Dry Eye Detective

Some articles describe the three main problem areas that can cause dry
eye:

1. Tears secreted by the lacrimal glands.

2. Lipids made by the meibomian glands in both the lower and upper
eyelids.

3. Mucin from somewhere?

I was diagnosed with dry eye based on irritation and burning symptoms
plus a dye test with a slit lamp. So for the past month I have been
on Restatsis, lubricant drops, warm compresses, lid washing, etc.

The warm compresses seem to work better than anything else in
relieving irritation. Takes 5-10 minutes and the irritation is gone,
especially if I use a lubricant after the warm compress. The relief
lasts a couple of hours and then I have to start the cycle again.

This seems to imply that the root cause of the dry eye is the
meibomian glands. Is this supposition correct? I fit is, then the
Restasis is probably not very useful.

On Thu, 09 Aug 2007 15:57:51 -0400, jay1000 <(E-Mail Removed)>
wrote:

>Some articles describe the three main problem areas that can cause dry
>eye:
>
>1. Tears secreted by the lacrimal glands.
>
>2. Lipids made by the meibomian glands in both the lower and upper
>eyelids.
>
>3. Mucin from somewhere?
>
>I was diagnosed with dry eye based on irritation and burning symptoms
>plus a dye test with a slit lamp. So for the past month I have been
>on Restatsis, lubricant drops, warm compresses, lid washing, etc.
>
>The warm compresses seem to work better than anything else in
>relieving irritation. Takes 5-10 minutes and the irritation is gone,
>especially if I use a lubricant after the warm compress. The relief
>lasts a couple of hours and then I have to start the cycle again.
>
>This seems to imply that the root cause of the dry eye is the
>meibomian glands. Is this supposition correct? I fit is, then the
>Restasis is probably not very useful.

Tear film comprises three layers: aqueous, mucin, and lipid.

Meibomian Gland Deficiency (MGD) causes a reduction in the lipid
(oily) layer of the tear film. This leads to evaporative dry eye
(short TBUT -- or Tear BreakUp Time). This is tear QUALITY. It IS
quite possible, based on your description, that this is what you have,
but it's relatively easily diagnosed by a qualified dry eye doc.

Aqueous deficient dry eye (lacrimal gland insufficiency) leads to low
Schirmer's test scores. This is tear QUANTITY (largely).

Damage to, or dysfunction of, the goblet cells leads to decreased
mucin production. This, too, can cause evaporative dry eye. This is
tear QUALITY.

There are all kinds of dry eye. Restasis CAN be useful, primarily in
aqueous deficient (quantity) issues, but is certainly far from a
guaranteed fix.

My best recommendation would be to visit:

www.dryeyezone.com

Review the introductory material, read the FAQ's, and browse around a
bit. Then join the forum and talk with all of the DES sufferers
there. They're a good bunch.

Tell 'em Neil sent you ;-)

Take care....

Neil

On Aug 9, 3:57 pm, jay1000 <jfschonSpamgu...@cox.net> wrote:
> Some articles describe the three main problem areas that can cause dry
> eye:
>
> 1. Tears secreted by the lacrimal glands.
>
> 2. Lipids made by the meibomian glands in both the lower and upper
> eyelids.
>
> 3. Mucin from somewhere?
>
> I was diagnosed with dry eye based on irritation and burning symptoms
> plus a dye test with a slit lamp. So for the past month I have been
> on Restatsis, lubricant drops, warm compresses, lid washing, etc.
>
> The warm compresses seem to work better than anything else in
> relieving irritation. Takes 5-10 minutes and the irritation is gone,
> especially if I use a lubricant after the warm compress. The relief
> lasts a couple of hours and then I have to start the cycle again.
>
> This seems to imply that the root cause of the dry eye is the
> meibomian glands. Is this supposition correct? I fit is, then the
> Restasis is probably not very useful.

The problem may be excess or too thick oil from the meibomian glands
or not enough mucin produced by goblet cells in conjunctiva. Oil
interferes with the mucin so that the tears don't "stick" to the eye;
solution to the problem is to remove oil or increase mucin.
Inflammation of the lids leads to increased oil release, inflammation
of eye leads to goblet cell malfunction and loss of mucin.

The warm compresses and lid scrubs address the excess oil. Restasis
decreases inflammation and addresses the oil quality, mucin quantity
problem; it also takes 3-6 months for the full effect of Restasis to
be felt so it may be too soon to tell if it is helping.

To test whether Restasis is helping, you will need to take it for
about 6 months, then discontinue for at least 3 months and note the
difference.

Dr Judy

On Thu, 09 Aug 2007 14:25:03 -0700, Dr Judy <(E-Mail Removed)>
wrote:

>On Aug 9, 3:57 pm, jay1000 <jfschonSpamgu...@cox.net> wrote:
>> Some articles describe the three main problem areas that can cause dry
>> eye:
>>
>> 1. Tears secreted by the lacrimal glands.
>>
>> 2. Lipids made by the meibomian glands in both the lower and upper
>> eyelids.
>>
>> 3. Mucin from somewhere?
>>
>> I was diagnosed with dry eye based on irritation and burning symptoms
>> plus a dye test with a slit lamp. So for the past month I have been
>> on Restatsis, lubricant drops, warm compresses, lid washing, etc.
>>
>> The warm compresses seem to work better than anything else in
>> relieving irritation. Takes 5-10 minutes and the irritation is gone,
>> especially if I use a lubricant after the warm compress. The relief
>> lasts a couple of hours and then I have to start the cycle again.
>>
>> This seems to imply that the root cause of the dry eye is the
>> meibomian glands. Is this supposition correct? I fit is, then the
>> Restasis is probably not very useful.
>
>The problem may be excess or too thick oil from the meibomian glands
>or not enough mucin produced by goblet cells in conjunctiva. Oil
>interferes with the mucin so that the tears don't "stick" to the eye;
>solution to the problem is to remove oil or increase mucin.
>Inflammation of the lids leads to increased oil release, inflammation
>of eye leads to goblet cell malfunction and loss of mucin.
>
>The warm compresses and lid scrubs address the excess oil. Restasis
>decreases inflammation and addresses the oil quality, mucin quantity
>problem; it also takes 3-6 months for the full effect of Restasis to
>be felt so it may be too soon to tell if it is helping.
>
>To test whether Restasis is helping, you will need to take it for
>about 6 months, then discontinue for at least 3 months and note the
>difference.
>
>Dr Judy

Thanks for the info. But if the dry eye is better in 3-6 months, there
is no way I'll stop the Restasis to check whether it was the helping
factor.

BTW, in googling Restasis and inflammation I ran across some
interesting info on dryeyepain.com.

"In addition, insufficient production of the "male" hormone androgen
(which, like estrogen, occurs in both men and women) is reported to
impair the function of both the lacrimal and meibomian glands (article
by Dr. Stuart S. Kassan in Sjogren's Syndrome Foundation newsletter,
February 2002)."

My dry eye problems started about six months after starting Proscar.
Proscar does its thing by decreasing androgen, so that might be the
trigger. Do you know if androgen eye drops are available? I'll check
with the eye doc on my next visit, but would still like to know.
Unfortunately, at present, cutting Proscar could be more serious than
dry eye.

Jay