Reduce Stress
Stress increases circulating cortisol, our body’s steroid. This turns down our immune system which should help by reducing inflammation. The problem is that it doesn’t reduce the inflammatory byproducts that call in those defenses, so they can accumulate as our immune system idles. Stress also bumps up blood pressure and fills dilated blood vessels with fresh, hot blood and inflammatory products. Stress is not good, but hard to control. Yoga, meditation and regular exercise can help.
Topical steroids
A common treatment for dry eyes is a topical steroid. Steroids should not be a mainstay of treatment as their side effects include potentially promoting cataracts, increasing eye pressure that may promote glaucoma, and the open the door for infections like HSV, the common cold sore virus). Non-steroidals like Xiidra and Ikervis do have a place as mainstay for some, but the root cause of dry eye still needs to be dealt with.
Antibiotics (oral or Topical)
These have anti-inflammatory properties but can also cause some problems. Oral antibiotics can bind to oils instead of germs, so there will be fewer pro-inflammatory byproducts. Eventually the defenses gradually get the message they are not needed and can back off. The problem with both oral or topical antibiotics is they also can mess with “good germs” as well as bad, and pave the way for antibiotic resistance. Orals can have other side effects, with tetracyclines (Doxycycline) causing abnormal fetal development, sensitivity to the sun, and stomach upset.
Unblocking Meibomian Glands
Meibomian glands in the eye produce meibum, an oily substance that protects the tears from evaporating. In most cases, the meibum is trapped or clogged causing inflammation of the eyelids. Often there is an associated diagnosis of Meibomian Gland Dysfunction. The glands can be unblocked by a treatment called Meibomian Gland Expression.
Omega 3 Oils
Anti-inflammatory omega oils can help prime the Meibomian Glands to make more and better oils. Oil should not be thick and toothpaste like, Rather it should be clear and smooth. Supplements should include Omegas 3,6&9 as they are the “essential” Free Fatty Acids, or “building blocks “ used in making good oils. Taking 1000-3000mg of a fish oil in the Triglyceride form (with a combined EPA/DHA of at least 600mg per 1000mg capsule) is recommended daily for inflammatory conditions. We recommend Lacritec as a supplement.
Keeping lids Clean
Products like Ocusoft Lid Scrub and hypochlorous acid (Ocusoft Hypochlor) can be used for eyelid maintenance and hygeine. Hypochlorous acid has intrinsic anti-inflammatory properties, anti bacterial, and anti microbial properites (and hence is able to kill off Dermodex mites )
Anti Inflammatory Diet
High sugar diets can contribute to inflammation. Alcohol can also increase inflammation bearing products to the skin and eyes. Water intake is helpful at flushing out toxins while aiding hydration. Dehydration leads to ocular dryness which leads to irritation and then inflammation.
Heat
Heat is good for melting blocked or sluggish oils in Meibomian Glands. Warm compresses applied to the outer lid surface must maintain a consistent 40-45 degrees in order for the therapeutic heat to reach the oil glands. The more obstructed the glands, the higher the melting point. Heat needs to be applied for a minimum of 10-20 minutes in order for the heat to pass through anatomical barriers that naturally shield the glands (eyelids). Blephasteam goggles keep the temperature at a controlled 40 degrees when applied as in office treatment. For at home treatment, an eye mask can be effective.