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Dry Eye Information Page 2

THERA TEARS


If you have sandy, gritty irritated eyes or burning eyes, and these symptoms get worse as the day goes on, you're probably one of the millions with the problem eye doctors call "dry eye." 
Now, after years of research, the good news is that we finally understand dry eye, and there is something you can do about it. 

 

Why Does Your Eye Need Tears Anyway?

Did you ever wonder why the eye is covered by tears? It's because the delicate living tissue on the surface of your eye has no blood supply-it has a tear supply instead. So rather than getting important things like oxygen and electrolytes from the blood, your eye surface gets them from the watery layer of your tears. 

 

What Happens In Dry Eye? 

In dry eye the tear film on the eye surface loses water because of either decreased tear production or increased evaporation. And as evaporation continues throughout the day, your eyes feel drier and drier. 

 

What Causes Dry Eye? 

The most common cause of dry eye is aging. As we get older we produce fewer tears, and evaporation increases. Other common causes include contact lens wear, sun, wind, dry air, reading, computer use and certain medications. Dry eye is seen with certain diseases such as Sjögren's syndrome as well. 

20 Years of Clinical Research, testing and development by an eye physician focused on one goal: to develop an effective medication for dry eye. The result: a medical breakthrough called TheraTears.

TheraTears has the extra water needed to rehydrate the tear film and quench dryness of the eye, and the patented electrolyte balance that promotes natural healing and provides dry-eye relief.
Preservative-free TheraTears Works Two Ways:

Hypotonic - More Moisture Per Drop
Each drop of TheraTears contains extra water, relative to its other ingredients, to more effectively quench dryness of the eye.

Patented Balance of Electrolytes
The eye surface depends upon the tears for a special balance of electrolytes. By providing your eyes with this electrolyte balance, and the extra water needed to rehydrate your tear film, TheraTears creates the environment needed to promote natural healing and provide dry-eye relief.

TheraTears in preservative-free single-use containers is designed to saturate dry eyes, providing the dosing that is ideal for very dry eyes. For maximum hydration and relief of dryness, doctors may recommend saturation dosing--splitting the entire contents of one container, in both eyes within a 5-minute period after opening at least 4 times a day.



TheraTears Liquid Gel is a thicker version of TheraTears that is perfect for night time, or for those who need a longer-lasting protective film during the day. Because TheraTears Liquid Gel is so long-lasting, it is formulated without a preservative so that unlike preserved gels, there never needs to be a concern regarding preservative-induced irritation. And because of its patented electrolyte balance, you will never experience the "electrolyte imbalance toxicity" you may get from other products..

 
TheraTears Nutrition for Dry Eyes (Omega-3 supplement with EPA and DHA-enriched flaxseed oil) provides the foundation for every dry-eye treatment program. The oil glands in the eyelid are critical to tear film structure and eye comfort. TheraTears Nutrition for Dry Eyes provides a special blend of pharmaceutical grade Omega-3 essential fatty acids that your eyes, lids and tear film need to function their best, but your body cannot produce. And most of us don't get enough Omega-3s from our diet. TheraTears Nutrition provides these Omega-3s for eye comfort upon awakening and continued eye comfort throughout the day.*


Whatever the cause for your dry eye (for example, wind, sun, age, surgery, contact lens wear, computer use, medication side effects), and no matter how mild or severe, your dry eye just doesn't stand a chance when you use the TheraTears treatment program.
TheraTears in preservative-free single-use containers is designed to saturate dry eyes, providing the dosing that is ideal for very dry eyes. For maximum hydration and relief of dryness, doctors may recommend saturation dosing--splitting the entire contents of one container, in both eyes within a 5-minute period after opening at least 4 times a day. 

*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease.

Each 2 softgels contain 100 IU of Vitamin E, 500 mg of Flaxseed Oil, 225 mg of EPA (Eicosapentaenoic Acid from Fish Oil) and 50 mg of DHA (Docosahexaenoic acid from Fish Oil). Two softgels provide 10.2 calories. 
Treating Dry Eye Will Never be the Same

How an EPA-enriched Flaxseed Oil Supplement Treats Dry Eye (by Jeffrey P. Gilbard, MD )

By decreasing inflammation, and augmenting the oil and water layers of the tear film, omega-3 supplementation with EPA-enriched flaxseed oil promises to provide the foundation for a broad spectrum of dry eye treatment regimens.

