Acupuncture & Holistic Treatment of Dry Eye Syndrome

Overview:

Dry eyes, often referred to as Dry Eye Syndrome, is the most frequent patient complaint to eye doctors. About 33 million Americans in all groups experience varying degrees of dry eye syndromes. Like most eye conditions, Dry Eye Syndrome is often related to health conditions in the rest of the body. It is commonly associated with dryness of other mucous membranes, interior body surfaces such as joints and brittle nails. It can also be a sign of digestive imbalances or of more serious systemic autoimmune diseases, such as rheumatoid arthritis, Sjogrens syndrome or lupus erthematosus.

The proper production of tears basically takes place at three layers:

1. The Mucus Layer - is the closest layer to the corneal epithelium. It is produced by the conjunctival goblet cells, and is absorbed by the corneal surface glycoproteins, creating a hydrophilic corneal surface.

2. The Aqueous Layer - is between the Mucous and Lipid Layers, and comprises 90% of the tear film's thickness. It is secreted by the lacrimal gland and incorporates all water-soluble components of the tear film (slightly alkaline at pH of 7.4).
3.The Lipid Layer - is the most superficial layer. It is produced by the Meibomiam glands with minor contribution from glands of Zeis and Moll. The secretion is a sebaceous material which is fluid at body temperature, and retards evaporation of the acqueous layer and lowers surface tension thereby allowing tear-film to mold itself to the eye's surface.
The Blink renews the tear film by delivering aqueous and lipid to tear film and sweeping away debris. The normal blink interval is every 5 seconds. Tear film is typically stable for about 10 seconds.

Symptoms

The typical symptoms include dryness, grittiness, irritation, difficulty reading for long periods of time, burning and even the seeming contradiction of excessive tearing or watering.

Causes

Any disruption in the tear production process as desribed in the Overview.
Blepharitis can often cause dry eye symptoms due to inflammation of the eye lid margins, which is caused by a bacterial infection (Staphylococci). This condition can compromise the quality of the tear film causing tears to evaporate more quickly. The bacteria produce waste material that can cause a mild toxic reaction leading to chronic red, irritated eyes. Click Blepharitis for treatment.

Computer Users tend to blink much less frequently (about 7 times per minute vs. a normal rate of around 22 times/minute). This leads to increased evaporation along with the fatigue and eye strain associated with staring at a computer monitor. Ideally, computer users should take short breaks about every 20 minutes to reduce this factor. Also, adjusting the monitor so that it is below eye level will allow the upper lid to be positioned lower and cover more of the eye’s surface, again to reduce evaporation.

LASIK surgery temporarily disrupts the ocular surface/lacrimal gland unit. Also, during LASIK, roughly 60-70% of the superficial nerve fibers in the cornea are severed, which impacts sensation and affects acqueous tears. With compromised sensation, the blink rate can slow to the point where the tear film breaks up before the next blink can reconstitute. This may result in mild to severe dry eye syndrome for many months after surgery. This condition usually eventually clears up.

Diseases that may be associated with dry eyes include Rheumatoid Arthritis, Diabetes (especially when the blood sugar is up), Asthma, Thyroid disease (lower lid does not move when blinking), Lupus, and possibly Glaucoma.

Age - Tear volume decreases as much as 60% by age 65 from that at age 18. Dry Eye Syndrome affects 75% of people over age 65.

Hormonal changes for women can cause decreased tear production brought on by pregnancy, lactation, menstruation, and post menopause.

Other including too much coffee drinking, smoking, wearing contact lenses, air-conditioning or heat.

Drugs that can cause dry eye symptoms (see "Drugs That Harm the Eyes" for a list of harmful drugs:)

Antibiotics

Blood pressure medications

Antidepressants

Diuretics

Over-the-counter vasoconstrictors (i.e. Visine)

Antihistamines

Birth control pills

Appetite suppressants

Ulcer medications

Conventional Treatment

Artificial Tears: Some form of over-the-counter artificial tears is usually recommended. Although they may provide temporary relief, they merely palliate the symptoms. Worse, the preservatives can aggravate the condition, and can even kill corneal cells. Tears that promise to “get the red out” will reduce circulation in the eye, decrease production of the tear film, and worse, eventually make your eyes even drier.

Punctal Occlusion: Punctal occlusion is a procedure used to help dry eye patients by closing the tear drainage canals with silicone plugs, which keep most of the fluid from the surface of the eye. This may provide long-term relief.

