“Dry Eyes”: Treat the Cause, Not the Symptoms

  • The major cause of “dry eyes” is a hormone deficiency; treatment for that deficiency eliminates dry eyes.

Even though a major cause of “dry eyes” was reported in 2002, and successful treatment of that cause was published the following year, every dry eyes sufferer with whom I’ve worked has been very surprised. Every one of them has told me that no ophthalmologist or optometrist informed them about it, instead recommending RestasisTM, a patent medicine whose original patent expired in 2014 but has since been kindly given more patents which don’t expire until August 27, 2024.[i],[ii]
Like all patent medicines foreign to human bodies (and almost always foreign to planet Earth, too), Restasis has numerous adverse effects. According to an online source,[iii] burning eyes is the most common, experienced by at least 10% of users. Between 1% and 10% develop red eyelids, excess tears, swollen eyes and/or eyelids, blurry vision, eye irritation, and eye pain. “Only” 0.1% to 1% develop bacterial irritation, herpes zoster (“shingles” in the eye), other eye infections, a “feeling of something in the eye,” malfunction of the cornea of the eye, corneal scarring, itchy eyelids, stinging eyes discharge, eye itching, inflammation of the iris of the eye, and inflammation—like a pimple—on the margin of the eyelid.
While it’s true that except for “burning eyes,” all of these adverse effects occur in fewer than 10% of users, the natural remedy for dry eyes has none of these adverse effects at all. This natural remedy actually is beneficial for our entire bodies, not just the eyes!
Before we go to this natural remedy, let’s look at what Restasis really is. It’s a “put-it-in-your-eye” version of a formerly patented medicine called cyclosporine (also spelled ciclosporin), which suppresses the immune system! No kidding! Cyclosporine is used in organ transplantation to prevent rejection by the immune system. Cyclosporine reduces the activity of the immune system by interfering with the growth and exposure of T cells.[iv] Why would anyone want to put an immunosuppressive patent medicine into their eyes?
On to the safe, usually effective natural remedy for dry eyes—the remedy that actually treats the cause of this problem: it’s testosterone. As simple as that! Is it any wonder that the majority of dry eye sufferers are older women, who are most likely to have low testosterone levels?
As noted above, this cause of dry eyes was found and originally published in 2002[v] by a research group led by Dr. D. A. Sullivan at the Schepens Eye Research Institute in Boston. Here are two quotes from their research report.
The first quote:
We have recently discovered that women with primary and secondary Sjögren’s syndrome are androgen-deficient. We hypothesize that this hormone insufficiency contributes to the meibomian gland dysfunction, tear film instability, and evaporative dry eye that are characteristic of this autoimmune disorder. If our hypothesis is correct, we predict: (1) that androgens regulate meibomian gland function, control the quality and/or quantity of lipids produced by this tissue, and promote the formation of the tear film’s lipid layer; and (2) that androgen deficiency, due to an attenuation in androgen synthesis (e.g., during Sjögren’s syndrome, menopause, aging, complete androgen-insensitivity syndrome [CAIS] and anti-androgen use), will lead to meibomian gland dysfunction and evaporative dry eye.
In simpler English, this quote tells us that meibomian glands in the eyelids produce oils that prevent tears from evaporating from our eyes. Meibomian glands are stimulated by androgens in both sexes; if androgens—particularly testosterone—are low, then the meibomian glands don’t make those oils, our tears evaporate . . . and we get “dry eye”!
And the second quote:
Our findings show that the meibomian gland is an androgen target organ and that androgen deficiency may promote meibomian gland dysfunction and evaporative dry eye. Overall, these results support our hypothesis that androgen deficiency may be an important etiologic factor in the pathogenesis of evaporative dry eye in women with Sjögren’s syndrome.
In brief English: androgen deficiency probably is a major cause of dry eye! Yes, these researchers limited their prediction to women with Sjögren’s syndrome, but it also applies to anyone else with meibomian glands, low testosterone, and dry eyes.
Didn’t take long (2003) for other researchers[vi] to test this prediction! A briefer quote:
Transdermal delivery of testosterone appears to be a safe and effective treatment for dry eye. The transdermal cream allows use of increased testosterone concentration and dramatically improves patient comfort. Post-menopausal females perceived the greatest relief of symptoms from the treatment, while males had the least benefit.
I’m not an ophthalmologist, so individuals with dry eyes don’t usually visit me specifically about that problem. However, over the years it’s been part of the overall health picture for many of those who visit for other reasons. Everyone with this problem—mostly women, as the research reports suggest would be the case—is checked for testosterone levels, and so far, all the women and some of the men tested have tested low or low-normal.
So far, every one of the women (but only about half of the men) have eliminated their dry eyes with testosterone use, and at the same time as a whole-body-effective hormone testosterone has improved muscle strength, lessened anxiety (yes, testosterone and other androgens significantly improve anxiety for women who test low) and in some cases improved libido, and improved auto-immune symptoms for women who have them!
One other detail about testosterone (and other bioidentical “steroid”) use: I always recommend transmucosal (rubbed-in) use because it keeps absorbing well indefinitely, while transdermal absorption frequently “fades away.” However, to relieve those dry eyes as rapidly as possible, women can safely use a tiny dab of testosterone on each eyelid in addition to what’s being used transmucosally. When the dry eyes are gone, the prescribed amount used transmucosally will maintain the eyes without any dryness!
So why haven’t many dry eye sufferers read, heard, or seen any advertisements about testosterone and dry eyes? It’s that word “patent,” which enables financing of the $2.5 billion dollar cost[vii] required to obtain approval by los federales at the FDA. With patent protection, sales of Restasis can stay at high levels ($3.26 billion in 2014),[viii] paying both this cost making a large profit, too.
Most natural treatments are unpatentable, and very often suppressed. Remember those warning letters sent from los federales at the FDA to the California walnut growers and the Michigan tart cherry growers? The FDA threatened confiscation and legal action if the walnut and cherry growers continued to publish scientifically proven truth about the health benefits of walnuts and tart cherries?
For obvious reasons, testosterone use is not likely to be suppressed, so if you have dry eyes, wouldn’t you rather give it a try for your eyes (and the rest of your body, too) instead of continuing to put an immune-system-suppressing molecule into your eyes every day?
Other articles in this issue:
Dramatically Decrease (or Even Eliminate) Your Risk of Heart Attack and Stroke

