Most Effective Dry Eye Home Remedies

Dry Eye Handbook The Ultimate Dry Eye Treatment

The Dry Eye Handbook is based on extensive independent research over a 10 year period. The publication is ideally suited for everything from mild to severe cases of dry eye. The Dry Eye Handbook has helped hundreds of dry eye sufferers to date, and its appreciated by individuals, larger organisations as well as ophthalmologists. You will learn: #1. How to diagnose your specific case of dry eye most doctors actually have a hard time getting this correct. #2. How to start a proper dry eye treatment dont waste time doing the wrong things, get off to a correct start quickly. #3. The best diet for dry eyes learn what to eat and drink to create the biggest impact on your eye health. #4. The best eye drops for dry eyes find out what eye drops you should use for your specific case of dry eyes. #5. The best supplements for dry eyes find out all there is about anti-inflammatory supplements, oil supplements and much more. #6. The newest treatments find out the best and most innovative treatments for dry eye (constantly updated) #7. How to treat Meibomian Gland Dysfunction find out all there is about the best supplements, eye drops, eyelid scrubs, eyelid massages, heat compresses, removing chalazia and styes and much, much more. #8. How to treat Blepharitis get the details on how to reduce inflammation by using the best supplements, diets, artificial tears, eyelid scrubs and much more. #9. How to treat Aqueous Tear Deficiency if youre suffering from a lack of tears or a incorrect composition of your tears I will show you how to increase tear production, stabilise the tear film and several additional areas that will improve your eye comfort considerably.

Dry Eye Handbook The Ultimate Dry Eye Treatment Summary

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Dry Eye Keratitis Sicca

Tears, because of their lubricating and bacteriostatic properties, are essential for maintaining a healthy cornea and conjunctiva. A deficiency in tear production may result in a dry eye, also known as keratitis sicca. Keratoconjunctivitis sicca is an acquired disorder seen frequently during the fifth decade Some cases of keratoconjunctivitis sicca are related to an autoimmune cause, particularly those patients with dry-ness of other mucous membranes. It also often occurs with rheumatoid arthritis, systemic lupus erythematosus, and Sjogren's syndrome. Initial treatment includes lubrication with artificial tears and ointments to supplement or replace the tear film deficit. In moderate or severe cases, an ophthalmologist may need to occlude the eyelid punctum surgically and perform a tarsorrhaphy to protect the corneal surface. Moisture chambers may also be prescribed. Topical antibiotics are required only if secondary infection occurs. Cyclosporine 0.05 (Restasis) is also useful in...

Delivery Systems For The Anterior Segment

The cornea is the primary route for anterior drug absorption, which is important for the treatment of diseases including infections, dry eye, glaucoma, and inflammations. Medications delivered in conventional eye drops are quickly removed from the eye by tear turnover and reflex blinking. The volume of a drop dispensed from a typical eye drop bottle varies significantly based on the tip design, formulation surface tension and viscosity, and the angle of instillation, but is on average approximately 40 pL. This volume is well in excess of the 20 pL holding capacity of the pre-corneal space, which is regularly filled with 7 pL tear film in an average person. Accordingly, while some of the instilled 40 pL drop is absorbed systemically through the conjunctival stroma, much of the drug spills over onto the cheeks or drains into the nasolacrimal duct, where it flows down the throat and gets swallowed, or enters the systemic circulation through the nasopharyngeal mucosa. As a result, most...

Sjogrens disease chronic urticaria

A double-blind study randomised 20 women with primary Sjogren's syndrome to treatment with androgen (nandrolone decanoate 100 mg fortnightly) or placebo for six months (Drosos etal. 1988). Androgen therapy did not produce any significant improvement over placebo in objective validated measures of xerostomia (stimulated parotid flow rate measurements, labial salivary gland histology), xerophthalmia (Schirmer's I test, slit lamp eye examination after rose Bengal staining) or systemic disease (ESR) although the subjective assessment ofxerostomia by patients and physicians as well as overall patient's well-being assessment were significantly better on nandrolone. Virilisation was reported in nearly all nandrolone-treated women with this relatively high androgen dose but none discontinued for this reason. Again these studies reinforce the observations that androgen therapy may significantly improve feelings of well-being regardless of the underlying disease activity.

Plummers Disease Toxic Multinodular Adenomatous Goiter

Adenomatous Goiter With Cystic Change

A recent study suggests that patients treated with high doses of 13II, such as those needed for Plummer's disease, may have xerostomia and xerophthalmia that persist for several years after therapy.53 Seventy-nine patients were treated between 1990 and 1995 with a dose ranging from 25 to 100 mCi. The numbers of patients who reported xerostomia 1, 2, and 3 years after therapy were 33 , 20 , and 15 , respectively. The most common symptoms were dry mouth and abnormal taste oral ulcers and sialadenitis were also reported. One explanation is that salivary glands and lacrimal tissue have sodium-iodide transporters. Induction of an autoimmune lacrimal gland dysfunction, similar to that in Sjogren's syndrome, may also occur.

