulating androgen hormones in affected tissues is decreased with KCS.

Research also shows that antigens (such as inflammatory marker HLA DR(?), toxins, bacteria, foreign cells, or anything that stimulate the production of antibodies ) appear on epithelial cells locally and result in targeting by the body's defensive CD4-positive T-helper cells. Then, nerves of glands thus attacked by the body's immune cells do not release neurotransmitters as they should due to blockage by pro-inflamatory cytokines ( regulatory proteins ), especially interleukin-1B.

 

 

Anatomy

The Tear Glands and Tear Film

The exact composition of the tear film is not yet fully understood. We do know that tears are a complex mixture of water, lipids, salts, mucins, immunoglobulins, anti microbial proteins, and growth factors. - 38 Several glands work together to produce tears. In my case, since my tear film breaks up quickly according to the test done by my ophthalmologist, my tear glands aren't doing their job.

 

The three layer tear film is made up (surface down to eyeball) of:

1) a lipid or oil layer

2) a lacrimal or aqueous (water) layer

3) a mucoid, mucin or mucous layer.

The first layer (lipid or oil film layer) is produced by the “Meibomian” and “Zeis” glands which are both sebaceous glands. This outer layer slows evaporation and prevents contamination of the tear layer.

meibomian

The middle aqueous or lacrimal tear film layer is the thickest. Its contents are water soluble. This layer is formed by lacrimal glands, primarily by the “Krause” and “Wolfring” glands and secondarily by the “lacrimal” gland, all of which are located in the eyelids.

lacrimal

The innermost mucin layer is semi-solid and functions much like two sided sticky tape or velcro bonding the cornea and the aqueous layer, according to one theory. The meibomian glands located in your eye lid produce the mucin layer.

 

Healthy Sebaceous Glands

Sebaceous glands are found in the skin of mammals. They secrete an oily substance called sebum. In hairless areas, the sebum surfaces through ducts.

The Lacrimal Gland

The lacrimal gland, located at the upper outer region of the bony orbit, above the eyeball, is the tear-producing gland. If this gland malfunctions, the body does not produce enough tears, or produces tears without the proper layers. 15 The lacrimal glands are each about the size an almond. Leading from the lacrimal glands are 6 to 12 excretory lacrimal ducts .

 

 

Physical Problems

Meibomian Gland Dysfunction

According to some, the major cause of dry eyes due to rapid evaporation of tears is obstructive MGD. If the meibomian glands are blocked the lipid (fat) supply decreases, which in turn leads to less sable tears, loss of lubrication, and damage to the surface of the eye, thus producing symptoms. ( 62 ) Meibomian glands are located in both the upper and lower eyelids.

What causes MGD?

Computers and Dry Eyes

Studies show those who spend time looking at computers blink less frequently. As you might guess from the huge amount of content on this web site, I have spent many more than eight hours per day for several years looking at a computer monitor. In the last year or two I've been using an LCD monitor. The onset of my dry eye problem has been very slow but it is now at the point where I notice it every night and it is getting worse. Did not blinking normally over a long period of time mess up my brain's signals to my tear producing glands?

According to a National Institute of Occupational Health and Safety study, "nearly 90% of employees who work with computers for more than three hours a day suffer from some form of eye trouble. ... blinking is the key. When computer users sit in front of a screen for an extended period of time, they blink less causing eye moisture to evaporate. The result is often a condition called dry eyes which manifests itself in numerous ways including itching, burning, double vision, color fringes and heavy, blurry, gritty or fatigued sensations. " - 34

Computer Use Tips

ACTION: Avoid glare. Never keep a bright light directly behind the screen, and never place a terminal in front of a large window.

ACTION: Do not work in the dark. The contrast between computer-generated light and lack of background light strains eyes.

ACTION: Break at least once an hour for about 10 minutes and blink frequently.

Dry Air

Dry air-conditioned air brings out the worse in dry eyes.

ACTION: Get a hygrometer at Radio Shack to measure humidity in your room.

Humidifier

ACTION: Get a humidifier and give it an honest try. Moisture in the air makes dry eyes less painful. One person writes: "I have found that having a humidifier in the bedroom helps keep me from waking up in the middle of the night with painful eyes. The humidifiers that put out extremely fine mists seem to work best. I have a Bionaire Clear-Mist 3S"

Warm Washcloth

ACTION: Steam your eyes for several minutes several times per day to loosen up the glands. This is annoying to have to do but it really helps some people! Some recommend alternating hot and icy cold washcloths.

