Dry Eye: The Infection Connection

Let me tell you a little story about how I first developed severe dry eye syndrome which I’m sure that many of you reading this will be able to relate to.

At the age of 19 I developed severe dry eye syndrome literally overnight. I had just been trialling a course of Ortho-K lenses which flatten your cornea as you sleep so that you can see without glasses the next day.

I know, sounds scary, right?

Now looking back, I can’t believe that I would do something like this, but I was young, naïve and blindly trusted the optometrist who recommended them. I thought that someone in a professional capacity would not put me in harm’s way.

Now that I know about the damage that drugs, contact lenses, surgical procedures and western medicine in general does to people. I can see how wrong I was. 

I had also just started taking a medication (Lexapro) at the time which is well-known to cause dry eyes.

One morning, I woke up, and took the contacts out of my eyes. My eyes felt awful, they burned, stung and felt extremely dry. The symptoms did not improve despite trying every artificial tear known to man, allergy eye drop, punctual plugs and many other things over the course of about 10 years.

Dry Eye Sufferers Share a Common Experience

It has come to my attention after speaking to many people with dry eye in my Facebook group: Dry Eye Natural Solutions, on the phone, and among my clients, that many people with dry eye share a very similar experience.  

Like me, many claim that their dry eyes started or became ALOT worse literally overnight.

For most of these people there was a specific event that triggered this to happen.

The event ranged from taking the steroid eye drop ‘Lotemax’, anti-biotic eye drops, laser eye surgery, falling asleep in contact lenses, a very stressful period in life, taking a medication, or even putting a dirty bean bag on their eye during a yoga class!

Here are some of the responses from people on my Facebook group whose dry eye seemed to come out of nowhere (names will remain anonymous):

‘’ Mine started immediately after the use of Lotemax. No dry eye issues before but they started immediately after use and I’ve had them ever since (1.5 years)’’.

‘’ I had very mild dry eye for a few years and then one day, I woke up with severe dry eye and my life has never been the same’’.

‘’ Mine started when I was in hospital I never had a eye issue so I thought but I had been put on steriods and just woke up few days later with big infection in my eye I believe due to the fact that at the time no one knew the cause’’.

‘’ Maybe there is a connection. I had severe sebboreic dermatitis (dandruff) in 2012 that’s when it started.’’

‘’ Interesting Sara, my severe dry eye started after a steroid drop for an allergic reaction. I also have terrible perfume/fragrance sensitivities and have for many years – they seemed to have gotten worse though’’.

‘’I had lasik in February 2014. Suffered from dry eyes afterwards for perhaps 9-12 months but improved to a point where I was using zero eye drops, barely even thought about my eyes. Then bam 2 years later I suddenly noticed my eyes become very painful at work, as if someone was squeezing my eyeball.’’

”Mine occurred literally overnight after the use of a steroid eye drop”.

‘’Never had it in my life until I had cataract surgery!’’

‘’ Then in June of 2015 I was working at a fairly stressful job and I got a stye in the upper lid of my left eye. I was given the drug tobradex by my doctor. I didn’t think it was a big deal. Tobradex is a steroid eye drops that also is an antibiotic. Two and a half months later I started noticing I was sensitive to light but it seemed to be occurring in both eyes.’’

No one, including any doctor that I’m aware of, is asking this one important question….

Why does this happen among so many people with dry eye? Surely it is not just a coincidence that so many people with dry eye share these two experiences, including me.

Because I am passionate about finding and addressing the ROOT cause of chronic disease, this got me thinking and I started doing some digging. I have come up with a theory and found some circumstantial research to back it up. 

The Infection Connection

It is my belief that many people with dry eye develop a low-grade chronic infection in their eyes and/or eye lids. This is the reason why dry eye can go from mild to severe overnight.

The infection could be caused by a bacteria, yeast (candida), parasites, or even a virus.

Once an infection sets in the eyes become red, inflamed, crusted (bleptharitis), the Lacrimal and Meibomian Glands cease to function optimally, oil thickens and tear production declines.

Inflammation occurs because the body brings certain immune cells and substances into the area to fight off the infection. These cells are white blood cells, histamine, leukotrienes, phagocytes, and others.

This is a natural inflammatory response to the presence of a pathogenic infection. It is the bodies defence against the many pathogenic microbes that we are exposed to in our environment.

Have you ever had a cut which got infected? Or cellulitis on your leg? The inflammation that occurs is an example of the body attempting to kill off the infection and stop it from spreading. 

The medical definition of a low-grade chronic infection:  

”Is a low-level infection which is not growing, feeding, but is continuously releasing toxic metabolic by-products that cause chronic tissue irritation. One example of this is a red form of yeast called ‘Chronic Atrophic Erythematous Candidiasis’ which is found in the burning gums of people with false teeth.”

