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Dry Eye, Autoimmune (Keratoconjunctivitis Sicca)

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Eye Stabilized with Cyclosporin Drops.

Eye Stabilized with Cyclosporin Eye Drops. Inflammation Controlled,  Still Edematous. GFW

What Is Keratoconjunctivitis Sicca?

Keratoconjunctivitis sicca is a distressing autoimmune form of dry eye that causes chronic bilateral dessication (dryness of both eyes) with inflammation of the conjunctiva and cornea due to tear abnormality.

Little sores develop that cause the symptoms and which can be seen through staining procedures. Thickening of the cornea may result, impairing vision, but there is not loss of tissue.

Q: What is tear abnormality?

A: Tear abnormality means that something is wrong with production of tears that continuously bathe the eyes to keep them moist, create a smooth surface for clear vision, nourish the cornea, wash away debris, and protect against germ invasion.

These tears are not the same composition as the tears produced when crying. Rather, they are a complex three layer fluid called the tear film. The tear film is made by the combined action of three eye structures: lacrimal glands produce an aqueous layer, Meibomian glands in the eyelids produce a lipid (oil) layer that coats the aqueous layer, and goblet cells in the conjunctiva produce a mucous layer that spreads the tear layer.

A qualitative and quantitative deficiency of tears can lead to the persistent and progressive damage of the ocular surface with a compromised wound-healing process. 

What Is Keratoconjunctivitis Sicca In Celiac Disease and/or Gluten Sensitivity?

  • Keratoconjunctivitis sicca is an associated eye disorder in celiac disease.
  • The association between celiac disease and other immune disorders may be due to the sharing of a common genetic background, such as HLA antigens. However, in a very large study, involving 909 patients with celiac disease, it was found that the development of immune disorders in celiac disease was clearly related to the duration of exposure to gluten.1

How Prevalent Is Keratoconjunctivitis Sicca In Celiac Disease and/or Gluten Sensitivity?

Prevalence of keratoconjunctivitis sicca is described by case report as associated with celiac disease.2

What Are The Symptoms Of Keratoconjunctivitis Sicca?

Keratoconjunctivitis sicca is marked by these symptoms:

  • Redness.
  • Itching.
  • Burning.
  • Photophobia (sensitivity to light).
  • A gritty sensation, also foreign body sensation.
  • Inability to produce tears.
  • Impaired eyelid movement.
  • White of the eye appears dull, thickened.
  • Excessive mucous secretion showing as yellow in the inner margin (at nose).

How Does Keratoconjunctivitis Sicca Develop In Celiac Disease and/or Gluten Sensitivity?

  • Keratoconjunctivitis sicca results from autoimmune-mediated decreased lacrimal (tear producing) function.

Does Keratoconjunctivitis Sicca Respond To Gluten-Free Diet?

Yes. Celiac disease-related keratoconjunctivitis sicca responds to gluten free diet.

6 Steps To Improve Keratoconjunctivitis Sicca In Celiac Disease and/or Gluten Sensitivity:

Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both keratoconjunctivitis sicca and gut health.

  • Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
  • A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
  • Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

  • Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
  • Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.3
  • The intestinal lining may take up to a year to heal.
  • 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

Here Are Major Inflammatory Food Types That Reduce Healing:

  • Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.4
  • Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
  • Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.4
  • Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.4.
  • Excessive Refined White Flours (bran layer removed)Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.4
  • Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
  • Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.4
  • Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.4
  • Cocoa and Black Tea increase blood sugar.
  • Rosemary. Increases blood sugar levels and should not be used by persons with insulin resistance or diabetes.

Here Are Important Anti-Inflammatory Food Types to Promote Health:

  • Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
  • Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
  • High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
  • Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
  • Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
  • Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
  • Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
  • Protective Herbs and Spices.  See below #6 below for examples.
  • 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

  • 4 Manage Your Medications Safely:

Certain medications promote eye inflammation. Ask your doctor or pharmacist about this possible adverse effect if you are taking regular medication. Do not stop prescribed medications without supervision.

 

  • 5Nutritional Supplements That May Help:

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

  • Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.

Storage NoteStore container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.

  • 6Manage Natural Remedies: 

Hydration:

  • Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
  • If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
  • Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
  • What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.

Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

  • Raspberry.
  • Carrot is also a cleansing digestive tonic.
  • Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
  • Redbeets also stimulate and improve digestion and are easily digested.
  • Cabbage also stimulates and improves digestion and is also a liver decongestant.
  • Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
  • Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

  • Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
  • Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
  • Parsley also relieves indigestion.
  • Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion. However, because it increases blood sugar levels, it should not be used by persons with insulin resistance or diabete.
  • Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

  • Cloves are also antispasmodic.
  • Nutmeg is also useful for indigestion.
  • Ginger.

Exercise Helps:

Exercise improves circulation and rids the body of toxins.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.

What Do Medical Research Studies Tell About Keratoconjunctivitis Sicca In Celiac Disease and/or Gluten Sensitivity?

“Celiac disease and keratoconjunctivitis. Occurrence with thrombocytopenic purpura.” This case report of a patient describes the rare association of celiac disease, keratoconjunctivitis sicca, and autoimmune thrombocytopenia. The development of three different autoimmune disorders in this patient may be related to the presence of HLA-B8 and HLA-Dw3, the prevalence of which is known to be increased in celiac disease and keratoconjunctivitis sicca, and that of HLA-B8 in autoimmune thrombocytopenic purpura. Despite the fact that thrombocytopenia is rarely encountered in celiac disease, it is suggested that an autoimmune mechanism should be excluded in patients with this combination.2

  1. La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol. 2003;9(6):1377-1380, Available at: http://www.wjgnet.com/1007-9327/9/1377.asp. Accessed Jan 3, 2005. []
  2. Eliakim R, Heyman S, Kornberg A. Celiac disease and keratoconjunctivitis. Occurrence with thrombocytopenic purpura. Archives of Internal Medicine. May 1982;142(5):1037. [] []
  3. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. []
  4. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [] [] [] [] [] []

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