Eye Exercises

One exciting possibility is that anyone can heal dry eyes by learning new eye habits. There is a book with a few exercises I've been trying, but it is too early to tell if they are helping my dry eye problem. ( I did improve my prescriptionby .25 diopters in just 20 days, but the eyes are still dry. Since doing these exercises the daytime dryness has gone away and my problem is only noticeable during the night. )

ACTION: Forced Blinking: Stimulate the tear ducts by squeezing your eyes shut tightly. Blink normally a few times, then squeeze again. Repeat and your eyes will feel more relaxed and comfortable as you replenish the tear film.

ACTION: Light therapy: Bathe eyes for a few minutes with a 150 watt light bulb a few feet from your CLOSED eyelids. Feel the light and heat. This will stimulate blood flow to the eyes so they can heal.

ACTION: Hot / Cold Compress: Alternate very hot and icy cold washcloths about a minute each for 3-5 minutes each night.

ACTION: Massage Eyelids: Wash hands well, then rub eyelids from inside near nose to sides of face to stimulate tear ducts.

ACTION: Eye Rolls: Roll eyes slowly in circles for a few minutes. Building up the muscles that move your eyes is important. A Dr. Bates believed that these muscles change the shape of your eyeball to help you focus. True or not, if you feel soreness when you roll your eyes, this is a sign that you have eye strain (probably from computer work).

ACTION: Pressure points: With your thumbs, find the two bumps under your eyebrows and apply light pressure in pulses for several minutes. Again, if they are sore, your eyes are overworked. These bumps are where muscles that move your eyes overlap. Also massage the bridge of your nose and then around the rest of the eyes.

ACTION: Eye Pushups: Find a place where you can see very far away, and alternate near and far looking every few seconds for several minutes. Many computer users fail to look far away. Over time, this causes your eye muscles to cramp and atrophy.

 

Immune System Problems

 

Colostrum - Spectactular Improvement of Severe Dry Eye

This is exciting:

- Bull Soc Ophtalmol Fr. 1982 Jan;82(1):15-6. Spectacular improvement of severe dry eye syndrome by instillation of colostrum [Article in French] Liotet S, Perrin D.

"Bovine Colostrum is the "mother's milk" taken from dairy cows during the first 24 hours after calving. The liquid is characterized by a high protein, immunoglobulin and antibody content, with immune and growth factors that are highly bio-available to humans. Colostrum also contains high concentrations of leukocytes, protective white cells which can destroy disease-causing bacteria and viruses."

Sounds good, but since I'm doing everything possible to avoid mad cow disease, I'd rather find another solution. It turns out, there is one, in everyone. 
ACTION: A new human mother produces colostrum as well, but only right after giving birth. If you had the right connections, you might be able to get some of this, refrigerate it, and use it as eye drops. I think this would be safer and cheaper than buying colostrum pills at the local health food store.

 Autologous Serum

Dr. Kazuo Tsubota in Japan reports a case where he performed a routine lacrimal gland biopsy in the process of diagnosing a 56 year old woman. Unlike his other 200 successful sample collections, however, this one bled for several hours and the woman was admitted to the hospital. :The bleeding finally stopped and the next day the woman reported "Doctor Tsubota, my eye isn't dry anymore" . The doctor checked and "there was no staining at all. .. Her drey eye had been cured."  The doctor concluded that the cure resulted because "essential tear components, such as EGF or vitamin A, were provided by the serum of the hemorrhaging blood."

Your blood, minus the red blood cells, contains may components as healthy tear film. Proteins (Lysozyme, Lactoferrin, Albumin, IgA, IgG, etc.) Growth Factors (EGF, TGF), Vitamins (A, C), Antioxidants (Tyrosine), Carbohydrate (Glucose), Electrolytes (Na+, K+, Ca2+, Cl-, HCO3-, No3-, Po4(3-), S04(2-)).  Dramatic improvement has resulted from creating eye drops from one's own blood. 

Method: "A total of 40 ml of blood is collected by veniuncture and centrifuged for 5 minutes at 1500 rpm. The serum is carefully separated in a sterile manner and diluted with sterile saline to 20%. The final preparation is aliquoted into 5 cc bottles with UV light-protection, because vitamin A is easily degrated by light. Perservative-free antibiotics must not be added to the serum. Patients are insructed to keep the bottle in a dark and cool place while using it. Serum drops are applied six to ten times a day. ... iit is recommended that paties use their autologous serum within 1 month when stored in a refrigerator, and within 3 months when stored in a freezer. " 72

This is not a sure fire solution, but Dr. Tsubota reports, "Our recent study showed improvements in many SS dry eye patients after using autologus serum for 1 month."

ACTION: If you are suffering greatly and don't mind needles, find a docotor willing to try this treatment. 


