Managing eye symptoms

A variety of palliative medications and over the counter supplements are available to patients suffering from glaucoma, uveitis, cataracts, and eye inflammation. Perhaps the most important thing MP patients with eye symptoms can do is to protect the protect their eyes from the effects of light both indoors and outdoors while they exhibit the symptoms of photosensitivity.

Because they suppress the innate immune response and contribute to disease relapse, MP patients should avoid immunosuppressive drugs such as eye drops with Prednisone except during emergencies. Opt instead for eye drops and medications which do not contain steroids such as Optive or artificial tears instead.

Patients who need temporary relief of their eye symptoms should contact their opthalmologist, physician or pharmacist for advice about palliative medications. Patients' opthalmologists who believe they need immunosuppressant eye drops to temorarily control inflammation may do so while on the Marshall Protocol (MP).

Patients who are taking steroids should work with their physician to wean from the medication.

• photosensitivity – Extreme sensitivity to sunlight and bright lights is common of the eye diseases and near universal among MP patients with chronic eye conditions. Diligent eye protection is crucial for any MP patient with eye inflammation.
• dry eye – Many people with “dry eye” find that their eyes water but still feel dry. This occurs because the eye has two different tear ducts. Unfortunately, the ducts that produce tears necessary to maintain normal moisture in the eyes are often blocked or reduced by inflammation. Although the tears produced by the eye’s other ducts attempt to make up for loss of moisture, they do not have the same lubricating properties and simply cause the eye to water.
• floaters – Deposits of various size, shape, consistency, refractive index, and motility within the eye's vitreous humour, which is normally transparent. There is no physical possibility that floaters are microbes.
• ocular migraine – During migraine processes, changes also may take place in blood flow to the area of the brain responsible for vision (visual cortex or occipital lobe). Resulting ophthalmic or ocular migraines commonly can produce visual symptoms even without a headache. Ocular migraines generally are considered harmless. They are typically painless, cause no permanent visual or brain damage, and usually do not require treatment. Nevertheless, patients should always consult their eye doctor when they have unusual vision symptoms, because it's possible that you have another condition requiring treatment, such as a retinal detachment, which should be checked out immediately.
• photopsia – Photopsia is an affection of the eye, in which the patient perceives luminous rays, flashes, coruscations, etc. Photopsia can be due to inflammation irritating the outer retina or photoreceptors. These perceive only light, so any stimulation will be perceived as light. But there are other, more serious causes including: retinal detachment, TIA, posterior vitreous detachment, and even migraines (with or without headache).
• vasculitis (visibly red conjunctiva) – Normally the conjunctiva is clear white. Visibly red veins of the eye is a sign of vasculitis (inflammation of the veins) and is common in chronic disease. Because it is in the eye, it is very obvious and disconcerting. But it is also common in the skin, small varicose veins, easy bruising; in the gut, microscopic blood loss and in hidden areas. Because immunopathology entails the release of cytokines and apoptosis (cell death) of infected cells caused by innate immune activation, this does occur prior to treatment as the bacteria as part of their life cycle will manifest in more typical forms causing immune identification and response.

The first recourse for improving symptomatic eyes is to limit the amount of light one's eyes are getting. This may mean:

• wearing NoIRsSpecial sunglasses worn by Marshall Protocol patients to block light. faithfully; when necessary, where the 2% NoIRs
• not exposing oneself to: sunny light outdoors, bright store lighting, bright computer screens
• wearing an eye mask, not only at night but when resting during the day

The MP is designed so that patients can minimize the chance of eye damage due to increased inflammation by maintaining a tight olmesartan blockade. Altering the dose and scheduling of antibiotics will manage the severity of the immunopathology by slowing the rate at which bacteria are destroyed and thus reduce the chance of eye inflammation. In addition, a variety of eye medications and drops are available to treat eye inflammation and dry eye.

