As we take a look at the state of health and wellbeing in our communities today, there is no doubt that the pursuit of homeostasis is somewhat of a holy grail. We are exposed to external forces and consume things that wreak havoc on our body down to the cellular level. Inflammation and attacks on our bodies’ immunology often head down a path where it becomes difficult to reverse course.
As spring turns to summer, we remember that up to 40% of the population have sensitization via IgE antibodies to foreign proteins in the environment.(1) The prevalence of dry eye or ocular surface disease per the TFOS DEWS II report ranges from 5 to 50 percent.(2)
I quote my colleague and friend Milton Hom who insightfully said, “There is one sinus.” What he meant by that is that the mucous membranes of the eye (conjunctiva), nose, throat, and gut are intricately connected. Immune cells called neutrophils get recruited to reduce inflammation. They are present in our tears in higher amounts while we sleep to presumably clear waste products but in Meibomian gland dysfunction (MGD), their numbers remain high in the daytime.
In fact, elevated neutrophils were most common in people with severe MGD who also suffered from conditions causing inflammation such as allergies, rosacea, and autoimmune diseases. The gland is not physically blocked by neutrophils, but their activity causes dysfunction to the process that creates that precious oil needed in the lipid layer of the tears to keep the ocular surface comfortable and protected.(3)
So in the interest of healing this “one sinus” and the body from the inside out, many have turned to all natural approaches. Whether it’s a green smoothie daily in the morning or consistently consuming superfoods, I want to turn our attention to probiotics for a moment. The word itself comes from the Greek meaning ‘for life.’ Certainly not all probiotic supplements are created equal, but their claims can be far reaching in just a simple search. At the end of day, certain probiotics simply balance gut health while specific strains have the ability to be immunomodulatory.(4)
The future of personalized medicine will certainly involve a holistic approach as instilling, injecting, and ingesting corticosteroids is not a long-term solution to combat recurrent inflammation. It has been said that it takes 17 years for research evidence to reach clinical practice.(5) While I am not proposing a new standard of care, we must remain diligent in reading the peer-reviewed literature and not accept the seeming finality of a suffering patient when the complexity of their disease warrants further and tireless investigation. Only then can we be confident we have deeply cared for those who seek our care.
Justin T. Kwan, OD, FAAO