Allergic Reactions

 

Sugar

ACTION: Stop Sugar. "Avoid sugar and/or artificial sweeteners: Consumption of more than 11 teaspoons of sugar a day has been linked to dry eye syndrome (a single can of soda contains approximately 9 teaspoons of sugar. Sugar is hidden throughout processed and refined foods including cereals, ketchup, and salad dressings." I gave up sugar a few years ago and it has helped. I still eat honey and fruit.

Toxic Fats

ACTION: Toxic Fats. "Avoid the toxic fats (hydrogenated and transfatty acids) in commercial red meat, dairy products, fried foods and hydrogenated oils (such as margarine, most chips, and shortening). These fats interfere with the proper metabolism of essential fatty acids in the body and are indirect causes of dry eye syndrome. Eat organic or free range whenever possible."

Caffeine

ACTION: Stop Caffeine. One person wrote, "If you wake up in the morning with dry eyes and mouth you are likely ingesting too much caffeine. I fixed my dry problems by cutting the caffeine." Sources of caffeine include coffee, tea, soft drinks, cocoa and chocolate, drugs like NoDoz, Weight-control drugs like Dexatrim, Dietac and Prolamine. - 35

Smoking

ACTION: Give up smoking, get away from all 2nd hand smoke. "Cigarette Smoking Increases Lupus Risk. Smoking cigarettes increases risk of developing lupus -- but quitting cuts that risk, new research shows. The toxins can potentially interact with DNA, causing genetic mutations and gene activation leading to development of autoimmune diseases." WebMD 03/04/04.

"... secondhand smoke contains ammonia, hydrogen cyanide, isoprene, lead, methyl ethyl ketone, nickel, acetone, nicotine, nitric oxide, benzene, phenol, butyraldehyde, cadmium, pyridine, carbon monoxide, chromium, styrene, tar and formaldehyde, to name a few." - airpure

 

Decongestants

ACTION: Avoid decongestants / antihistamines. Several people have reported dry eye problems to me after using flonase. I think my eyes got worse after my doctor had me on oral Sudafed 3 times a day for several weeks due to an ear infection. One person writes, "flonase, after six months my nose was completely clear and has been ever since (though I only used flonase for those six months). The problem is, I also developed this sleepy dry eyes condition." My ophthalmologist was certain there was no connection between my ear infection and my dry eyes.

Drug Reactions

ACTION: Avoid drugs that may cause dry eyes. Dry eyes may at times be the result of adverse reactions to drugs such as diuretics, oral contraceptive pill, drugs with antimuscarinic effects (e.g. antihistamines, tricyclic antidepressants, atropine derivatives), or beta-blockers. - 38

 

 

 

Nutrition

Fish Oils

ACTION: Eat fish or take Fish Oils. The blepharitis and meibomitis components of dry eye syndrome involve inflammation. Numerous double-masked, controlled, peer-reviewed studies have shown fish oils reduce inflammation. and work to treat rheumatoid arthritis. Fish oils amplify the effects of flaxseed oil and contain the profoundly anti-inflammatory ecosanoid called ecosapentanoic acid (EPA) as well as docosahexaenoic acid (DHA).

Flaxseed Oil

ACTION: Take 1 to 3 tablespoons of organic Flaxseed oil per day. Get the refrigerated kind and keep it away from light and heat. Americans are typically starved for omega-3 essential fatty acids. Meibomian gland secretions of patients with dry eye become thinner and clearer with omega-3 treatment. An improved oil layer further contributes to improved comfort throughout the day. The abundance of the omega-3 fatty acid called alpha-linolenic acid (ALA) in flaxseed oil is converted to the profoundly anti-inflammatory ecosanoid called ecosapentanoic acid (EPA).

Vitamin E

ACTION: Get enough Vitamin E. 1. Acting as an antioxidant and maintains the integrity of oils. 2. long-term supplementation with omega-3 fatty acids, whether from flaxseed oil or fish oil, depletes serum levels of vitamin E.

Tuna Fish

ACTION: Eat Tuna Fish. A huge Women's Health Study of 32,470 female health professionals showed that five or six four-ounce servings of tuna every week lowered the risk of dry eye syndrome by a whopping 66%.

DHA - Docosahexaenoic Acid

DHA (Docosahexaenoic Acid). An Omega-3 fatty acid, DHA is a major building  block of brain and retinal tissue that plays a role in blood clotting, blood vessel  dilation, and the inflammation response.

Amino Acids

ACTION: Be sure you get enough protein. Most Americans do, but if you are a vegan or vegetarian, try taking a good healthy protein powder in a shake daily. A full complement of essential amino acids are crucial to the proper function of the mucin and lipid layers of the tear film.