• Optive – Non-prescription eye lubricant, which is a safer option than Restasis.
• cyclosporine (Restasis) – A corticosteroid. Generally contraindicated for MP patients, however, less immunosuppressive than prednisolone.
• nepafenac (Nevanac) – An NSAID available by prescription.
• prednisolone (Prednisone, Pred Mild, Pred Forte) – A corticosteroid. Generally contraindicated for MP patients. More immunosuppressive than cyclosporine.
• terramycin – An antibacterial eye ointment.
• Ganfort – Prescription eye drops which lower the pressure in the eye by decreasing the fluid produced and helping the flow of fluid out of the eye chamber. Although GANFORT® PF 0.3/5 eye drops help control your condition, it does not cure it.
• Methotrexate – Contraindicated.

Some patients have reported that their dry eye responds better to artificial tears which do not contain preservatives or special ingredients for “red eye,” allergies, etc.

See artificial tears

Patients should work with their doctor or ophthalmologist to limit their use of substances which affect the proper functioning of the immune system. Patients' doctors who believe they need immunosuppressant eye drops to temorarily control inflammation may use the drugs while on the MP.

Be advised that use of steroids delays resolution of original disease symptoms while on the MP, and can have serious side effects. These side effects include glaucoma,¹⁾ cataracts,²⁾ ocular hypertension,³⁾ various other side effects, ⁴⁾ as well as increase in ocular pressure.

Although newer corticosteroidsA first-line treatment for a number of diseases. Corticosteroids work by slowing the innate immune response. This provides some patients with temporary symptom palliation but exacerbates the disease over the long-term by allowing chronic pathogens to proliferate. with lesser pressure elevating characteristics have been developed, corticosteroid-induced ocular hypertension and glaucoma continue to be significant risks of local and systemic administration.

McGhee et al.⁵⁾

When possible, physicians should try weaning their patients from immunosuppressive eye drops. Try going down one drop a day, and then dropping down one drop every other day. Patients are more likely to be successful weaning from prednisone when they wean very slowly.

Also, note that changing from Pred Forte eye drops to one of the lower strength prednisolone eye drops (such as Pred Mild, or Lotemax)

Regular use of olmesartan as per the MP guidelines can help a patient wean from higher doses of prednisolone (Prednisone).

Tumor necrosis factor-alphaA cytokine critical for effective immune surveillance and is required for proper proliferation and function of immune cells. or TNF-alphaA cytokine critical for effective immune surveillance and is required for proper proliferation and function of immune cells. is a cytokine critical for effective immune surveillance.⁶⁾ TNF-alpha inhibitors, also known as TNF blockers, anti-TNF drugsDrugs which interfere with the body's production of TNF-alpha - a cytokine necessary for recovery from infection or TNF-alpha antagonists, are drugs which interfere with the body's production of TNF-alpha.⁷⁾ Anti-TNF drugs are expensive, ineffective at treating chronic disease and have a number of adverse effects such as increase risk of serious infection such as mycobacterial infection.^{8) 9)}

Moxifloxacin ophthalmic solution is used to treat bacterial conjunctivitis (pink eye; infection of the membrane that covers the outside of the eyeballs and the inside of the eyelids). Moxifloxacin is in a class of antibiotics called fluoroquinolones. A report from a patient on the MP indicated it was effective for resolving their acute eye infection symptoms.

Pfizer markets Terramycin opthalmic ointment for humans in other parts of the world, and as a veterinary medication in the US, therefore it may require some research to identify a source for it. Calling around to local veterinary supply stores or looking online may be options. It is described as a “versatile antibiotic ointment with broad-spectrum antibacterial activity against gram-positive and gram-negative organisms.”

Some people on the MP who have anterior uveitis have reported it to be very helpful. It should penetrate the front part of the eye, just as the various eye drops used to treat uveitis do.

A good and natural remedy for eye symptoms is the use of chamomile tea eye compresses. Can either use cool tea on cloth or the actual tea bag on the affected eyes for five to ten minutes, two to three times per day. You may find that warm or cool or wet compresses may help to relieve uncomfortable eye symptoms.

A punctal plug is a small medical device that is inserted into the tear duct (puncta) of an eye to block the duct. Patients should always make sure their hands are clean when touching their eyes.

Inflammation can damage the delicate structures of the eyes. Anyone with a history of eye inflammation, especially uveitis or iritis, should have their eyes examined by an ophthalmologist regularly while on the Marshall Protocol. For example, people with sarcoidosis are advised to see an ophthalmologist every six months. Over time, the MP should address such inflammation, but one could have occasional increases of inflammation that could require some temporary medical intervention.

