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I think once per paragraph is enough. If you have different sources in the paragraph put them all at the end of the paragraph.--Chrisdab 03:20, 6 January 2007 (UTC)
The number of citations in this article is absolutely ridiculous. There's no need for a citations after every word. 84.90.41.37 22:03, 15 January 2007 (UTC)
For some it wouldnt be a problem to reduce the citations. the 2nd paragraph in Symptons for example has the same citation after every sentence while the citation could just be at the end of the paragraph. it would be a good idea to review the article and make citation changes so it isnt so cluddered. 24.241.227.184 23:46, 19 January 2007 (UTC)
Most of the citations are from the same source, so it isn't necessary to put all of these citations after every single phrase. It becomes an eye sore for the article and also becomes difficult to read and print. Citations should be added at the end of the paragraph. -Vlad (talk) 00:43, 13 December 2007 (UTC)
This section includes unsourced text that has been removed from the article. --Amit 16:16, 18 September 2007 (UTC)
Other research indicates the film does not evaporate but suffers de-wetting caused by a hydrophobic ocular surface - ref Frank Holly Phd —Preceding unsigned comment added by 92.233.165.60 (talk) 21:12, 31 May 2008 (UTC)
References
I'm moving all of the info about Clarymist from the article to this page. This is because of several reasons, namely:
It seems more than a bit unusual that a product for dry eyes would work even when sprayed with the eyes closed. I had to try it out for myself though to be sure. I did, and it did not have any effect, irrespective of whether it was sprayed with eyes closed or open. The text removed is below. --Amit 01:08, 29 September 2007 (UTC)
Clarymist is designed to help people who have dry eye and although trials have shown it to benefit people without dry eye the perceived effects are less marked. If you don't have dry eye then it doesn't surprise me that you didn't find it had any affect. Many people find it difficult to believe that this spray can have any effect when sprayed on to the closed eye. When I'm working with patients who have dry eye it can be difficult to persuade them to even try Clarymist because they immediately think it can't possibly work. However, its my experience in clinical practice, that those patients who have lipid dysfunction dry eye do often get benefit from this spray and tell me that their symptoms are much reduced. Once sprayed on the closed eye the solution works its way along the eye lashes and the lid margins and then into the eye. Enough will enter the eye in this way to improve the tear film for many people with lipid dysfunction dry eye. This is a recognised method of applying eye medication and is often used in procedures for the detection of eye diseases. Frank45 09:20, 4 October 2007 (UTC)
References
((cite journal))
: CS1 maint: multiple names: authors list (link)
I don't have time to work on this now, especially with Wikipedia's rules about citations. But maybe someone else would like to get all the citations to back up the following. David Sullivan at Harvard Medical School's Eye Institute has done some work over the last several years that shows that androgen therapy helps with dry eye. Allergan currently has some androgen eye drops in clinical trials. I heard Sullivan speak at a scientific meeting (where my job was to write up the proceedings, write, not just transcribe) and his ideas were good. Basically, dry eye is more common in older women than men. He thinks it is because as women go through menopause, testosterone levels drop (little known fact), which leads to dry eye. Androgens control the viscosity of the oils in the skin oil glands and similar ones that protect the cornea as well. Men's testosterone levels generally being higher to begin with, it's less of a problem for them--oil stays thin,not too thick to stream over the eye and prevent fluid from evaporating. I'm happy to provide my write up of the meeting proceedings, which were published in 2002 and constitute a respectable secondary source (though not, ironically, if I write the material here myself). Here's the title "Proceedings of the 3rd annual conference on Sex and Gene Expression" I'll check my watchlist to see if anyone asks for it. Also, there was a recent article in the LA Times in which Sullivan's work was mentioned. Eperotao 17:01, 17 March 2007 (UTC)
Tell me, does that bit about "Restasis" sound too advirtisementy? (it was added 11 March 2006 by 67.87.254.63)
Hi chaps, I've renamed the 'omega 3' subsection as 'fish oils' as the study cited by Miljanovic et al examined used questions on sea food consumption as a surrogate for omega-3 intake. Cross sectional surveys are open to confounding and it would be safer to report the study findings rather than the authors inferences. I've also amended my typo regarding the Arch Ophth study Nernst (talk) 18:13, 6 May 2008 (UTC)
Has anybody thought of changing the page title to Dry eyes or Dry eye syndrome. Most people (vets and optoms included) are unlikely to put 'keratoconjuncitivitis sicca' in to google. This is a good article and shouldn't be hidden. It's quite a big change and I'd be reluctant to make it without some feedback. —Preceding unsigned comment added by 78.146.186.66 (talk) 14:24, 9 May 2008 (UTC)
Thanks for the further contributions to this section. I do think some further improvements need to be made -
"It is the only prescription product approved for chronic dry eyes.[5]" Reference is 3 years out of date and refers only to the US. While it is commendable to avoid weasel words, it is impossible to have complete confidence in this statement
"Approved by the U.S. Food and Drug Administration in 2002 for this indication[5], the drug decreases inflammation[6] on the eye surface." Tautalogy / clumsy. By eye surface does the article mean conjuncitva/sclera/cornea ?