Leafy Greens

ACTION: Be sure you eat lots of leafy green vegetables (raw spinach, kale, and collard greens).

"Research suggests that individuals whose diets are rich in leafy green vegetables have less risk of AMD. This is thought to be secondary to the intake of a group of carotenoids (colorful pigments) found in high concentrations in certain leafy green vegetables. These pigments are also present in significant concentrations in the macula itself. These carotenoids, known as lutein and zeaxanthin, are antioxidants, which likely play a role in neutralizing free radicals (charged molecules), produced in the highly metabolically active macula. A recent study sponsored by the National Institutes of Health found that individuals who had the highest consumption of vegetables rich in carotenoids, especially lutein and zeaxanthin, had a 43% lower risk of developing AMD than those who ate these foods the least. Vegetables that are rich in these two carotenoids would include raw spinach, kale, and collard greens." ( 52 )

 

Hormone Problems

Hormone Replacement Therapy

I'm fairly young and male, but the following tells me one important thing: hormones can be connected to dry eye syndrome.

"Those red, burning eyes may not be the result of too many hours in front of the computer. If you're a woman past menopause who takes hormone replacement therapy, the treatment could be causing those parched peepers, reports a new study.

The study, appearing in the Nov. 7 (2001) issue of the Journal of the American Medical Association , looked at more than 25,000 postmenopausal women and found that hormone replacement therapy (HRT) could cause as much as a 69 percent increase in risk for developing dry eye syndrome. ( 13 )

Estrogens

Reshearch has shown there are estrogen (female sex hormones) receptors in those in the upper eyelids. "Unlike sebaceous glands elsewhere on the skin, the meibomian glands lack androgen receptors. Estrogen receptors may play a role in modulation of the lipid layer of the tear film, and their activity may be linked to meibomian gland dysfunction and dry eye syndrome. " ( 64 )

This statement about androgen (male sex hormone) receptors is interesting because it seems to contradict other studies.

1) the meibomian glands of rats, rabbits, and humans are androgen target organs and contain androgen receptor messenger RNA (mRNA) and/or androgen receptor protein within acinar epithelial cell nuclei ( 66 | 67 );

2) human meibomian glands contain the mRNAs for both Types 1 and 2 5 {alpha}-reductase ( 9 ), an enzyme that converts testosterone into the potent androgen 5 {alpha}-dihydrotestosterone (DHT) ( 10 );

3) application of dehydroepiandrosterone, an androgen precursor ( 10 ), to the ocular surface of rabbits, dogs, and/or a human stimulates the production and release of meibomian gland lipids and prolongs the tear film breakup time ( 11 );

4) orchiectomy causes a significant alteration in the lipid profile of rabbit meibomian glands, whereas the topical administration of 19-nortestosterone for 2 weeks, but not placebo compounds, begins to restore the lipid pattern to that found in intact animals ( 12 ); and

5) the one common denominator in menopause ( 13 ), aging in both sexes ( 10 , 13 ), and primary and secondary Sjögren's syndrome ( 14 , 15 , 16 ) seems to be androgen deficiency.

Androgens

Androgens are male sex hormones. According to one harvard web site, Dr. David A. Sullivan at The Schepens has found that androgens (which? what concentrations?) regulate the function of the tear-producing glands - the lacrimal and meibomian glands. Increasing these hormones could restore proper functioning to these glands. "We believe that administering androgen topically may serve as a safe and effective therapy for the treatment of dry eye syndromes," Dr. Sullivan said.

"At The Schepens, which has the largest dry eye research program anywhere in the world, biomedical scientists are piecing together the puzzle of dry eye syndrome. They are attacking the problem at the molecular level, tearing apart the tear film, examining layers of cells, learning what makes tears and what goes wrong."

Allergan Inc. initiated Multi-Center Phase II clinical trials in Sept 2001. On May 16, 2003 Allergan acquired all assets of Bardeen Sciences Company, LLC, including "compounds under development and research projects" such as Androgen Tears. ( 19 | 20 ) Androgen Tears is expected to reach the market in 2005 in Europe. ( 21 )

The androgen hypothesis is supported by clinical research. "Our findings show that the meibomian gland is an androgen target organ and that androgen deficiency may promote meibomian gland dysfunction and evaporative dry eye."

A USC team found that when androgens are low, more immune cells migrate into the gland. It appears that simply the presence of immune cells can lead to these cells attacking the gland, and eventually to more serious autoimmune disease.