My tear ducts are producing their own/adequate tears now on the MP for 3 mos. About 10 yrs ago I was told that they weren't producing enough tears and have gradually been using more and more artificial tears - especially upon awakening in the a.m.'s. When I would wake up my eyes would feel so dry it was scary and my eyes would literally BURN when I put the drops in!!! WOW!

Elisabeth, MarshallProtocol.com

I just wanted to let you and others know about my solution for painful dry eyes, especially while sleeping or first thing in the morning for me. I bought a case of these small reusable bottles from a pharmacy that deals with a lot of specialty stuff near here, filled with pure sterile saline (water at the same salinity as our bodies) which is normally used to flush out IV lines before they start IVs. I put a needle that screws into a syringe into the rubber top, and whenever my eyes are bothering me, i just unscrew the Luer lock syringe (you leave the needle part stuck in the bottle permanently) and drop some saline into my eyes. i look right to left a few times and this distributes it well. Instant Heaven.

I do this because i react to EVERY product out there for eyes. And it took me a long time to get this figured out. I tried putting this saline into a dropper bottle and using that but i eventually ended up having something akin to an infection, probably because the dropper was getting dirty and going back into the source bottle. The way I have done if for months now there is really no way for germs to get into the source bottle.

Satay, MarshallProtocol.com

For dry eyes I use Bion Tears. They don't have preservatives which can cause trouble in some people. My eye man prescribes three boxes at a time with a special authority and I get them at the PBS basic cost for the three. I find they work very well.

Eliz, MarshallProtocol.com

I react to every product out there, so it took me a long time to figure out a solution for my painful dry eyes. I use small reusable bottles filled with pure sterile saline – water at the same salinity as our bodies – which is normally used to flush out IV lines before they are used. I bought a case of the bottles at a pharmacy that deals with a lot of specialty stuff.

I put a needle that screws into a syringe into the rubber top, and whenever my eyes are bothering me, I just unscrew the Luer lock syringe (you leave the needle part stuck in the bottle permanently) and drop some saline into your eyes. I look right to left a few times and this distributes it well. Instant heaven.

Satay, MarshallProtocol.com

My left eye is my worst as far as being dry. Sometimes nothing will focus. Finally, it will dawn on me, and I use artificial tears and my vision clears up!

What really lets me know that it's dry is that I can often put four drops of artificial tears in my left eye and none of it runs out of my eye. At the same time, I put two in my right eye, and it runs down my cheek. That can happen whether or not the left eye has been tearing.

Lottie, MarshallProtocol.com

I use Allergan-Refresh-Lubricant-Ointment-Nighttime |Refresh PM gel by Allergan, sourced through Amazon, a night-time product for soothing dry eyes. It is actually an ointment developed for dry eyes that bathes the eyes all night. It lasts much longer than the gel drops. Refresh PM causes blurry vision which is why it was developed for night time use. Works great!

DNStog, MarshallProtocol.com

I found the artifical tears were not working well enough for me, had to use them at least once an hour. I got some lubricating drops, Walmart's Equate Gentle Lubricant Eye Drops, and they're working much better.

Jillian, MarshallProtocol.com

It is not unusual for Sarcoidosis patients to have “dry eye”. Which sounds strange when a person is told that by their ophthalmologist, because “dry eyes” tend to water a lot, with tears running down their face. When I said, “How can they be dry when they're watering all the time!!??” My doctor kept trying to explain to me that it's not the same tears, that the tears that run down your face, are the ones that also appear when you cry or when your eye is irritated, and they don't lubricate the eyes.

Finally, it dawned on me, and I asked him, “So, there are two different tear ducts?” He nodded, “yes”, and told me that the problem is that the tears that are necessary to maintain the moisture in the eyes are the ones that are missing or reduced by the inflammation of Sarcoidosis. And, so lots of the “crying” tears are manufactured in an attempt to maintain moisture in the eye. Since they aren't very good at it… it takes a lot, and they run down your face.

The reason that I mention “dry eye”, is that it can also affect your vision. My left eye is my worst as far as being dry… or “watering”. And, sometimes, my eye doesn't water much, if at all, and yet my vision is bad. Nothing will focus. Finally, it will dawn on me, and I use artificial tears… and my vision clears up!!

