What Is Intestinal Dysbiosis? [dropcap]I[/dropcap]ntestinal dysbiosis is an imbalance of the composition and quantity of microbe populations (called the microbiota), that naturally inhabit our human gut. Dysbiosis causes altered gut immunity, abnormal fermentation of undigested foodstuffs,…
[dropcap]C[/dropcap]hronic dry eye syndrome is an inflammatory condition of the conjunctiva with inadequate tear production or distribution over the eye surface. It is characterized by surface damage to the conjunctiva, giving the appearance of redness.
This complex condition involves the lacrimal glands, eyelids, and tear film, as well as a variety of eye surface tissues, including epithelial, inflammatory, immune, and goblet cells.1
Q: What is the conjunctiva?
A: The conjunctiva is the mucous membrane that lines the inside of the eyelids and covers the eyeball surface, also called the white of eye. The conjunctiva has a rich blood supply that can quickly bring microbe fighting cells to prevent invasion and overcome infection.
While infection and inflammation go hand-in-hand, they are not the cause of, but may result from, chronic dry eyes.
Dry eye syndrome develops from poor health of the conjunctiva that is associated with inadequate nutrition and poor quality of the tears that steadily lubricate the eye surface. These tears are called the tear film and are not the same as tears produced when crying or that result from irritating substances such as onions. Blinking spreads the tears that protect the surface from drying and flushes away unwanted matter.
The tear film is made up of three layers: mucous layer produced by goblet cells in the conjunctiva, aqueous (water) layer produced by the lacrimal glands, and lipid (fat) layer produced by the meibomian glands in the eyelids. Dysfunction of any of these layers impairs the the tear film. Without an adequate tear film the conjunctiva becomes dry and inflamed.
When the meibomian glands fail to produce sufficient lipid that is clear and fluid but rather cloudy and thick, the condition is called meibomian gland dysfunction (MGD). The main cause of MGD is hyperkeratinization (thickening of the glands) and its related pathogenesis (for example, ductal dilatation and acinar atrophy). Other disorders such as atopy, pemphigoid acne, rosacea, and seborrhea are related to MGD and may result in a chronic inflammation of the eye surface.2
MGD is “the most underrecognized, underappreciated and undertreated disease in ophthalmic care. It is so common as to be taken as ‘normal’ in many clinical practices,” according to Joseph Tauber, MD, an anterior segment subspecialist and refractive surgeon in Kansas City, Mo.3
Untreated dry eye progresses to xerophthalmia, a condition of extreme drying and thickening of the conjunctiva characterized by hazy, dry cornea. Other causes of dry eye, beside celiac disease, include certain systemic conditions such as Sjogren’s syndrome, an autoimmune disease.
[dropcap]N[/dropcap]on-infectious uveitis, as opposed to that which is caused by an infection, is an inflammatory eye disorder characterized mainly by swelling of the uveal tract structures in the anterior (front) of the eye.
Inflammation can also affect the lens, retina, optic nerve, and vitreous, producing reduced vision or blindness if left untreated.
Q: What are structures of the uveal tract?
A: Structures of the uveal tract are composed of the iris, the ciliary body, and the choroid:
Uveitis may be caused by problems or diseases occurring in the eye itself or it can be part of an inflammatory disease affecting other parts of the body. The uveal tract has a rich supply of blood vessels that contain immune cells to fight microbial invasion. These immune cells are lymphocytes, phagocytes, and plasma cells.
The uvea can be attacked by autoimmune antibodies produced in autoimmune diseases that affect similar tissues in other parts of the body such as psoriasis, Behcet’s syndrome, multiple sclerosis, sarcoidosis, Vogt Koyanagi Harada’s disease, and celiac disease.
Uveitis can last for a short (acute) or a long (chronic) time. The severest forms of uveitis reoccur many times.
What Is Unexplained Blurred Vision?[dropcap]U[/dropcap]nexplained blurred vision is unclear or distorted vision that is not caused by allergy, poor refraction (eye test), medication side effects, metabolic disorders, or defects in any part of the eyeball, optic nerve, or in the occipital area of the brain resulting from such problems as calcifications, aneurysm, or tumors.
What Is Cheilosis?[dropcap]C[/dropcap]heilosis is a painful feature of nutritional deficiencies, especially riboflavin and/or pyridoxine deficiency, and less frequently, from vitamin B12, folic acid, and iron. It is characterized by redness of the lips with cracking and weeping in the corner of the mouth.
Q: What is the consequence of weeping at the corners of the mouth?
A: The open sores that develop at the corners of the mouth invite infection by candida albicans, a yeast organism, and less commonly by bacteria normally present on the skin such as staphylococcus aureus.
These sores make opening the mouth very painful and so restrict eating, talking, socializing, and dental care.
Chronic lesions of the oral mucosa are disorders of the mouth that are characterized by soreness and sores of the soft mucosal lining of the mouth.
[dropcap]G[/dropcap]eographic tongue is a painful alteration in tongue tissue that is characteristic of riboflavin (vitamin B2) deficiency.1
Q: How does the tongue surface appear?
A: Areas of inflamed tissue with flattened papillae develop among areas of normal tissue, giving a map-like appearance to the tongue surface. There are often swollen papillae that hurt or sting, such as is seen in the photo to the left.
A diet that does not provide adequate amounts of riboflavin and any condition that 1) interferes with riboflavin absorption from the gut, 2) depletes the vitamin from the body, 3) overuses the vitamin in the body, or 4) adversely affects its use in the body will result in riboflavin deficiency causing geographic tongue.
Riboflavin is essential for converting foodstuffs into energy, maintaining the normal lifespan of red blood cells and maintaining healthy skin, eyes, hair, and nervous system. Riboflavin is converted into its active forms, flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN). These enzymes are primarily involved as co-factors in oxidation reduction reactions that are essential for cellular energy production and respiration.
Riboflavin is required for the conversion of pyridoxine (vitamin B6) to its functional form and the production of niacin (vitamin B3) from the amino acid tryptophan. Riboflavin has a role in antioxidant status by activating glutathione reductase, which regenerates used glutathione, a powerful antioxidant.
Respiratory infection, exercise, certain diseases, drugs and hormones can adversely influence riboflavin status.2 Stress is a major depleter of riboflavin.