Omega-3s are essential fatty acids that your body can't produce. Your body must obtain them from your diet. Unfortunately, the Western diet is deficient in Omega 3s. we just don't eat enough salmon and other cold-water fish. It has been estimated that 83% of Americans are deficient in Omega-3s. The two best sources of Omega-3s are fish oil and flaxseed oil, and Omega 3s have a multitude of health benefits.

Omega-6s are another group of essential fatty acids. Americans obtain an excess of these through their consumption of beef, dairy, vegetable cooking oils, and vegetable shortenings (i.e. cookies, potato chips, snacks etc.). While the ideal dietary ratio of Omega-3s to Omega-6s is about 1:1, the existing ratio in the American diet is about 1:20. Let's have a closer look at how Omega-3s address the root causes of meibomitis and dry eye.

Omega-3s and Dry Eye

First Mechanism-Decrease Inflammation

Once eaten, Omega-3s are acted upon by enzymes in the body to produce prostaglandin E3 (PGE3) and leukotriene B5 (LTB5) (Figure 1). These are two eicosanoids * that decrease inflammation. In addition, and perhaps more importantly, Omega-3s have been shown, in cartilage, to produce a dose dependent decrease in the gene expression and activity of proteoglycan degrading enzymes (aggrecanases), the gene expression of pro-inflammatory interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), and cyclooxygenase (COX-2) (Figure 2). There is an abundance of clinical evidence that ingestion of Omega-3s decreases the inflammation seen in the joints in rheumatoid arthritis3-6 and in the skin in dermatitis as well.7 Not surprisingly given the cartilaginous tarsal plate, reports are emerging to indicate that consumption of Omega-3s decrease the inflammation of meibomitis.8 As a result, meibomitis patients taking Omega-3 supplements have experienced relief from eye irritation upon awakening in the morning.

*Eicosanoids are oxygenated fatty acids that act as local hormones that act near their site of synthesis. Eicosanoids are derived from arachidonic acid (AA), dihomo-gamma-linoleic acid (DGLA) and eicosapentaenoic acid (EPA). 


Second Mechanism-Augment Oil Layer

Second, essential fatty acids are used by the meibomian glands in the eyelid to manufacture the oil layer of the tear film. HPLC/mass spectrometry studies have shown that the polar lipid profiles of meibomian gland secretions in female Sjögren's patients are controlled by the dietary intake of omega-3 essential fatty acids. Patients with high intakes of omega-3s show a single-prominent-peak polar lipid pattern whereas patients with low dietary intake show multiple smaller peaks. 9 It seems reasonable to surmise that dietary omega-3s are being utilized in the production of meibomian secretions and are contributing to and augmenting the tear film oil layer. Clinical reports have observed clearer and thinner oils with omega-3 treatment.8 With an improved supply of Omega-3s, the oils produced by the meibomian glands flow better and therefore create a better oil layer covering for the tear film. The improvement of the oil layer provides dry-eye relief for patients with meibomian gland dysfunction.


Third Mechanism-Stimulate Tear Secretion

The essential fatty acid metabolic pathways are dynamic, complex and interrelated. Levels of certain omega-3s for example, can influence activity in the metabolism of omega-6s. The most important example of this is the activity of eicosapentaenoic acid (EPA) (Figures 1 and 2). It is EPA that has been shown, in cartilage, to produce a dose dependent decrease in the gene expression and activity of proteoglycan degrading enzymes (aggrecanases), the gene expression of pro-inflammatory interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), and cyclooxygenase (COX-2) (Figure 2). In addition, EPA also inhibits the arachidonic acid inflammatory cascade (Figure 2). But EPA plays another role as well. Specifically, EPA competitively inhibits the conversion of DGLA to arachidonic acid (AA), and in doing so, promotes the conversion of DGLA to PGE1. Why is this desirable? First, PGE1 has anti-inflammatory properties,10,11 further helping to reduce meibomitis and associated ocular surface inflammation. More importantly, PGE1 acts on G protein-coupled receptors designated E-prostanoid or "EP" receptors. Specifically, PGE1 binds to EP2 and EP4 receptors to activate adenylate cyclase to increase cyclic AMP (cAMP).12 PGE1 has been shown to stimulate aqueous tear production in rabbits,13 and cAMP has been shown to stimulate aqueous tear secretion in dry eye patients.14,15