Clinical Manifestations Of Sjogrens Syndrome

Sjogren Swollen Salivary Glands

Most patients with Sjogren's syndrome develop symptoms related to decreased salivary gland and lacrimal gland function. Primary Sjogren's syndrome patients generally complain of dry eyes, often described as a sandy or gritty feeling under the eyelids. Other symptoms such as itching of the eyes, eye fatigue, and increased sensitivity to light can accompany the primary symptoms. Many of these symptoms are due to the destruction of corneal and bulbar conjunctival epithelium and come under the diagnosis of keratoconjunctivitis sicca. This disorder is assessed by tear flow and composition. Tear flow is measured using the Schirmer test, while tear composition can be determined by tear break-up time or tear lysozyme content. The Schirmer test is considered positive when filter paper wetting of less than 5 mm occurs in 5 minutes, and suggests clinically significant keratoconjunctivitis sicca (Moutsopoulos 1993). There are, nonetheless, numerous false positive and negative results, such that...

Structure and Physiology

Senile Loss Elasticity

As a result of a reduction of orbital fat, the eyes appear sunken. Laxity of the eyelids, or senile ptosis, often develops. Ectropion or entropion may develop, caused by the lower eyelid's falling away or falling inward, respectively. There may also be a clogging of the lacrimal duct, resulting in epiphora, or tearing. Fatty deposits in the cornea may produce an arcus senilis, seen in Figures 10-53 and 10-54. Inadequate production of mucous tears by the conjunctiva may predispose persons to corneal ulcers, exposure keratitis, or dry eye syndrome.

Pharmacologic Therapy

Regardless of the cause, the mainstay of treatment for dry eye is artificial tears. Artificial tears augment the tear film topically and provide relief. If a patient uses artificial tears more than four times daily, recommend a preservative-free formulation. Preservative-free formulations are also appropriate if the patient develops an allergy to ophthalmic preservatives. Artificial tears are available in gel, ointment, and emulsion The oral cholinergic agonists pilocarpine and cevimeline are used for patients with combined dry eye and dry mouth (e.g., Sjogren's syndrome) or severe dry eye. By binding to muscarinic receptors, the cholinergic agonists may increase tear production. Excessive sweating is a common side effect with pilocarpine and may limit its use (Table 63-12).

Nonpharmacologic Therapy

Behavioral and environmental modifications may significantly improve dry eye, especially in mild cases. Evaluate the patient's environment for air drafts. Consider adding a humidifier in low-humidity areas. Schedule regular breaks from computer work or reading. Lower the computer screen to below eye level to decrease lid aperture. Evaluate medication profile and therapeutically substitute medications that do not exacer- bate dry eye. Spectacle sideshields or goggles may reduce tear evaporation. If pharmacologic and other therapies are not sufficient, punctal occlusion or lateral tarsorrhaphy may be an option. Punctal occlusion is the plugging of the punctal drainage sites with collagen (temporary) or Silastic (permanent) plugs. Lateral tarsor-rhaphy sutures portions of the lid margins together to decrease evaporative tear loss. These procedures are reserved for severe cases of dry eye secondary to other diseases.1

Nutritional Deficiencies and Disorders

Xerophthalmia or night blindness due to vitamin A deficiency is common in the Middle East and North Africa. Lack of vitamin A also lowers resistance to infection. For example, keratoconjunctivitis occurring in a child deficient in vitamin A increases that child's susceptibility to chronic trachoma. Also, in Libya bacterial infections rise during the autumn date harvest when flies proliferate combined with vitamin A deficiency, an eye infection may lead to serious complications - rupture of the cornea and prolapse of the iris - and blindness (Kanter 1967). Night blindness has been reported in Iran and among sedentary communities of the northern Sahara in North Africa (May and Jarcho 1961 May 1967 Benenson 1975). Rickets, on the other hand, has been observed in large towns of Iran, Syria, and Egypt where infants were swaddled and therefore not exposed to the sun. In North Africa rickets was reported in the sunless slums of coastal cities in Morocco, Algeria, and Tunisia and among...

Highaltitude Retinal Hemorrhage Clinical Summary

Retinal hemorrhages are common above 5200 m (17,060 ft) and are not always associated with acute mountain sickness (AMS). High-altitude retinal hemorrhages (HARH) are rarely symptomatic, but if found over the macula, these hemorrhages may cause temporary blindness. The diagnosis can be established by ophthalmoscopy. Without visualization of the lesion, the differential diagnosis of unilaterally decreased vision or blindness at high altitude includes migraine equivalent, cerebrovascular accident, and dry eye (often unilateral, due to strong winds), as well as all conditions found at sea level.