"androgen receptor protein exists in the human lacrimal gland, meibomian gland, cornea, bulbar and forniceal conjunctivae, lens epithelial cells, and retinal pigment epithelial cells" ( 36 )

"Evaporative loss is due predominantly to meibomian gland dysfunction ...It has been postulated that in MGD a deficiency in androgens results in loss of the oil layer, exacerbating the evaporative tear loss." ( 37 )

Androgens are produced in the ovaries, testes ( Leydig cells in young men produce ), adrenal glands ( walnut sized glands that sit on top of the kidneys ) and fat cells. Androgens include testosterone and dihydrotestosterone (DHT), as well as other hormones that can be converted into testosterone or DHT, including androstenedione, dehydroepiandrosterone (DHEA) and DHEA sulfate." ( 25 | 26 )

Here are some side effects of taking androgens. One study showed that antiandrogen pharmaceuticals and chronic androgen deficiency is associated with meibomian gland dysfunction and dry eye. ( 65 )

Increasing Androgens without Drugs

ACTION: Get off the ATKINS diet: Research suggests that eating a high protein, low carb diet can cramp your testosterone levels. High amounts of dietary protein in your blood can eventually lower the amount of testosterone produced in your testes. Your protein intake should be about 16% of your daily calories. If you're the average 170 pound man eating 2,900 calories per day, you should be eating as part of that 140 grams of protein ... about two (chicken) breasts and a 6 ounce can of tuna.

ACTION: Exercise, workout: squats, bench presses and back rows increase levels more than curls, and tricepspush-downs.

ACTION: Get enough rest: If you don't adequately rest between training sessions circulating testosterone levels can plunge by as much as 40% as discovered by studies at the University of North Carolina.

ACTION: Have MORNING SEX: Scientist in Germany found that simply having an erection causes circulating testosterone levels to rise dramatically and significantly. ( 28 )

ACTION: You might try some WEIGHT LIFTING SUPPLEMENTS: I don't know about long term safety, but this might be worth a try for dry eyes, just for curiosity.

"ZMA Fuel will raise your natural body-producing anabolic testosterone levels by 30%. If you're looking to maximize your gains, try stacking ZMA with high quality Tribulus Terrstris . Tribulus Terrestris increases testosterone levels naturally by increasing levels of another hormone, LH. When LH levels increase, testosterone increases to compensate. What a great combo! Such a stack, along with 7-isopropoxyisoflavone found in Proxylon will enhance the strength/muscle-building potential of your body even further by putting your body in an enhanced anabolic state. The combination of these three products in a stack will safely raise your testosterone levels a total of 90%! If you really want to spike your stack, add the most potent (and least side-effect producing) andro there is... 4-Androstenediol .

4-Androstenediol converts to testosterone at three times the level of regular androstenedione...AND, it doesn't convert to estrogen or DHT. By the time you are finished with the complete 4 product stack, your testosterone levels will have attained the rank of professional body builder ...steroidfree! A regular person has an average testosterone level of 500 ng/dl. After the stack it will be somewhere around 1350 ng/dl!"

Tests

ACTION: Buy a test kits where you send in saliva sample and they check your androgen levels. The test is $40. I wonder if my HMO ophthalmologist will approve this so I don't have to pay for it? Haha. Logic: my tear film tests as braking up quickly. That means there is a problem with the tear glands. Tear glands are attacked by immune cells when androgens are low.

 

Neurological Problems

 

The Neural Arc

ACTION: Don't use your cell phone next to your head. Use speaker phone only or an earplug with a long cable. Reason: cell phones cause brain damage in rats. Brain damage may trigger dry eyes:

The Neural Arc is comprised of the interaction between the corneal sensory nerves, the brain, and the three main tear producing glands in the eye. The corneal sensory nerves send signals to the brain, these signals are then processed, and in turn, sent to the various glands that participate in the production of tears. If the Neural Arc is dysfunctional or damaged, there is a resulting decrease in these signals.

The three glands ( lacrimal, Meibomian and sebaceous) are the manufacturing network for healthy tear production. Each receives signals from the brain independently of the others and the dysfunction of any one can result in dry eye symptoms.

MRI Evidence

A visitor asked me if an MRI would show any damage in the Neural Arc?

I'm not sure. But one study which used an fMRI scan at the Department of Ophthalmology, Tokyo Dental College, Japan 50 found that the "blinking process, especially the rate, appears to be controlled in the orbitofrontal cortex." I think this indicates that fMRI is a valid tool to examine the pathways which control blinking and tear production.

 

 

 

Drops and Drugs

Arthritis Drug Helps Dry Eyes

Note the hormone connection to dry eyes. "For years doctors have known that arthritis and dry eyes usually go hand in hand, and if an arthritis drug (Vioxx) has helped me with my eyes then I am going to let people know. I do not even have arthritis. " This drug is a hormone-like compound that increases metabolic rate and causes weight loss. "... KB-141, works on the same principle as the hormone normally produced by the thyroid." Here is a page with some normal thyroid test ranges. If you have dry eyes, why not have a thyroid test?