What really lets me know that it's dry is that I can often put FOUR drops of artificial tears in my left eye and none of it runs out of my eye. At the same time, I put two in my right eye… and it runs down my cheek. And, that can happen whether or not the left eye has been “tearing”. And, you only want to use plain artificial tears for “dry eye”. Not any of the ones that have ingredients for “red eye”, allergies, and such.“ People also report preferring preservative-free articial tears to the ones with preservatives.

Lottie, MarshallProtocol.com

My tear ducts are producing their own/adequate tears now that I have been on the MP for 3 months. About 10 years ago I was told that they weren't producing enough tears and have gradually been using more and more artificial tears - especially upon awakening in the AM. When I would wake up my eyes would feel so dry it was scary and my eyes would literally burn when I put the drops in!

Elisabeth, MarshallProtocol.com

You may have experienced an ophthalmic migraine, which i have all the time. They are perfectly harmless, although they can be scary the first few times you have them… ha!

Sunflower

Without an eye mask my eyes were always tired from a night of ever-present LCD clock displays, charging mobile phones, other electrical appliances, and light that creeps in from cracks in the windows and under doors. I was surprised at the difference that little eyemask change made.

JRFoutin, MarshallProtocol.com

The following suggestions may help relieve burning or tearing:

• NoIRs: Indoors, TV, Computer, Outdoors. When in doubt or having frequent eye herxes, put them on. Leave them on. Dark ones for TV if your eyes are in pain with the light ones.
• Eye mask at night: Kill all available light at night or during naps and eyes really do feel better.
• Inexpensive, fast, at-home eye spa: Circulation boost. One clean wash cloth cooled with cool water, then switch to clean warm wash cloth. Wring to nearly dry before applying–no drips (you don't want water IN your eye). Not Hot & Cold. Moderation, and only for a a little while each before changing to next. Feels good.
• Blot: When they run, gently blot beneath runny eyes – on face but not on eyes or sore lids at all. Never rub eyes. Tissue fibers do irritate. Avoid scented tissue, same concept here.

JRFoutin, MarshallProtocol.com

I just saw that you are in need of ABX for eye? If so, I recently had pink eye, and another member suggested VIGAMOX. This is moxifloxacin hydorchloride ophthalmic solution 0.5% comes in 3ml bottle.

You know how I am very medication sensitive, but I did just fine with this.

Lori (LH1953), MarshallProtocol.com

I may be experiencing a detached retina, but it could be something else. I got the symptoms a few times yesterday, but it disappeared. Now, the symptoms are back. When I look dead ahead, there appears to be a black slash where my vision should be in the upper regions of my vision in my left eye; if I look up, it disappears. I've had these symptoms previously (over 20 years ago they happened on/off for a weekk or so) and they disappeared on their own without my ever seeking medical help.

Had my intensely light intrusive eye appointment this AM and was told that it was a “subjective visual disturbance,” as there is no explanation for what I was experiencing. No physical evidence, no readily available “sounds like.” I was told that if I lose part of my vision for a full day, to call the eye doctor the next day for an immediate appointment. This, of course, is why I didn't see an eye doctor 20 years ago when this happened for a couple of weeks straight: weird symptoms, no explanations.

eClaire

MP day 142 (17/05/06) I am not sure where this fits into things but it is now gone and my eyes are evenly open. I think this is a significant improvement.

VickiSA

My daughter has been on the Methotrexate and the Predforte eye drops. (You can read more about her at Teen on MP.)

My understanding is that people generally wean from Methotrexate so they can tell at what dose their symptoms return. Otherwise, I don't think that weaning is necessary.

My daughter has had a lot of benefit from the Marshall Protocol while using Pred Forte eye drops - but we are concerned that the Pred drops might be interfering with resolution of her uveitis. From my experience with my daughter, I imagine that you could benefit from the MP, even while using your current low dose of Pred Forte eye drops. If you can successfully wean from the pred drops, that would be even better.

Benicar is likely to help you wean down from the pred drops (just as it helps people to wean from oral prednisone). (There is also research that suggests that medicine in the same class as Benicar helps.

Margo