Dry eyes : what acupuncture and Chinese medicine can do



In Los Angeles, the recent smoky and polluted air from the wild fires, the seasonal pollen, and drier windy fall and cold winter approaching are creating the perfect storm for dry eyes. Environment combined with our ever increasing screen time hours, aggravates dry, burning, and itchy eyes, a condition known as dry eye syndrome. This is the number one complaint that eye doctors hear from patients.

Why we get dry eyes


Dry eye syndrome (DES) develops either because not enough tears are produced or because the tears evaporate too fast.


The moist surface of the eye known as tear film is actually very complex, and is composed of 3 layers of way more than just water: inside is a mucous layer made of electrolytes, proteins and water.  Outside that is a thick, more watery aqueous layer that is mildly alkaline. And the outside most layer is actually a lipid layer made of oily meibum. The oil sits on top of the water and keeps it from evaporating.


Any disorder in any of these layers can lead to DES, though the most common imbalance is in the meibomian gland.


Dry Eye Syndrome is inflammatory in nature


More and more research seems to indicate that dry eye syndrome is an inflammatory process, an therefore, any inflammation in the body is a major contributor to DES.[1]

Age-related inflammation has been shown to deteriorate all 3 layers of the tear film.[2]

So as we age, it becomes more and more crucial to combat inflammation.


Aging alone is considered a serious risk factor for dry eye syndrome.[3] Women are more susceptible to DES, and dry eyes in women appear to also be related to fluctuations in hormone levels, especially estrogen and androgens.[4]


There is also increasing evidence that DES is autoimmune related.[5]


Remember to blink !


Environmental factors such as air quality and computer usage are also important.

Computer users blink less; their blink rate decreases by about 40%.[6]


Blinking acts as a pump to keep the tear film spread evenly over the eye. Tear film begins to naturally degrade after about 10 seconds, so we automatically blink about 10-12 times a minute.


But when focused on a screen, our blink rate slows and our eyes get dry and tired.



Foods & Supplements for dry eyes

As integrative and holistic medicine practitioners, we believe that the best way to address dry eye syndrome is to combat systemic inflammation, balance hormones, and favor the integrity of the tear film.



Omega-3 fatty acids can reduce DES by 66% by slowing down film breakdown time, especially in its form called DHA.

[7,8,9] 

They can found in the highest concentration is the following foods:

  • avocado & avocado oil

  • flax seeds, chia seeds

  • maquerel, sardines, herring, salmon

  • olive oil

  • cod liver oil

  • walnuts



Omega-7 is a more recently discovered type of fatty acid that can combat inflammation. In controlled trials, purified palmitoleic acid (an omega-7) was proven to reduce inflammation markers such as hs-CRP.[10]


Vitamin D supplementation improves dry eye symptoms, quality of tear film, and the ocular surface. Vitamin D deficiency is linked to tears without enough watery content and tear film deterioration.[11,12] 

Since elderly people usually have a tendency of lower vitamin D levels , supplementation with vitamin D3 is a good idea.


Avoid sugar and/or artificial sweeteners: It's thought that excess sugar in the diet results in too much un-utilizable glucose in the eyes (more than half of all diabetics suffer from dry eye syndrome.[13]


Taking more than 11 teaspoons of sugar a day has been linked to dry eye syndrome. A single can of soda contains 9 teaspoons of sugar.

Chinese medicine for dry eyes



You can easily find the ingredients for this daily herbal tea to prevent and relieve DES.


Chrysanthemum flowers (菊花)calm the liver and clear the eyes, are used for dry, swollen and/or painful eyes. They are also great for High blood pressure


Goji berries (枸杞子)benefit the kidneys and the liver to help nourish eyes for those with dizziness, blurred vision and diminished visual acuity.



In more severe cases, your herbalist can also prescribe more complex formulas to help resolve your dry eyes. It is important that you DO NOT self medicate, as each of these formulas answers to a very specific pattern and addresses uniqueness in your body. Your dry eyes might be very different than somebody else's, and everyone should be treated with tailor-made formulas.