• Tests that can be performed by an eye doctor include the following:
• Rose Bengal staining pattern
• Tear film break-up time (<10 seconds)
• Schirmer tear test
• Tear Osmolarity
• Tear protein levels (lactorerrin and lysozyme)
• Evaluation of debris in tear film
• Conjunctival impression cytoloty
• Presence of corneal filaments

Holistic Treatement

Holistic treatment first begins with identifying the most probable causes of dry eyes in each based on each individual case. Each person is unique with different underlying causes for dry eyes. The most commonly seen causes are dehydration, hormonal imbalances, post-lasik surgery, allergies, autoimmune conditions, acute/chrinic infections, medication, enviromental exposure, perscription medication, etc. Perhaps eye drops may help, but it will only act like a “band-aid” until the underlying problem is identified and corrected. Identifying the underlying cause requires inquiry, testing and checking blood work.

Unfortuantely most ophthamologists are not looking at blood work in order to find the cause for dry eyes. Why? I can’t answer that, but I do know that I can count on one hand the number of eye patients I’ve seen over the last 15 years who’s eye doctor reviewed their blood work. EVAUATING BLOOD WORK IS CRITICAL FOR IDENTIFYING THE CAUSE OF YOUR DRY EYES! Just hypothesizing and persribing eye drops is poor medical practice.

Every pateint that I see has blood work in order to identify the underlying cause. We use food, supplement, lifesyle recommenations and acupuncture/acupressure in order to incrase the blood flow and fluid supply to the eyes. We also work on regulating the underlying imbalances and reduce eye inflammation if that is an issue. Our success rate is astonishingly well over 80%!

We achieve these great result are because we take the time to identify the undwerlying cause of your dry eyes. Typically, the 20% of cases who do no have either major autoimmune conditions and/or surguries or trauma to the eye that is beyond repair. Some of these cases can be improved significantly, but results are less with these kinds fo cases. Also, patients who are certain medications indefinitelly may not have the great results because the meds may be so dehydrating and pro-inflammtory that they overide anything we can do. These cases represet a very small pecentage of the population and most of our patients experiene great relief within a few days to a few weeks of treatment.

Dr. Rosenfarb featured in Eye World Magazine

A New Holistic Perspective on Glaucoma

By Andy Rosenfarb, ND, LAc.

 

Glaucoma is not just an eye disease; it's an effect of a larger systemic disease pattern. In the field of holistic eye care, we realize that symptoms like peripheral vision loss (tunnel vision) and increased eye pressure are always effects of underlying health conditions. We need to understand and correct the underlying causes - treating symptoms has proven to be insufficient. Unlike conventional medicine, we do not try to control symptoms, we seek the root cause.

Primary Goals

The primary goals are clinical objectives involved in addressing glaucoma include:

• Regulate Autonomic Nervous System & Control the Global Stress Response
• Regulate Oxygen Supply to the Eyes
• Regulate Blood Sugar (Glucose) Supply to the Eyes
• Regulate & Control Inflammatory Response
• Promote Neuro-Protection by Activating Antioxidant Production
• Essential Fatty Acid (EFA) Support

Reporting the Research Specific herbs, vitamins and minerals and alternative therapies support and regulate each of the above stated objectives. I am working on putting together a research report demonstrating clear evidence-based research supporting this information. My goal is to have it available within the next year. Some of the supplements are already well known like Ginko, Turmeric, dang gui, bilberry, ginseng salvia, fish oil and more recently resveratrol. These among others are widely known nutrients and botanicals and have been used for thousands of years. It is just now that they are being researched and increasing evidence is supporting their efficacy. It is not enough to just say that "X" herb is helpful for glaucoma, we must understand why, when and how to use them. For example:

ANS Support - Ginseng
Oxygenation - Dang Gui, Salvia, Ginko
Blood Sugar Stabilization - (proper diet and nutrition)
Neuro Inflammation - Tumeric, Resveratrol
Neuro Protection - Alpha Lipoic Acid, N-Acetyl Cysteine (NAC)
Fatty Acid Support - DHA, Omega 3, 6, 9

When we collectively consider and regulate all of potential trouble spots that may result in conditions like Glaucoma, we often see improvement in the overall health, and the condition of glaucoma may begin to improve. In many cases there is even some restoration of lost vision. When the above physiological processes are regulated we revitalize the dormant cells in the eyes. Dormant cells may be inactive, but are not dead or totally dysfunctional. It has been suggested by many experts in the field of neuro science that as long as the nucleolus of the cell is still alive and functioning, a cell may be restored to its normal, healthy state.