This type of infection is ‘intra-cellular’ which means it is found inside-the-cell. This makes it hard to treat with antifungals, antibiotics or other drugs, and also means that its diagnosis is usually missed by most doctors.

The yeasts invade underlying tissues and penetrate inside mucosal linings, glands and various organs of the body.

They continually release irritating chemicals into tissues, causing chronic inflammation, redness and burning. All of which are symptoms in dry eye!  

Another example of a low-grade infection is put forward by Dr Marjorie Crandall. She found that low-grade infections can infect various tissues and organs in the body. Her research specifically looked at yeasts which invade the tissues of the vagina. She believes that this is the cause of a chronic condition called ‘Vulvodyna’ which presents as burning, redness and pain in the vagina (1).

I also believe that a low-grade infection can account for a lot of the symptoms in dry eye, such as burning, redness, pain and dryness. 

Just like the vagina, the eye and eyelids also contain a mucosal lining that covers the eye and inner eyelids. This mucosal lining is mucoid associated lymphoid tissue (MALT).

I believe that a low-grade infection may occur after a person has had an acute eye infection such as conjunctivitis and were given antibiotics . The antibiotics knock down most of the infection, but not all of it, and some of it remains in the tissue.

Doctor Lawrence Wilson states that common sites for low-grade infections are the eyes, ears, intestines, sinuses, liver and the joints. As people heal on a nutritional balancing/detox program, they will go through a process called ”retracing”- whereby the body removes these chronic infections itself. This happens when the bio-energetics of the body raise to a certain level after balancing body chemistry with the correct nutrition. The immune system will then be able to fight off and deal with these low-grade infections. No drug or herb is needed. The body is an amazing self-healing machine (2). 

I have personally experienced this, I have retraced many infections in different parts of my body. After, fixing my gut and doing a comprehensive nutritional program for a year or so, many of my chronic infections started to die off on their own.

I had candida and parasites in my gut which died off on their own without the need for herbal remedies. I also retraced an infection in my eyes. Last September my eyes flared up and became very itchy. This flare up lasted for about a month. I spoke to Dr Wilson on the phone and he said that I was most likely retracing an eye infection. His exact words were ”You don’t have dry eye, you have an eye infection”. I thought this statement was very interesting.

Viral Infections Have Been Linked to Dry Eye

Several studies show that systemic and ocular viral infections may play a role in dry eye.

Sjogrens like symptoms have been reported in patients who have been confirmed to have the human T-cell lymphotropic virus (HTLV), Human Immunodeficiency Virus (HIV), Epstein-Barr virus (EBV), and Hepatitis C Virus (HCV).

Studies demonstrated the prevalence of auto-antibodies to HTLV in Sjögren patients ranging from 23-36%. This was significantly higher than that of normal controls (3,4,5). 

There is increasing evidence suggesting that Epstein-Barr-Virus may infect the Lacrimal glands leading to an immune reaction, whereby the immune system attacks the lacrimal glands in an attempt to fight off the infection. This leads to decreased aqueous tear production and severe dry eye in those diagnosed with Sjogrens syndrome (6).

Many studies have reported that patients developed Sjögrens Syndrome immediately after a Epstein-Barr Virus diagnosis. In addition, traces of EBV have been found in the majority of lacrimal gland biopsies of Sjögren patients. This implies that EBV may be involved in the lacrimal gland pathology of those with Sjögrens Syndrome (7).

Dry eye also appears to be much more prevalent among individuals with AIDS (21.4-38.8% of HIV-infected men, 16.9% of HIV-infected women) than in the general population (8,9). Burtin et al evaluated the ocular surface in a group of HIV positive patients. 70% of these patients complained of dry eye symptoms, and 85% present at least one clinical sign of ocular surface dysfunction tested through Schirmer test, tear break-up time and lissamine stain (10).

This means that people with HIV are more prone to dry eye. Why is this? Is it possible that the HIV virus could infect the eye leading to symptoms of dry eye?

What Causes Low Grade Eye Infections?

An infection in the eyes may result from any of the following:

  • Eye trauma

Many people develop dry eye after laser eye surgery, or other eye surgeries. Eye surgery is a type of ‘trauma’ to the eye. Studies show that fungal (yeast) and bacterial eye infections commonly occur after eye surgery. Yeast infection may be enhanced by the use of steroid and antibacterial eye drops pre and post surgery (11, 12).

  • Anti-biotic eye drops  

Many people say that their dry eye started after using an anti-biotic eye drop such as Tobradex.

Interestingly, the following study claims that antibiotics can increase the risk of developing a fungal infection in the mucosal lining of the eye. This is the part of the eye which covers the eye surface and the eyelids.

The negative effect that antibiotics have on friendly bacteria in the gut is well established. Antibiotics do not only kill bad bacteria in the gut, they also kill friendly bacteria too!

Just like the gut, the eye contains a host of friendly bacteria that protects the eye from infection by pathogenic bacteria and yeast overgrowth. Alterations to this microbial balance may be linked to ophthalmic pathologies (13).

