Segment 10 A - What we know about inflammation…
Segment 10 A
What we know about inflammation - and what to do if you already have too much inflammation.
Apart from avoiding inflammation - by eating healthy, taking anti-inflammatory supplements like Omega Oils 3-6-9 and by keeping eyelids free of harmful levels of germs, there are also more prescriptive ways to help, too. The glands making our tears are very sensitive to inflammation and too much of it will first shut them down - and then it will damage them.
Water-producing glands appear to be especially sensitive, and when dry eye doctors measure your volume, most of a healthy tear is water - so low volume means we have Aqueous Tear Dysfunction or ATD (and inflammation can aggravate MGD or Meibomian Gland Dysfunction, too).
To make more water, we usually need to drink more water, as well as to reduce water loss from things like caffeine, alcohol and other so-called “diuretics.” We also can help by reducing inflammation with prescriptive eye-drops and certain treatments.
Anti-inflammatory prescriptive drops include those in the USA, containing cyclosporine as is commonly found in Restasis, Cequa, and Klarity-C. Another, newer class is Lifitegrast, found in Novartis’ (formerly Shire’s) name brand product called Xiidra. So far, we don’t have good studies comparing one drop to another, but each product has unique properties that may give them an edge over the other for certain patients. What they share in common is the ability to reduce some of the inflammation related to - and commonly causing - dry eye disease (remember the “vicious cycle”).
Another class of anti-inflammatory, prescriptive drops, include the “biological” drops utilizing human or human-like products. These include Amnion fluid-derived products (Regener-Eyes and StimulEyes are two), where amnionic fluid (the fluid around a human baby while in the mother’s womb, taken safely at delivery and processed carefully to exclude any transmissible diseases) is then mixed with artificial tears in various concentrations and applied as a prescriptive eye drop. Because these products contain some of the natural, supportive products that keep a baby healthy as it grows in the womb, these can offer similar benefits that also fight inflammation. Another version of this inflammatory biology is called Autologous Serum Tears, (ASTs) which involves taking blood from the dry eye patient, spinning it down to collect the clear fluid (serum in most cases, or platelet-rich-plasma in others) and mixing it with artificial tears (Vital Tears among other companies can help produce these). My clinical experience is that while both are biologic "tear" preparations, the processing that makes amnionic fluids a non-infectious product also negates some of the biologic activity and then they dilute it (in the case of Regener-Eyes, a bit for the Pro and a lot for the Lite), so the end product is a bit better than a standard Over-The-Counter Artificial Tear product. Because ASTs (like Vital Tears) can be concentrated to a customizable level (20-100%) and because it contains what the blood would contain of the patient's own biologic products (Nerve Growth Factor, Epidermal Growth Factor, etc), it is - in my patient base - a stronger and more meaningful product for most. The bigger benefits of the amnion products is the obvious - no need for blood drawing and - depending on the concentration and frequency of application - sometimes lower cost. The obvious problem with the Autologous Serum Tears, apart from cost and blood drawing - is that if a patient has "bad blood" (ie advanced autoimmune, or medications/infections that contribute to poor health) - their blood may be less "helpful". Certain Amnionic Membrane products (either frozen or freeze-dried) can “melt” some of the anti-inflammatory proteins and related substances into the tears as they dissolve, so can be thought of as a biologic contact lens that can function as a higher level of amnionic fluid and these are often used as a “jump start” for severely weakened surfaces of the eye and eye membranes. My primary goal is to help my patients make more of their own "good" tears - so that they can be less dependent (or completely independent) on these other products - but they do have an important place in helping some dry eye-damaged surfaces recover.
Going back to my analogy of the immune system mounting warfare against irritation caused by dryness, we can understand some of the fallout from this artillery fire could cause inadvertent damage to the delicate tear glands. In my next post, I will cover some of my protocols for using these anti-inflammatory tools.