Dysfunctional Automonic Nervous System
In the field of holistic eye care, we never treat specific eye diseases, in this case Glaucoma. We treat the patient based on comprehensive clinical findings that paint a picture of a patient's entire state of health. We make global observations about peoples' overall health as they relate to certain health conditions - like Glaucoma. In this case we can say based on the holistic model that Glaucoma is an effect of an underlying dysfunction of the body's Autonomic Nervous System (ANS). There is an overwhelming base of evidence in the field of neuro-science that supports this theory and it seems to be extremely accurate.

Co-Existing Conditions
In my years of clinical experience I observed that most of my patients with glaucoma had one or more of the following co-existing conditions: hypertension, elevated cholesterol, poor peripheral circulation, poor kidney function (based on blood test analysis), elevated homocystene & C-reactive protein (cardio inflammatory-stress markers), urination problems, poor digestion, poor hearing, poor memory, etc. Conventional medicine has recently been looking at each one of these as a causative factor for glaucoma including cardiovascular disease and H-pylori as possible causes for glaucoma. After spending much time researching brain and neuro science, it become obvious to me that the common thread in this clinical picture was improper functioning of the ANS. Although conventional medicine and the pharmaceutical companies have attempted to put out countless drugs in an attempt to regulate the ANS, none seem to be as effective as alternative therapies.

Regulating ANS with Acupuncture
In my experience there is nothing that regulates the ANS more effectively and more rapidly than acupuncture performed by a well trained professional. Acupuncture falls under the category of Sensory-Based Therapies (SBT). Drugs work fast but there are always side effects, acupuncture and most SBT's have little or no known negative side effects. Risks only occur when acupuncture is performed by someone who is poorly trained. This includes physicians, or "Medical Acupuncturists" who have taken weekend courses or a 300 hour course (mostly on video). Be sure to ask about both training and experience if you wish to seek out acupuncture. There are few well trained acupuncturists who specialize in the treatment of eye disease and I train quite a few each year. You will find practitioners all over the country and our clinic is happy to help you find someone in your area that may be able to help you, a friend or family member.
The goal is to use safe and natural methods that will help improve and support the healthy regulation of the entire ANS, circulation, inflammation, glucose, and neuro-protective mechanism. Supporting these processes may dramatically slow the rate of or arrest the progression of degenerative vision loss. Other effective holistic therapies include supplementation (herbs, vitamins minerals), exercise, relaxation techniques, massage, diet, stress management, meditation, and lifestyle modifications.
I often get asked by my patients, "Why doesn't my doctor know about or recommend alternative therapies?" There may be a host of reasons but the most common response I hear is that there is a lack of peer reviewed double-blind scientific research supporting it's efficacy. That position is simply untrue.

Research
It is a fact that there is little research performed in the US on the efficacy of alternative modalities that have positive effects on patients diagnosed with glaucoma. This is mainly because drugs are more profitable than herbs, and therapies l ike acupuncture are much more cost effective and hold significantly lower risk than eye surgery or medication. Here are some research studies on glaucoma and acupuncture that show a positive outcome. We can expect that there will always be someone who will criticize and the research methodology:

Acupuncture For Patients With Glaucoma

EXPLORE: The Journal of Science and Healing, Volume 1, Issue 5, Pages 372-376
M.Kurusu, K.Watanabe, T.Nakazawa, T.Seki, H.Arai, H.Sasaki, N.Fuse, M.Tamai

Henry H.L. Chan, Mason C.P. Leung, Kwok-Fai So. The Journal of Alternative and Complementary Medicine. April 2005, 11(2): 315-322. doi:10.1089/acm.2005.11.315.

Teh-Ching Chu, David E. Potter. Journal of Ocular Pharmacology and Therapeutics. August 2002, 18(4): 293-305. doi:10.1089/10807680260218461.

It is not possible to patent herbs, vitamins, or minerals and therefore little money can be made - pharmaceutical companies are in the business of mass producing highly profitable drugs, and making sure that we stay on those drugs. It is in the company's best interest to keep any new research on any non-medical beneficial information for glaucoma (and other health conditions), that is non-drug related from the general public. Why? Because it takes away from their profits. It is a sad truth that our country is "Pharmaceutically Biased" rather than "Scientifically Based."

