Manuka Honey - How sweet it is (or might be?) for treating dry eyes!
Have you heard of Manuka Honey? Until relatively recently, I had not – but a series of postings in various dry eye forums brought it into focus for me (pun intended). I’ve since learned that it’s a form of honey currently being used to treat a variety of medical issues, from burn and superficial wound care to dental/gum and throat issues, to my favorite topic – blepharitis, dry eyes and ocular surface diseases. It is created from the nectar of Manuka bush (leptospermum scoparium) flowers by unique species of bees (while there are 28 species of bees in native New Zealand, it is said that only one is shared with Australia, which by itself, has over 1,500 species of bees and both countries grow Manuka plants producing this honey).
Manuka is also called a “tea tree” but differs from the tea tree we think of (Melaleuca Alternifolia) when we think of “tea tree oil.” Both types of tea trees are from the myrtle family of shrubs (and can grow into trees) but Mauka has found a niche for its honey, while the “other tea tree” found its niche for its oil. (Not to confuse further, but Manuka can also be distilled for its oil, which is touted for its medicinal benefits in topical treatments but is less pungent than the “other” tea tree oil).
The "Man of Bicorp" holding onto lianas to gather honey from a beehive as depicted on an 8000-year-old cave painting near Valencia, Spain https://en.wikipedia.org/wiki/Cuevas_de_la_Ara%C3%B1a#/media/File:Cueva_arana.svg
Honey and mankind go back untold millennia, with early cave paintings suggesting we gathered it at least 8,000 years ago (see above), but ancient Egyptians (circa 3,500 BCE, https://bugsinourbackyard.org/the-fascinating-history-of-honey/ ) recorded “a large number of practical applications for honey. Citizens used the liquid as a sweetener in food, while doctors capitalized on the natural antibiotic properties of honey to produce salves for healing wounds. Even the mummified benefited from Egypt’s expert use of honey, as many of their sarcophagi were sealed with wax collected from honey producing hives and full honeypots were typically offed to the dead as food during the afterlife. Believe it or not, some mummies were even embalmed in the golden liquid to improve preservation of the body!”
Webmd has a very good article on Manuka Honey, which I will clip and paste in near total, from here:
https://www.webmd.com/a-to-z-guides/manuka-honey-medicinal-uses
They claim: “It wasn't until the late 19th century that researchers discovered that honey has natural antibacterial qualities.
Honey protects the body against damage caused by bacteria. Some honeys also boost production of special cells that can repair tissue damaged by infection. Manuka honey has an anti-inflammatory action that can help ease pain and inflammation.
However, not all honey is the same. The antibacterial quality of honey depends on the type of honey as well as when and how it's harvested. Some kinds may be 100 times more potent than others.
Components of Manuka Honey
Hydrogen peroxide gives most honey its antibiotic quality. But some types, including Manuka honey, also have unique antibacterial qualities. One of the major antibacterial components of Manuka honey is a compound called methylglyoxal (MGO). MGO comes from the conversion of another compound in Manuka honey known as dihydroxyacetone (DHA), a high concentration of which is found in the nectar of Manuka flowers.
The higher the concentration of MGO, the stronger the antibacterial effect. Honey producers have a scale for rating the potency of Manuka honey. The rating is called UMFTM, which stands for Unique Manuka Factor.
The UMFTM rating reflects the concentration of 3 signature compounds found in genuine Manuka honey, MGO, DHA and leptosperin. To be considered potent enough to be therapeutic, Manuka honey needs a minimum rating of UMF™ 10+. However, doctors and researchers aren’t sure if this rating means anything from a medical standpoint.
How Manuka Honey Is Used
The main medical use for Manuka honey is for wound and burn healing. It is generally used for treating minor wounds and burns. Research shows Manuka honey to be effective in treating other conditions, including:
Skin care including eczema and dermatitis
Soothing a cough or sore throat
Digestive Health
But the evidence is limited on whether it works for these conditions.
The honey used to treat wounds is a medical-grade honey. It is specially sterilized and prepared as a dressing. So the jar of Manuka honey in the pantry shouldn’t be part of your first aid kit. Wounds and infections should be seen and treated by a health care professional.” (My bold italic underlining). I should add that I’d say the same regarding use in and around eyes.
