More Dry Eye News (& how do I know if I have dry eye disease?)

While I’ve covered some of this before, I had a dry eye sufferer recently ask me if they had MGD - knowing that they had Conjunctivochalasis (CCH) from another doctor. My answer was like this:

“While testing with fancy equipment is helpful, most doctors can tell by observing how quickly the tears evaporate during their slit lamp exam and then by pressing over the oil glands during the same exam. One less specific but generally helpful way for you to test at home, is to set a stopwatch for 20 seconds and then blink. Start the watch at the moment of your blink and time how your eyes feel over those 20 seconds without blinking. If you comfortably can last the full 20 seconds and your vision doesn’t change, then there’s less chance you have MGD. (My very first post touched on this test here: https://www.eyethera.com/blog/rn9p8ouyjzjhyfpkvrysxjx28no0q8?rq=blink%20test ) In my experience, most people with CCH also have MGD, but every case is different.”

Recently a new “dry eye hack” has come on the study scene that can help address this rapid evaporation - a so called “TRPM8 agonist” that is being studied as an eyelid wipe that can trigger the “Sprinkler System” to create a fuller tear production. “Transient receptor potential melastatin 8” or TRPM8 to those in the know, opens the “ion channels” I described in my posting about how tears are made (I describe ions as “tokens that open gates” in this blog: https://www.eyethera.com/blog/making-tears-part-2?rq=ion where the gates are the so called ion channels). Key to this discussion is how various ions that pass through certain gates can trigger tear production at higher rates. TRPM8 is the gate triggered by the cooling common to evaporation - so a NORMAL response to evaporation, is to make more tears. Since eyes with MGD have accelerated evaporation (because the lack of oil exposes the water of a tear to air - which leads to early and extensive evaporation), one of the common complaints I hear from my MGD patients, is how their eyes “puddle up” when they expose their eyes to cold, dry air.

In a normal eye (without dry eye disease), the healthy tear produced by evaporation would have enough oil floating on top, so as to “seal in” the moisture under that oil and allow a healthy patient the opportunity (should they be so inclined) to continue skiing down the slopes without leaving a trail of salty tears in their wake. Adding a chemical to the lid’s margins - that causes the ion channels to trigger tearing - would create the same effect that the skier encounters (without the skies and without the cold dry air of the slopes). I think this could be a good adjunctive treatment for dry eye patients, but that it would work best if that tear can contain enough “good oil” to act as the natural “shield” that protects this tear from rapid evaporation. Otherwise it seems likely it will spool up the “Reflex Tearing” of the “Firehose.” This means more salty tears that will also rapidly evaporate and potentially leave a patient looking like they are actively crying (when they don’t mean to).

I discussed “Neurostimulation” in an earlier post https://www.eyethera.com/blog/what-is-neurostimulation-for-dry-eye-treatment-and-do-i-need-it?rq=fire%20hose and see the TRPM8 stimulators as a somewhat related version of this. If the oil glands are overly “clogged” then any stimulation of the tear production is liable to produce salty tears that will go on to evaporate and leave more salts behind. Another of my posts goes into more detail about why you don’t want “overly salty tears” here: https://www.eyethera.com/blog/overly-salty-tears?rq=fire%20hose Ultimately, it is crucial to protect, support and encourage your oil glands to do their best. If they work well, then many of the other technologies to stimulate good tear production will help you make good tears!

To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:

(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020

(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463

Also note that past topics I’ve posted on can be easily found by using the “Search Bar” in the blue gauze “mask” on the woman at the top of the Blog Page.