Autoimmune Disorders

Sjogren's syndrome is characterized by xerostomia (dry mouth) with or without parotid gland enlargement. Chronic inflammatory cells and lymphocytes infiltrate the glands, leading to fibrosis and atrophy of the parenchyma. Xerophthalmia suggests involvement of the lacrimal gland and causes a gritty or painful sensation of the eye. Primary Sjogren's syndrome involves the exocrine glands, only without association with other connective tissue disorders. Secondary Sjogren's

Chemotherapy agents

Dysfunction may be caused by aging, systemic inflammatory diseases, a decrease in androgen hormones, surgery, ocular surface diseases (such as herpes zoster), systemic diseases, or medications that affect the efferent cholinergic nerves. Decreased tear secretion produces an inflammatory response on the ocular surface called keratoconjunctivitis sicca. This inflammation is a target for new medications that treat dry eye.32,33 Conditions that increase the evaporative loss of tears also worsen dry eye. In addition to environmental causes (Table 63-11), an abnormal blink reflex is a common

Exclusions

Sarcoidosis, preexisting lymphoma, HIV infection, hepatitis virus B or C infection, primary fibromyalgia, and other known causes of autonomic neuropathy, keratitis sicca, or salivary gland enlargement A diagnosis of definite SS requires a minor salivary gland biopsy a probable SS diagnosis can be based on demonstrating decreased salivary function. Exclusions to the diagnosis based on the San Diego Criteria include patients with HIV, primary fibromyalgia, sarcoidosis, preexisting lymphoma, keratitis sicca, hepatitis B or C, or salivary gland enlargement (Box 32-4). Objective evidence of ocular dryness can be obtained by the Schirmer II test, which involves stimulating the nasolacrimal reflex by inserting a cotton swab into the nostril the increase in tear flow is then measured for both eyes (Tsubota, 1991). Rose bengal staining of the corneal or conjunctiva epithelial layer is another objective test. Serologic evidence of SS includes an elevated RF (> 1 320), elevated ANA (> 1...

Saliva

SALIVA IN THE MANAGEMENT OF XEROPHTHALMIA Although dry eyes may occur in relation to dry mouth in conditions such as Sjogren's syndrome, keratoconjunctivitis sicca can occur in isolation. Isolated keratoconjunctivitis sicca is not an uncommon condition and currently there is no satisfactory treatment. Transfer of the submandibular gland duct into the lacrimal basin was first undertaken in 1986 (Murube-Del-Castillo 1986). The largest series of cases with micro-anastomosis of the submandibular gland vessels to the temporal vessels in the temporal fossa and insertion of Wharton's duct into the upper eyelid is 38 (Yu, Zhu, and Mao et al. 2004). In this series only 5 cases failed, 8 cases had epiphora, which required reduction of the size of the submandibular gland, and 2 cases had ductal reconstruction secondary to blockage. The authors stress the use of scintig-raphy preoperatively to assess the salivary gland function and rule out a Sjogren's disease, and also postoperatively to assess...

Sjogrens Syndrome

Progressive disease characterized by keratoconjunctivitis sicca and xerostomia. Since 1965, it has been defined as a triad of dry eyes, dry mouth, and rheumatoid arthritis or other connective tissue diseases (Daniels 1991). This process may evolve from an exocrine organ-specific disorder to an extraglandular multisystem disease affecting the lungs, kidneys, blood vessels, and muscles (Table 6.1). These features are believed to be the result of immune system activation with the production of various autoantibodies with lymphocyte invasion of the salivary and lacrimal glands and other affected organs. The autoantibodies include those produced to the ribonucleoprotein particles SS-A Ro and SS-B La, and these are thought to interfere with muscarinic receptors (Garcia-Carrasco, Fuentes-Alexandra, and Escarcega et al. 2006). One study identified IgG from patients with primary Sjogren's syndrome containing autoantibodies capable of damaging saliva production and contributing to xerostomia...

Clinical Summary

Jimsonweed (Datura stramonium ) is a toxic plant that contains tropane alkaloids consisting of atropine, scopolamine, and hyoscyamine compounds. Ingestion may occur through the drinking of tea made from the leaves or flowers of jimsonweed or from eating the plant's seeds or leaves. Poisoned victims demonstrate an anticholinergic toxidrome resulting from the antimuscarinic receptor effects of atropine and scopolamine. Patients may exhibit altered mental status, xerostomia, xeroderma, xerophthalmia, blurred vision, mydriasis, tachycardia, decreased bowel and bladder motility, and hyperthermia.