More from Webmd:
“What the Science Says About Manuka Honey
Several recent studies show Manuka honey can be helpful when it’s used on top of wounds and leg ulcers. Studies also show it might fight infection and boost healing.
The Natural Medicines Comprehensive Database lists honey as being "possibly effective" to treat burns and wounds. The Cochrane Review notes that honey may shorten healing times in mild burns and surgical wounds compared with traditional dressings. But they also say more research needs to be done.
Another study suggests that Manuka honey may help prevent gingivitis and other periodontal disease by reducing the buildup of plaque. In some studies, Manuka honey seemed to help prevent inflammation in the esophagus caused by radiation and chemotherapy used for cancer.
Another possible benefit of honey is that, unlike antibiotics, it doesn’t appear to lead to resistant bacteria. These so-called "superbugs" develop after repeated exposure to common antibiotics. Special antibiotics are needed to treat them.
Most of the studies on Manuka honey have been with small numbers of people, and so far, research hasn’t shown that Manuka honey helps with high cholesterol or balancing the bacteria in the gut. Furthermore, no major studies have looked at the effect of Manuka honey on cancer, diabetes, or fungal infections.
Possible Side Effects of Manuka Honey
These may include:
Allergic reaction, especially in people who are allergic to bees
A rise in blood sugar if large quantities are consumed
Effects on certain chemotherapy drugs and interactions with various other medicines.”
This brings up the question of how we might use it to treat eyes and eyelids.
Dr. Rolando Toyos posted on use of Manuka honey products for treatment of eye allergies and for dry eyes here: https://toyosclinic.com/blog-feed/optimel-manuka-honey-drops-a-great-option-for-allergy-eyes-and-allergy-with-dry-eyes It appears his centers may be studying it for the allergy application, but to date, I am not aware of any published clinical studies specifically tailored for eye allergy treatment. Still, Dr. Toyos makes a good case for the anti-inflammatory benefits being useful in this capacity and several small studies suggest it can help for certain skin and nasal allergies.
The following testimonial was posted by a dry eye sufferer, who uses “the drop form for keratitis, the gel form for MGD.” The person posting claims to use:
"a match-head sized drop spread on the lower lid margin. It will sting and the eyes will close automatically. Use gel once a day at night. The drops used 1-4 times a day in addition to any other drops."
Others have complained of the burning and stinging immediately following the application of the gel. My response was: “While I've heard that edible honey has been found in the tombs of ancient pharaohs, indicating the degree to which it may resist bacterial degradation, and where I've read articles reporting studies of (in total) several hundred patients who have tried this as a treatment for dry eye disease, I don't have any personal experience with it in my own patients as of yet. I believe the acidic nature of the product is what gives it the natural antibacterial properties, but this same acidity will typically cause stinging and burning on instillation. My general inclination is that too much stinging and burning may trigger inflammation (the body's reaction to irritation) - and though early reports suggest this unique honey may reduce inflammation (as any antibacterial seems to do), because each patient is different, there are likely patients at either end of the spectrum where some will get positive results and others may get negative results. If you are finding it hard to tolerate, then it seems possible you may be in the latter group - but as I always suggest, it is best to consult directly with your own dry eye specialist to find what may be best for you.”
So, is Manuka (or any other) Honey worth using as a dry eye treatment? I’d say the jury is still out on this, but it does appear to be worth considering. A review of the literature suggests we are still constrained by small studies (so far, 300’s-400’s of patients and not the thousands we expect to see in prescriptive medical trials). Looked at through the lens of antiquity, we definitely have a long history of using honeys for medicinal uses – so one might infer that the staying power over this passage of time is perhaps the best testimonial - but eyes are delicate and special – so before I broadly recommend Optimel (or other honey) products, I’ll be looking within my practice and to future studies to better determine who, when and for what conditions I will recommend them. I also won’t go out of my way to discourage my patients from trying them (and hopefully I’ll be able to track their progress to gain more insights into this medical mystery).