Therefore, it would not be a stretch to conclude that antibiotics could have the same effect on the delicate balance of bacteria within the eye. This may then lead to an overgrowth of pathogenic bacteria in the eyes (14).

  • Steroid eye drops: Lotemax and Cortisone.

These steroids work by blocking the inflammatory response in the eye. As already mentioned the inflammatory response is part of the body’s immune system. The purpose of the immune system is to fight off infections, allergens and so on.

So in other words, steroids suppress the immune system in the eyes. This may allow pathogenic bacteria, yeasts or parasites to bypass the mucosal associated lymphoid tissue (MALT) and enter the eye/eyelids.

MALT is a layer of tissue with covers the corneal surface and the inner eyelids and is our first line of defence against pathogenic microbes and toxic substances. MALT tissue is found anywhere in which the external environment (the outside world) meets the internal environment (the blood). It is therefore found in the eyes, nasal passages, the entire gut and the vagina (15).

It is packed with immune cells such as B-Cells (secretary IGA), macrophages and T-Cells. It is the job of these cells to defend the eye against pathogenic microbes and prevent them from penetrating through this mucosal lining (16). They are like soldiers on the front line of a battle ground.

  • Stress

Stress also suppresses the immune system and lowers our natural defences against pathogenic microbes. That’s why you tend to catch a cold when you are stressed or ‘run down’.

  • Rubbing the eyes a lot and holding a bean bag on the eyes during a yoga class

 Well this goes without saying! Rubbing the eyes or putting a dirty bean bag on your eyes may introduce bacteria into the eyes!

Part two of this post will explain how to treat this low-grade infection by balancing body chemistry with nutrition. Watch this space…

 

References

  1. M. Crandall: http://www.yeastconsulting.com/yeast-infection-cause-vulvodynia.html
  2. Dr L Wilson: http://www.drlwilson.com/articles/retracing.htm and http://drlwilson.com/Articles/EYES.htm
  3. Ramos-Casals M, García-Carrasco M, Brito Zerón MP, Cervera R, Font J. Viral etiopathogenesis of Sjögren’s syndrome: role of the hepatitis C virus. Autoimmun Rev. 2002; 1(4):238-4
  4. Pflugfelder SC, Crouse C, Pereira I, Atherton S. Amplification of Epstein-Barr virus genomic sequences in blood cells, lacrimal glands, and tears from primary Sjögren’s syndrome patients. Ophthalmology. 1990;97(8):976-84. 
  5. Gaston JS, Rowe M, Bacon P. Sjögren’s syndrome after infection by Epstein-Barr virus. J Rheumatol. 1990;17(4):558-61. 
  6. Whittingham S, McNeilage J, Mackay IR. Primary Sjögren’s syndrome after infectious mononucleosis. Ann Intern Med. 1985;102(4):490-3.
  7. Pflugfelder SC, Crouse C, Pereira I, Atherton S. Amplification of Epstein-Barr virus genomic sequences in blood cells, lacrimal glands, and tears from primary Sjögren’s syndrome patients. Ophthalmology. 1990;97(8):976-84.
  8. DeCarlo DK, Penner SL, Schamerloh RJ, Fullard RJ. Dry eye among males infected with the human immunodeficiency virus. J Am Optom Assoc. 1995;66(9):533-8
  9. Lucca JA, Farris RL, Bielory L, Caputo AR. Keratoconjunctivitis sicca in male patients infected with human immunodeficiency virus type 1. Ophthalmology. 1990;97(8): 1008-10
  10. Burtin T, Guepratte N, Bourges JL, Garcher C, Le Hoang P, Baudouin C. [Abnormalities of the ocular surface in patients with AIDS]. J Fr Ophtalmol. 1998;21(9):637-42. French.  
  11. Stern et al (1985). Epidemic postsurgical Candida parapsilosis endophthalmitis. Ophthalmology 92:1701-1709
  12. Pettit et al (1980) Fungal endophthalmitis following intraocular lens implantation. A surgical epidemic. Arch. Ophthalmol. 98:10251
  13. Nema et al. (1968) Effects of topical corticosteroids and antibiotics on mycotic flora of conjunctiva. Am. J. Ophthalmol. 65:747750.
  14. Lu & Liu (2016). Yale J Biol Med. 2016 Sep 30;89(3):325-330. eCollection 2016.
  15. https://en.wikipedia.org/wiki/Mucosa-associated_lymphoid_tissue
  16. Mannis & Smolin. (1996) Natural defense mechanism of the ocular surface. Ocular infection and immunity. (Mosby, St. Louis, Mo).

For further reading:

Dry eye and vial infections: http://cmr.asm.org/content/13/4/662.full#ref-170

Fungal eye infections:  http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492013000200016

 

 

 

      

 

 

 

 

 

 

 

 

 

 

 

 

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