 

Restasis

ACTION: You might try Restasis. (I'm wary of anything made by drug companies who make more money by NOT curing you, however.) Your ophthalmologist can now prescribe this drug: "Restasis (cyclosporine) from Allergan is the first therapeutic product aimed at the underlying inflammatory process that is present in dry eye. By preventing T-cell activation, both on the ocular surface and in the lacrimal gland, Restasis maintains homeostasis in these tissues, explains David Power, Director, Global Eye Care Pharmaceutical Marketing." Mine says she wouldn't prescribe this until after I had punctal plugs because it increases tear production and there is no reason to increase tear production if the tears are just going to run away. (?) She also said there are preservatives and other things so you want to use this only when other options are exhausted. One person wrote and said Restasis has not preservatives.

Benzalkonium Chloride

ACTION: Avoid eye drops with Benzalkonium chloride. "Benzalkonium chloride has been shown to be toxic to the corneal endothelium; therefore, the more frequently drops containing benzalkonium chloride are used, the greater the risk of ocular toxicity and irritation." - 38

 

Vitamin A Drops

ACTION: Avoid eye drops or ointments with Vitamin A. "Vitamin A ointment seemed logical, but did not work when tested in a lab. It now appears that this was the result of interaction between Vitamin A and male sex hormones like testosterone, also known as androgens. ... Androgens also appear to control function of the meibomian glands on the edges of the eyelids which produce oil that keeps tears from evaporating. Ubels notes that retinoids usually work against androgens. Examples of this action include such things as drugs like RetinAand Accutane, which contain forms of Vitamin A and are used to treat acne, which is stimulated by androgens. In fact, people who take Accutane often suffer from dry-eyes because the vitamin A in the medicine works not only against the androgens causing oily skin, but also the androgens which help tear glands lubricate the eye." - 39

ACTION: Are you taking too much Vitamin A? If so, cut down. Interesting. Will too much oral vitamin A will suppress androgens? Need to find out of Retin-A and Accutane are topical or oral and if oral, what do they do?

One site says, "Ointments containing vitamin A can help dry eye if it is caused by unusual conditions such as Stevens-Johnson syndrome or pemphigoid." - 44

Physical Actions

Punctal Plugs

I have not tried these myself. A few people have said they help somewhat, but before you get them, read this post I found:

... As far as the punctal plugs, here is my advice first hand. DON'T GET THEM. this is my opinion. I have been battling all sorts of problems since I had 1 put in in my right eye, in addition to the problems I
had before. The plug has migrated somewhere between my punctum and nose. The following are the problems I have ONLY in the right eye/side of my face. Burning, stinging (Stabbing), infection, sinus infection, tender/red/swollen right nostril, red swollen skin around area, pain, and more. it turns out that the plug used was too small and is no longer accessible to be taken out. So now my only options are either to push it in further into my lacrimal sac (if it's not there already) where I risk infection for the rest of my life, OR get it surgically removed. Both of which suck. Right now I cannot breathe correctly out of my right nostril. I've been to ENT's, Specialists, you name it, and was told that I could be having an allergic reaction causing the swelling. If you wanna try a temporary plug, MAKE SURE you go with the collagen first. they dissolve after about a week or so, but will give you an idea if plugs will help or not. Unfortunately, my doctor told me none of this (Collagen, risk of infection, migration), and I am only finding all this out after the fact. He went straight to silicone, used too small of a plug, even told me to my face right then and there that it was too small, yet he sent me on my way. too bad i
didn't know then what I know now. Now the battle I have is trying to find a procedure (CT scan, Dye x-ray) that can tell me exactly where this plug migrated to before I make a decision to have surgery, push it in further etc.. Anyway, that is my experience. - googlegroups

A Virus?

Sjogren's Syndrome Caused by a Virus?

"TORONTO (CP) - A surprise finding by researchers investigating a suspected link between Type 1 diabetes and multiple sclerosis may help people with a highly irritating condition known as Sjogren's syndrome. The team of scientists from the Hospital for Sick Children has discovered a protein that is critical for the development of Sjogren's, an autoimmune disease that attacks the body's moisture-producing glands."

".. senior investigator Dr. Michael Dosch ... and his team are hopeful that the process which triggers Sjogren's can be turned off - and the damage done by the disease essentially reversed - by vaccinating people who suffer from it. They even have a prototype vaccine they hope can be put into human trials in a year or so. The process works in mice, but more research is needed on the human form before clinical trials can be undertaken.