"Cyclosporine appears to work since the chronic inflammation of the ocular surface is mediated mainly by T-lymphocytes and cyclosporine’s proposed mechanism of action in immunosuppression is through T-lymphocyte inhibition[15] through “binding an intracellular protein that ultimately controls transcription factors required for cytokine production and T-lymphocyte maturation”.[16]" Poorly worded, repetitive and overstated. The pathogenesis is variable and still poorly understood. Most drugs ulitmately work by modification of protein transcription, what is the purpose of this statement ?
"It increases healthy tear production,[6] which may be reduced because of inflammation on the eye surface.[5] In a clinical trial involving 1,200 individuals, Restasis increased tear production in 15 percent of patients, compared with 5 percent of patients in the placebo group.[5]" Repetitive and confusing - "inflammation of the eye surface~" has already been mentioned twice in this paragraph. Clarify. Are there 'unhealthy' tears as well as healthy tears ? Surely a decrease in tear production promotes inflammation. If the pathogenisis is chicken and egg then this should be stated. What is the journal reference for the improvement in 15% of 1200 people ?
"Usually, 1 gtt (drop) of Restasis is instilled in each eye twice a day, 12 hours apart.[1] It should not be used when ??while?? wearing contact lenses,[1] or by persons ?? people ?? with eye infections[5] or hypersensitivity[5] to the ingredients. It has not been tested in people with herpes viral infections of the eye,[5] and it should not be used by anyone with a history[6] of such an infection. The most common side effect is a burning sensation.[5] Other side effects may be eye redness, discharge, watery eyes, eye pain, foreign body sensation, itching, stinging, and blurred vision.[1][5]" Does it have to be exactly 12 hours apart, is this convention or evidence based ? Of course it shoudn't be given it to people who are allergic to it. Cyclosporin has been tested on patients with HSV in the treatment of stromal keratitis (Heiligenhaus et al, Graefs '99)
I'd welcome further ideas before re-modifying this secion Nernst (talk) 10:27, 21 July 2008 (UTC)
"As of 2005" would be one solution but its not hugely helpful to emphasise the licenced status since on and off label topical corticosteroids remain the mainstay of treatment of ocular surface disease. I've reinserted the 15% claim but it's still not ideal and it's only examining a surrogate outcome (patients want to know if there eyes will feel less dry, not if they'll produce more tears). To be honest I'd prefer to remove the whole 2nd paragraph because if you're taking the drug, you'll already have the small print and if you're not, it's not really relevant. 219.88.218.112 (talk) 07:50, 22 July 2008 (UTC)
Regardless of background, input is always appreciated but context is important and it is less helpful to modify sections in isolation. This article works best when it provides an overview of options and ideas. Professionals can provide more detail and up to date research to individuals where it's needed. I'm as guilty as anyone of selective editing but don't really have the time or expertise to go over the whole thing. There are lots of general review are out there for anyone inclined to improve the article further (see below). Evidence from manufacturers should always be treated with caution and in a complex disease like this, outcomes like tear production are less useful than perceived improvement or willingness to recommed the product (98% in one study). Remember, many people with dry eyes will get reflex tearing! http://www.ajmc.com/article.cfm?ID=10265 http://www.ajmc.com/article.cfm?ID=10266 If we're keeping the side effects section, then we should probably include the risk of cancer at high doses of cyclosporin. —Preceding unsigned comment added by Nernst (talk • contribs) 11:41, 23 July 2008 (UTC)
Good point and fair enough. The article is still readable and that's the main thing. I think what I'm trying to say is that we shouldn't get bogged down in detail and miss the wood from the trees. If we do talk about one treatment we should do it in the context of the other therapies. I managed to track down a review that includes FDA licencing info and have accordingly removed the "only licenced treatment" bit (again, sorry) on the basis that it can be misleading if it makes people think that other treatments are not safe or have not been FDA approved. Management and therapy of dry eye disease: report of the Management and Therapy Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5:163-178. http://www.tearfilm.org/dewsreport/. 139.80.144.99 (talk) 04:59, 25 July 2008 (UTC) P.S. I'm not even going to get started on that/those on the basis that if we start debating pronouns my brain will melt —Preceding unsigned comment added by 139.80.144.99 (talk) 05:01, 25 July 2008 (UTC) P.P.S. Has anyone thought of merging artificial tears in to this article ?