Virtually No Side Effects
The greatest advantage in using nutritional supplementation and sensory based therapies like acupuncture is that there are virtually no side effects. Cautions should be used when recommending supplements so as to avoid any negative herb-drug interactions. A well trained practitioner will be aware of these contra-indications. In general, holistic therapies are safe and pose little risk. Of course glaucoma meds have a lot of side effects including eye irritation, blood pressure irregularities, fatigue, frequent urination, headaches, etc. The risk of eye surgery and invasive procedures are present and there are increased risks for causing further damage to the eyes. Holistic therapies will not make vision worse, unless used by someone who is inadequately trained. The worst case scenario with holistic eye therapies is that they won't work. The risks are small and the potential upside is great.
With the growing amount of information available on the internet, the public is rapidly becoming more aware of this state of affairs. New research on alternative treatments is showing up on sites like Google Scholar and other research-based web sites. Here are a few research abstracts that investigate the link between glaucoma and cardiovascular disease. They are on the right track but seem to be missing the ANS component:

The Role of Age and Cardiovascular Disease in Glaucomatous Optic Neuropathy1
Survey of Ophthalmology, Volume 43, Issue null, Pages S27-S42, S.Hayreh.

Retinal Microvascular Abnormalities and their Relationship with Hypertension, Cardiovascular Disease, and Mortality
Survey of Ophthalmology, Volume 46, Issue 1, Pages 59-80
T.Wong, R.Klein, B.Klein, J.Tielsch, L.Hubbard, F.Nieto

Relationship between Helicobacter pylori infection and glaucoma
Ophthalmology, Volume 108, Issue 3, Pages 599-604, J.Kountouras

The first two studies suggest the cardiovascular link to glaucoma, which we now know is rooted in ANS dysfunction. The third study suggests the link between glaucoma and H-pylori. The ANS also regulates digestion; impaired ANS regulation will have a degenerative effect on the Gastro-intestinal function rendering it more susceptible to infections like H-pylori. Do your own research and find out what is available to you!

About Dr. Rosenfarb
Dr. Andy Rosenfarb, ND, L.Ac. is an international leading authority on holistic eye health. He is a doctor of Naturopathy and a Licensed Acupuncturist. Dr. Rosenfarb has dedicated his life's work to uncovering the underlying causes of degenerative vision loss. He has also created Acu-Gen, a holistic system that supports eye health. Acu-Gen has shown to be extremely helpful for most degenerative vision loss cases. Dr. Rosenfarb is the author of "Healing Your Eyes with Chinese Medicine."

Treating Macular Degeneration
with Acupuncture & Chinese Medicine

By Dr. Andy Rosenfarb, ND, Dipl. Ac., Dipl. C.H.

Macular Degeneration (ARMD-Aged Related Macular Degeneration) is the slow deterioration of the cells in the macula, a tiny yellowish area near the center of the retina. The macula functions to give us clear central vision and fine detailed images. The deterioration of the macula affects an individual's central vision - the ability to read, write, drive and recognizing faces - among other visual abnormalities.
There are two types of macular degeneration, wet and dry. Ninety percent of people with macular degeneration have the dry-type in which small, yellow spots called Drusen form underneath the macula. Drusen are believed to be metabolic waste products that accumulate and cause cellular damage. It has been suggested that Drusen slowly breaks down the cells of the macula, causing distorted vision.
Dry macular degeneration can progress into the second, more severe type, called wet-type macular degeneration. The cause of this progression is unknown to conventional medicine. In wet-type ARMD, new, abnormal blood vessels begin to grow toward the macula, causing rapid and severe vision loss. These weak blood vessels can rupture and bleed, thus "wet-type" ARMD. Both wet and dry ARMD are diagnosed by an ophthalmologist and there is currently no safe and effective conventional treatment.
Individual risk factors for macular degeneration have been identified as contributing factors to the development and progression of ARMD. These include: female gender, smoking (increase risk by 200-300%), diabetics, high blood pressure (uncontrolled) and family history of macular degeneration.