"It even worked late in the disease and stopped it and even made it go almost normal," Dosch said in an interview. "It comes out of left field. I mean, nobody would have ever guessed." The team is working with Dr. Arthur Bookman, a rheumatologist who runs a Sjogren's clinic at Toronto Western Hospital, to recruit people suffering from the disease. (Bookman is also a co-author of the study.)

They need to do further study of the role of the protein, ICA69, in the human disease to determine whether the reaction to it is the same across the board. They plan to do that by testing blood samples from between 70 to 100 Sjogren's patients. ...

The "trigger is not known, though some suspect it is a virus. Whatever the cause, it prompts the body's immune system to go haywire. Instead of attacking foreign invaders like bacteria and viruses, it attacks ICA69, which is found in moisture-producing glands like tear ducts and salivary and sweat glands. The result: the glands stop working. Excruciatingly dry eyes and dry mouth are only the beginning of the problems. - link

Interesting that both high sugar intake and ICA69 are linked to both diabetes and dry eye syndrome. "Islet cell antigen p69 (ICA69) is a neuro-endocrine protein of unknown function (7-9)." I gave up excessive refined sugar years ago and I still have this problem. I do still eat a lot of white flower and rice, however.

"ICA69 is a self-antigen expressed in brain, pancreas, salivary, and lacrimal glands. ... Disruption of the ICA69 locus prevented lacrimal gland disease and greatly reduced salivary gland disease in NOD mice." - nih.gov Lancet. 2002 Oct 5;360(9339):1063-9.

 

Pollution

Pollution and Dry Eyes

ACTION: Get rid of politicans who allow companies to pollute more to make a buck. (If you have dry eye syndrome and you vote for Bush, you are pretty much jabbing yourself in the eye).

Certain environmental toxins can interfere with the endocrine (hormone- producing) and reproductive systems to a degree that merits public concern. Environmental pollutants that can mimic the hormone estrogen include DDT, DDE, kepone, heptachlor, PCBs, dioxin, and break-down products of detergents. Many of these compounds can be carried for long distances through air pollution (from municipal solid waste incinerators, cars) and then deposited into soil and water, and eventually into the food chain. 


Dioxin

Dioxin, one of the most toxic chemicals in the environment, is capable of blocking estrogen action, lowering levels of androgens (male hormones), and affecting the amount of thyroid hormones produced.
http://www.nutramed.com/environment/airpollutionintro.htm

http://www.monitor.net/rachel/r508.html

Airborne dioxin eventually makes its way into the food chain, concentrating especially in fish, a favorite food of the Japanese. There is a blood test for dioxin. As proposed for the United States, people should consume no more than 0.01 trillionths of a gram per kilogram (of body weight?)
http://www.lexingtonma.org/swat/Sep0398N.htm

Dioxins are produced when chlorinated products ( weed killers, paper bleached with elemental chlorine and polyvinyl chloride (PVC) plastic) are made and again when these products are burned.

 

Bisphenol A (BPA)

The chemical bisphenol A or BPA is a xenoestrogen (hormone disrupter). BPA is one of the most commonly used plastic materials. It is found in all kinds of common products, mostly in polycarbonate plastics. Nearly all plastic baby bottles in the U.S., many common food containers, water storage bottles, aluminum can linings, and even some kinds of dental sealants. It is ubiquitous, one of the top 50 chemicals in production.

According to the Los Angeles Times, two billion pounds of Bisphenol A are used yearly and at least one study has linked it to severe birth defects.

"Bisphenol A can also act as an anti androgen blocking the action of dihydrotestosterone in a yeast screen containing a human androgen receptor (Sohoni and Sumpter, 1998). In this screen bisphenol a was approximately as potent as flutamide, a well known anti-androgenic chemical." - lineone

BPA does not bind to normal androgen receptor known as AR-T877A, but BPA induces androgen receptor activation according to one study.

ACTION: Get new glasses.

WHY: If the lenses and frames of your glasses are made of polycarbonate plastic and they are yellowing a bit this could be a problem. Old polycarbonate leaches much more rapidly than new polycarbonate. Mine are "High Index Plastic" and I've had them for two and a half years. They are yellowing. Today, 3/25/04, I replaced the nose pads which were also yellowing and I ordered some new glasses.

ACTION: Don't eat food heated (e.g., microwaved) in polycarbonate containers.

WHY: The hotter polycarbonate gets, the faster bisphenol A leaches out of it. Other than the "eggmit" bagels at Noah's I've been avoiding microwaved food for a long time. Microwave in glass or ceramic.

ACTION: Stop drinking from plastic water bottles.