Common formulas used in Chinese medicine are:

  • Preserve Vistas Pill (Zhu Jing Wan).

  • Ming Mu Di Huang Wan (Rehmannia Pills to Brighten the Eyes). Related to the following patterns: Liver Blood Deficiency, Kidney Yin Deficiency, Liver Yin Deficiency

  • Xiao Yao San (Rambling Powder). Classic Liver tonic support the flow of the Liver meridian energy (see ReVision Formula as website below)

If you tell your acupuncturist about your DES, they will include points on the body, near and around the eyes to decrease inflammation and increase nutrition.


Lifestyle advice for Dry Eyes

Exercise daily. Something as simple as a daily walk is crucial for any eye disorder, and for your general health. A Japanese study concluded that an increase in the level of physical activity can be effective in preventing of and treating ofDES [14]


Use a humidifier at home and/or at work to keep the air from drying out in the winter.


Check your medications . Some drugs can contribute to dry eyes , such as NSAIDS like ibuprofen, synthetic penicillins, antihistamines, birth control pills, blood pressure medications, and anti-depressants.



Give yourself a gentle massage


You can do this while in a warm shower to benefit from increased humidity.


Use your ring finger (the most delicate of fingers) to very gently rub your upper lid from the inner corner of your eye toward the temple. Repeat with the lower lid. Continue in a circular motion until you feel a gentle tingle, sign that circulation has improved.





References


[1] Yamaguchi, T. (2018). Inflammatory Response in Dry Eye. Invest Ophthalmol Vis Sci, 2018 Nov 1;59(14):DES192-DES199.

[2] de Paiva CS. (2017). Effects of Aging in Dry Eye. Int Ophthalmol Clin.Spring;57(2):47-64.

[3] Ibid. de Paiva. (2018)

[4] Lurati AR. (2019). Menopause and Dry Eye Syndrome. Nurs Womens Health. Feb;23(1):71-78

[5] Ibid. de Paiva. (2018)

[6] Hauser W. (2017). Dry Eye: A Young Person’s Disease? Rev Optom. Feb 15

[7]Epitropoulous, A.T., Donnenfeld, E.D., Shah, Z.A., Holland, E.J., Gross, M., et al. (2016). Effect of Oral Re-esterified Omega-3 Nutritional Supplementation on Dry Eyes. Cornea, Sep;35(9):1185-91.

[8] Miljanovic, B., Trivedi, K.A., Dana, M.R., Gilbard, J.P., Buring, J.E., et al. (2005). Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women. Am J Clin Nutr, Oct;82(4):887-93.

[9] McCusker MM, Durrani KK, Payette MJ, Suchecki J. (2016). An eye on nutrition: The role of vitamins, essential fatty acids, and antixodants in age-related macular degeneration, dry eye syndrome, and cataract. Clin Dermatol. Mar-Apr;34(2):276-85.

[10] Bueno-Hernandez N, Sixtos-Alonso MS, Garcia MDLP, Yamamoto-Furusho JK. (2017). Effect of Cis-palmitoleic acid supplementation on inflammation and expression of HNF4Y, HNF4a and IL6 in patients with ulcerative colitis. Minerva Gastroenterol Dietol. Sep;63(3:257-263

[11] Yang CH, Albietz J, Harkin DG, Kimlin MG, Schmid KL. (2018). Impact of oral vitamin D supplementation in people with dry eye and/or low serum vitamin D. Cont Lens Anterior Eye. Feb;41(1):69-76.

[12] Gemirci G, Erdur SK, Ozsutcu M, Eliacik M, Olmuscelik O, et al. (2018). Dry Assessment in Patients with Vitamin D Deficiency. Eye Contact Lens. Sep;44 Suppl 1:S62-S65

[14] Kawashima, M., Uchino, M., Yokoi, N., Uchino, Y., Dogru, M., et al. (2014). The Association between dry eye disease and physical activity as well as sedentary behavior: Results from the Osaka study. J Ophthalmol, 2014:943786.





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