Your Mother Was Right: Eat Your Veggies!
[i] http://www.drugs.com/availability/generic-restasis.html (accessed April 2016).
[ii] http://seekingalpha.com/article/1945551-new-patents-could-sustain-allergan-restasis-franchise-until-2024 (accessed April 2016).
[iii] http://www.drugs.com/sfx/restasis-side-effects.html (accessed April 2016).
[iv] Kaminski HJ (ed), Myasthenia Gravis and Related Disorders (New York: Springer, 2008), p. 163.
[v] Sullivan DA, et al. “Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye.” Ann NY Acad Sci. 2002 Jun; 966:211-22.
[vi] Connor CG. “Treatment of Dry Eye with a Transdermal 3% Testosterone Cream.” Invest Ophthalmol Vis Sci 2003; 44(13):2450.
[vii] http://csdd.tufts.edu/news/complete_story/tufts_csdd_rd_cost_study_now_published (accessed April 2016).
[viii] http://connect.dcat.org/blogs/pharma-news/2015/07/20/allergan-faces-battle-over-generic-restasis (accessed April 2016).

1 comment

  1. Dear Dr Wright,
    Excellent discussion of Testosterone for Dry Eye Syndrome !!
    I devoted a chapter in my book Bioidentical Hormones 101 to this topic:
    In 2000, Dr. Sullivan reported that men taking testosterone blocking drugs have dry eye syndrome. Men on testosterone blocking drug treatment
    for prostate cancer were found to have poor quality tear fluid. This was demonstrated by analyzing the meibomian gland secretions. The dry eye
    symptoms included light sensitivity, painful and blurry eyes. Dr. Sullivan said:
    “the use of anti-androgen pharmaceuticals was associated with
    significant changes in the relative amounts of lipids in meibomian gland
    secretions. Our findings indicate that chronic androgen deficiency is
    associated with meibomian gland dysfunction and dry eye.” (2)
    In 2001, Drs. Worda and Nepp from Vienna Austria reported that topically administered androgen can restore the lipid phase of the tear film, and was useful in treatment of “keratoconjunctivitis sicca”, the
    medical term for Dry Eye Syndrome. (3)
    Complete Insensitivity to Androgen and Dry Eyes
    Next, Dr Sullivan turned his attention to a genetic disorder called Complete Insensitivity to Androgen (CIAS). In this genetic disorder, the androgen
    receptor is nonfunctional, and subsequently, there is insensitivity to
    testosterone. Without a functioning receptor, the normal activity of testosterone is completely blocked. Dr Sullivan examined the fluid in tears from Meibomian gland secretions in women with CIAS and compared them to normal controls. The patients with CIAS had alteration in the lipid fractions of tear fluid. This study was published in a 2002 report in Arch Ophthalmology (5).
    Trans-Dermal Testosterone For Dry Eye Syndrome
    In 2003, Dr. Connor reported transdermal testosterone is safe and effective treatment for dry eye, with the post-menopausal females having the greatest relief of symptoms. (10)
    In 2005, Dr Schirra et al studied the molecular biology of testosterone, and gene expression in the meibomian gland of mice. Dr Schirra reported that testosterone regulates the expression of more than 1500 genes in the mouse meibomian gland which serves to stimulate lipid and fatty acid metabolism in the lubricating eye fluid. (11) The sum total of the above evidence is overwhelming that testosterone plays a key role in production of oil, the lipid component for lubricating the eyes, and that testosterone deficiency is a treatable cause of dry eye syndrome. The treatment is testosterone, a bioidentical hormone.
    Omega 3 Fish Oils Also Useful for Dry Eye
    Since the lubrication of the eye is an oily film, one might think
    that nutritional oil consumption to be of benefit in the disorder. That
    is what Dr Rahul Bhargava found in a 2013 study in the Journal of Ophthalmology.
    For refernces , see free chapter from book:
    regards from
    jeffrey dach md

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