There have been some attempts to treat dry eye with the omega-6 essential fatty acid gamma linolenic acid (GLA) found in black currant seed oil, evening primrose oil and borage oil. There are two published studies that concluded GLA was not effective in treating dry eye.16,17 Moreover, there are risks in long-term GLA and omega-6 supplementation related to the accumulation of arachidonic acid (inflammation, thrombosis and immunosuppression).18-20

By decreasing inflammation, and augmenting the oil and water layers of the tear film, omega-3 supplementation with EPA-enriched flaxseed oil promises to provide the foundation for a broad spectrum of dry-eye treatment regimens. Studies are now underway with TheraTears Nutrition, a highly refined patent pending EPA-enriched flaxseed oil, to fully evaluate the magnitude of its efficacy in treating dry eye patients.

Footnotes

1Simopoulos AP. Omega-3 fatty acids in health and disease and in growth and development. Am J Clin Nutr 1991;54:438-463.
2James MJ. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr 2000;71(suppl):343S-8S.
3James MJ, Cleland LG. Dietary n-3 fatty acids and therapy for rheumatoid arthirits. Semin Arthritis Rheum Oct 1997, 27(2):85-87.
4Volker D, et al. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis. J of Rhem Oct 2000, 27:2343-2346.
5Fortin PR et al. Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis. J of Clin Epidemiology 1995, 48:1379-1390.
6Kremer JM et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping non-steroidal anti-inflammatory drugs. Arthritis & Rheumatism 1995,38:1107-1114.
7Goodman J. The Omega Solution. Prima Publishing, Roseville, California. 2001:p4-5.
8Boerner CF. Dry eye successfully treated with oral flaxseed oil. Ocular Surgery News, October 15, 2000, p147-148.
9Sullivan RM et al. Correlations between nutrient intake and the polar lipid profiles of meibomian gland secretions in women with Sjogren's Syndrome. Third International Conference on the Lacirmal Gland, Tear Film and Dry Eye Syndromes: Basic Science and Clinical Relevance. Maui, Hawaii, November 15-18, 2000.
10De Perrot M et al. Prostaglandin E1 protects lung transplants from ishemia-reperfusion injury: a shift from pro- to anti-inflammatory cyctokines. Transplantation 2001 72(9):1505-1512.
11Kotani N et al. Intraoperative prostaglandin E1 improves antimicrobial inflammatory responses in alveolar immune cells. Crit Care Med 2001 29(10):1943-1949.
12Narumiya S et al. Prostanoid receptors: Structures, properties, and functions. Physiol Rev 1999;7:1193-1226.
13Pholpramol C. Secretory effect of prostaglandins on the rabbit lacrimal gland in vivo. Prostaglandins Med 1979;3:185-192. 
14Gilbard JP et al. Stimulation of tear secretion by topical agents that increase cyclic nucleotide levels. Invest Ophthalmol Vis Sci. 1990; 31:1381-1388.
15Gilbard JP, Rossi SR, Gray Heyda K, Dartt DA. Stimulation of tear secretion and treatment of dry eye disease with 3-Isobutyl-1-methylxanthine. Arch Ophthalmol. 1991; 109:672-676.
16Oxholm P et al. Patients with primary Sjogren's syndrome treated for two months with evening primrose oil. Scand J Rheumatol 1986;15(2):103-8.
17Theander E et al. Gammalinolenic acid treatment of fatigue associated with primary Sjogren's syndrome. Scand J Rheumatol 2002;31(2):72-9.
18Johnson MM et al. Dietary supplementation with g-linolenic acid alters fatty acid content and eicosanoid production in healthy humans. J Nutri 1997;127:1435-1444.
19Phinney S. Potential risk of prolonged gamma-linolenic acid use. Ann Intern Med 1994;120:692-
20Yam et al. Diet and disease-the Israeli paradox: Possible dangers of a high omega-6 polyunsaturated fatty acid diet. Is J Med Sci 1996;32:1134-1143.

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