Chinese Medicine and Macular Degeneration

In my experience Chinese Medicine can offer a very effective treatment for both types of ARMD. Although this kind of treatment will not help every single ARMD case presented, my personal success rate has been at least 80%. By success I mean that there are either subjective and/or objective measurable improvements in a person's vision after a series of treatment. There are many simple ways to test vision that are well within our scope of practice as acupuncturists; two being Visual Acuity Test (eye chart) and an Amsler Grid Test.
The clinical objective in treating ARMD is to treat the root cause of the disease pattern. The branch treatment or temporary solution can be to activate the blood circulation in order to resolve stagnation. Visual capacity may be improved by promoting the circulation in choroids and retina, preventing cell death, and reversing the inability to absorb and circulate vital nutrients for healthy vision.
ARMD (wet and dry) is most often an exhaustion of the body's Yin. The Yin aspect of the visual field is the central vision, and the peripheral vision is more Yang in nature. When the central vision goes, it indicates a "burn-out" of Kidney and Liver Yin, so using Chinese herbs that nourish Yin seems to work best.
 
 

 
The function of the Spleen (supported by the Kidney) is to transform and transport nourishment that is ingested. When working towards generating Yin in the body, it is essential that the Earth element (spleen-pancreas and stomach) be in a state of optimal function. The process of breaking down food into usable nourishment for the cells of the body requires a digestive system. It has been stated in the Pi Wei Lun by Li Ding Yuan that as we age, our earth element (digestive function) weakens. When the body's capacity to break down food becomes less efficient, the ability to replenish Yin and Blood can compromised as a result of poor digestion. Again, ARMD is generally seen as Yin deficiency cause by a "starvation" with an impaired transformation and transportation function.
The yin deficiency typically leads to a progressive dry-stagnation of Qi and Blood - the later stages in the development of ARMD. The blood vessels of the eye often become so dry and brittle that they can leak blood or burst altogether, thus giving rise to the less common "wet ARMD." One of the key ways to observe if a patient with dry-type ARMD is susceptible to developing wet-type ARMD is to see if they tend to bruise easily. If they do in fact bruise easily (and have a history of bleeding disorders or have been over-dosed on blood thinners), they have a higher probability of developing wet-type ARMD. If bleeding occurs the following steps should be taken AFTER the patient has been stabilized by their ophthalmologist.
In cases of wet ARMD, if the bleeding is severe they will need laser treatment to arrest the bleeding. If the bleeding is light and the patient has previously seen their ophthalmologist, you cab suggest snail shell moxa techniques - developed by Shmuel Halevi in Isreal.
Once the bleeding has stopped, the next step is to nourish the Yin and invigorate the Qi and blood with acupuncture and Chinese herbal medicine. An herb like Chinese Notoginseng (Sanqi) would be a good choice for wet ARMD, whereas Dan Shen based formulas work better for dry ARMD. You can then follow up with digestive tonic formulas and yin-nourishing formulas, based on the dominating TCM pattern. These formulas should be taken long term (6-12 months), as it can take time to build the Central Qi, and generate Yin.

Acupuncture Treatment:

Body Points:
Distal: Li-3, Si-3, Ht-8, SJ-3, Sp-3, Ki-1, Sp-6, St-36
Local: UB-2 (same effect as UB-1), Yuyao, GB-14, Yintang

Ear Points: Adrenal, Pt. Zero, & Corpus Callosum
Electro-acupuncture:
E-Stim #1: UB-2 to Alt Point - 1 finger medial to St-2
E-stim #2: SJ-23, Tongming ( ½ cun below GB-1)
Note: I recommend using a Pantheon 4C E-Stim Device, where the points are stimulated at a constant 2Hz for 20-30 min.

Caution: Retinal Bleeding

Please DO NOT use local electro-acupuncture on patients with retinal bleeding or elevated inter-ocular pressure (IOP)/ glaucoma. It can cause bleeding in weak vessels and raise IOP.

Use snail shell moxa treatment for light retinal bleeding.
Snail shell moxa can be done daily of every other day for 1-2 weeks with the presence of retinal bleeding. The patient should feel the warmth of the moxa burning.

Chinese Herbal Medicine - Base Formulas:

Wet ARMD
1. Yunnan Paiyao or Sanqi Powder (dissolve 2 g 2x/day in water)
2. Ming Mu Di Huang Tang (Bright Eye Tea)
3. Shu Gan Tang + Erchen Tang (Soothe the Liver Tea + Two Aged Tea)
4. Xiao Yao San
5. Bu Zhong Yi Qi Tang

Dry ARMD
1. Ming Mu Di Huang Tang (Bright Eye Tea)
2. Shu Gan Tang (Soothe the Liver Tea) + Er Chen Tang ( Two Aged Tea)
3. Dan Shen Pain
4. BuZhing Yi Qi Tang
NOTE: These are suggested base formulas. Chinese herbal formulas are most effective when tailored to each patients needs based on your TCM diagnosis.