WHY: bottled water may be packaged in polycarbonate plastic. (A #7 recycling code on the bottom of some containers like large water bottles in water dispensers, indicate that they are made of polycarbonate.) Use glass, ceramic and metal containers. This is pretty hard to do. I've been drinking at least two bottles of plastic water per day for the last year or more.

My dry eye problem has gotten worse and I've been drinking out of plastic regularly. It got better when I drank only out of glass. Coincidence? I'll have to switch again to see how it goes.

ACTION: Move.

WHY: For the past few years I've lived by a freeway and a plastic recycling plant.

"The effect we saw is pretty dramatic," Hunt tells WebMD. "We were stunned by how low a dose it took. I am becoming pretty convinced there are significant effects [of BPA] at pretty low exposures. I can't say how scared you should be because our studies don't say anything about humans. But that's why we study animals. We assume the processes are pretty well the same in humans." ( 40 )

According to one study, 2 ng/g or 20 ng/g of body weight is an environmentally relevant concentration of BPA. ( 41 )

Well, I moved, but my condition has actually gotten worse since I moved farther from the freeway and into an area with a lot of old oak trees. Got tested and had an allergy to oak. Moved again, but still have the problem.

ACTION: Check with dentist about sealants used.

WHY: "Some plastic dental sealants leach bisphenol A, others do not. According to some estimates, the use of bisphenol A in sealants is declining and no sealants currently recommended by the American Dental Association leach BPA. Ask your dentist about the details of the sealants he/she is using." ( 42 )

Trees and Isoprene

ACTION: Get away from oak (esp. English oak ) and poplar trees. I moved away from a plastic processing plant and into an aprtment with a lot of oak trees and my eyes got worse.

Some trees can produce "huge amounts of a hydrocarbon called isoprene, which dominated in the formation of ozone." This does not mean trees themselves cause pollution because, "isoprene can only form ozone when it combines with nitrogen oxides emitted from cars, industry and power stations. The Lancaster University research also shows that some trees help to clean the air of ozone and nitrogen dioxide." - chenna

"According to research in 2004 by the UK Natural Environment Research Council (NERC), isoprene is released by vascular plants in extreme hot weather, catalysing the conversion of nitrogen oxide, an atmospheric pollutant, to ozone , a gas that irritates the lungs, particularly in asthma sufferers." - wiki

"Live oaks ( Quercus fusiformis (Small) Sarg. and Q. virginiana Mill) are major emitters of isoprene in the southern United States" - duke.edu

Since tears are caused by hormones, might isoprene in the air have some negative effect? "Many biologically important molecules, such as abscisic acid (a plant growth regulator), cholesterol (a component of cell membranes), natural rubber, oestrogen (a female sex hormone), retinal (a photochemical pigment in the mammalian eye), and testosterone (a male sex hormone), are based on a repeating five-carbon unit known as isoprene." - wissen

Even if isoprene in the air has no effect, the ozone it produces may. Ozone, along with dust, solvent fumes, etc. are environmental strains that can cause dry eyes. - augen

 

More ideas

One article mentions these things: all-trans retinoic acid, pilocarpine, bromhexine chloride and eloisin. Anti-inflammatory medications, such as steroids, antimetabolites and cyclosporine A, as well as tetracyclines and hormones, are used to treat more severe forms of dry eye. Surgical techniques used to preserve tears include punctal cautery, punctal plugs and tarsorraphy.

Interesting, but not sure what to make of it:

1. Abnormal protein profiles in tears with dry eye syndrome. Found decrease in both lactoferrin and EGF proteins. - Am J Ophthalmol. 2003 Aug;136(2):291-9.

RESULTS: After one night of the fish oil, some protein powder, flaxseed oil and the warm washcloth before bed, I woke up without dry eyes. It was raining outside and that made the air more humid. Will have to see how things go over time. Problem continues however on other nights.

Dry Eye Journal

Now on a separate page, here.

Reader Comments

2-16-05: "Something you might try. For me it can be the difference between having it when I wake up or not (already use omega 3's and eye mist)."

A half hour or an hour before bed turn out all the lights and cover any LED lights. Light a couple candles (beeswax has a more gentle glow), and listen to music or an audiobook. Let your eyes roam around as they want.

It may be part of the reason for the dry eye is that when you're asleep your eyes don't move around as much as they should. Too much looking straight ahead at the computer or whatever."- Alan

Cool. Sounds simple. This makes sense. Our eyes move during REM sleep when we dream (every 90 minutes after you fall asleep), but not much otherwise. I'll give it a try tonight and report back tomorrow. I love hearing what has worked and what hasn't for others with this problem.

References

Now here.

 

 

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