Thanks for doing that. I suppose there is enough information on artificial tears to justify another entry given that Lemp devotes 20 paragraphs to it but we should probably include a bit more within this article as well. I'll try and add a bit more later this week. Nernst (talk) 04:25, 27 July 2008 (UTC)
I'm trying to add Lacrisert to the medications section and it keeps on getting removed for being too advertorial. Can someone help with this? It's an approved drug and has a full page on wikipedia. All of the info is right from the fda approved info. Not sure how this is different than the Restasis info. Thank you. --Astanger (talk) 21:14, 1 February 2010 (UTC)
Makes sense but shouldn't it also be in the dry eye section. It is an approved product for dry eye. Is there something we can put in the dry eye/medications section? --Astanger (talk) 20:34, 2 February 2010 (UTC)
Maybe I'm missing something here, but Lacrisert does not have "a full page on Wikipedia" as stated above, but is only a redirect to hydroxypropyl cellulose. Given that fact, today's addition of a section labeled "Lacrisert" and repeating that name 10 times seems inappropriate, should it remain? The section was added by user User:RCWAMS, and is the same content added 17 February by User:AMSRCW, who received a warning for product promotion at the time. --CliffC (talk) 20:45, 10 March 2010 (UTC)
Regarding the SPI - RCWAMS/AMSRCW is another company that works with AStanger and took over trying to get Lacrisert added. I work with AStanger and would like to continue the discussion on how to get Lacrisert added. Please advise. WillAb (talk) 23:17, 31 March 2010 (UTC)
IO Device - regarding your comment dated 6/Feb, please explain why you suspect anything Lacrisert-related put in the dry eye article will be removed? Since the drug indication is for dry eye syndrome, I'm not clear why it would be removed (other than being too advertorial, which I can work on). Thank you. WillAb (talk) 00:27, 5 April 2010 (UTC)
OK - I would like to update the information on Lacrisert in the artificial tears article with the following. Before I go and actually upload it, wanted to float it by you for any red flags before I reference/link it. You can ignore the terms in parentheses; those are just placeholders for citations. Thanks. Update: A formulation of hydroxypropyl cellulose is manufactured by Aton Pharma under the trade name Lacrisert. Approved by the U.S. Food and Drug Administration, it has been used as a dry eye therapy for over 25 years.(DOF) Lacrisert is indicated for patients with moderate to severe dry eye syndromes, including keratoconjunctivitis sicca; for patients who remain symptomatic after therapy with artificial tear solutions; and patients with exposure keratitis, decreased corneal sensitivity, and recurrent corneal erosions.(PI) Lacrisert helps to retain tears (Katz 1978) by maintaining tear film on the surface of the eye longer. (PI)
Lacrisert does not contain any preservatives and is supplied as a single-dose insert that is placed in the lower lid of each eye, every morning.(PI) The insert dissolves within minutes of insertion and can be used in contact wearers. Side effects include temporary blurring of vision, eye discomfort or irritation, increased sensitivity to light, eyelid swelling, and eye redness.(PI) —Preceding unsigned comment added by WillAb (talk • contribs) 12:11, 6 April 2010 (UTC)
If this many symptoms must be added, I highly suggest they be entered in a LIST FORMAT. —Preceding unsigned comment added by Lindendoss (talk • contribs) 18:08, 21 September 2010 (UTC)
It makes sense then one way to prevent the condition is to avoid contact lenses, no? 66.108.223.179 (talk) 13:49, 7 May 2011 (UTC)
Per the notice on the top of this talk page, the guideline WP:MEDRS should be followed when selecting sources for this article. I will tag what I feel are the unsuitable references so they can be replaced at some point. Lesion (talk) 15:56, 14 December 2013 (UTC)
Having suffered severe dry eye symptoms for years, I now use a combination of annual total punctal cauterization of all four puncta, Restasis, and synthetic vitamin A 10000 IU as retinyl palmitate daily for close to complete management of dryness symptoms, to the point where I rarely need to use lubricants, except when using contact lenses. It is not that my eyes are now more wet; they aren't, but they don't feel dry or irritated anymore. Note that vitamin A as beta carotene is not similarly effective, and a lower dose of 5000 IU is not comparably effective either. For some reason, vitamin A as cod liver oil hasn't worked for me either, only the synthetic form has, and I don't know why. Relevant scientific information about vitamin A supplementation for dry eyes is pending inclusion into the article. --IO Device (talk) 20:04, 4 June 2019 (UTC)
To supplement the above, low humidity in the winter, i.e. under 30%, can lead to severe symptoms which are easily reversed by using a humidifier which restores the humidity to 30% or higher. The symptoms can be especially severe at 15%. There isn't much extra benefit after the humidity is at least about 35%. --Acyclic (talk) 14:28, 31 March 2019 (UTC)
Different information for listing of K'Sicca here
http://timdietrich.me/icd-10/cm/H16.221/ — Preceding unsigned comment added by 75.108.69.219 (talk) 21:32, 17 February 2016 (UTC)
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Contact lenses don't cause dry eye disease afaik, but they typically do worsen the symptoms while the lens is in use. Having said that, some contacts are much more hydrating than others. --Acyclic (talk) 04:50, 17 August 2017 (UTC)
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Concerns reference 46. While checking the update of the Cochrane Review I did not find the contents of the sentence in the reference. I find no data in the review on epidemiology. Please advise us on this. — Preceding unsigned comment added by HMill88 (talk • contribs) 10:07, 16 September 2017 (UTC)
I have excised this section as it was built on unreliable (i.e. non-WP:MEDRS) sources. This was particularly unfortunate as the current science is pointing in exactly the opposite direction that Wikpedia was.[3]. Alexbrn (talk) 10:53, 29 September 2018 (UTC)