Tuesday, October 15, 2024

Tea Tree Oil: The Controversy and The Facts

The Facts:

Tea Tree Oil (TTO) is a natural oil dervived from the leaf of Australian native plant Melaleuca alternifolia. It has been used for almost 100years in Australia according to one study(Ref 1)  Distilled & diluted, it has long been used as a natural killer for mites, bacteria, viruses, and fungi. It is effective against S. aureus, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans and is known to be highly effective in eradicating Demodex. Ref 1, 2, 3

terpene hydrocarbons, mainly monoterpenes, sesquiterpenes, and their associated alcohols. Terpenes are volatile, aromatic hydrocarbons and may be considered polymers of isoprene, which has the formula C5H8

[,]

The study below performed on human used TTO eyelid scrub (Naviblef™ Eyelid Foam/Novax Pharma/Italy) which was applied 2 times daily for 30 days. This TTO formula contains extracts of TTO, extracts of pharmaceutical grade chamomile which has soothing and decongestant properties, and Vitamin B5 which is known to have moisturizing properties. The authors not NO financial interest in the product.

The Issues:

1. Demodex destroys meibomian glands

2. Aging destroys meibomian glands.

3. An intro study (not done in humans yet) showed TTO destroys meibomian glands.

4. Does Ivermectin destroy meibomian glands?

5. Does Blue Light destroy meibomian glands?

References:

1. 

2.  Gao YY, Di Pascuale MA, Li W, Liu DT, Baradaran-Rafii A, Elizondo A, et al. High prevalence of Demodex in eyelashes with cylindrical dandruff. Invest Ophthalmol Vis Sci. 2005;46:3089–94. [PubMed[]

3. Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (Tea tree) oil: A review of antimicrobial and other medicinal properties. Clin Microbiol Rev. 2006;19:50–62. [PMC free article] [PubMed[]

4. J Appl Bacteriol

1995 Mar;78(3):264-9.
 doi: 10.1111/j.1365-2672.1995.tb05025.x.

Antimicrobial activity of the major components of the essential oil of Melaleuca alternifolia

Affiliations 

https://teamtoyos.com/stop-using-tea-tree-oil/

Effects of Terpinen-4-ol on meibomian gland epithelial cells in vitro – Di Chen, MD et al Cornea. 2020 Dec; 39(12): 1541–1546.

Highlight Quotes from the Paper

“Our findings show that T4O (Tea Tree Oil) caused a dose- and time-dependent decrease in the survival of Human Meibomian Gland Epithelial Cells IHMGECs, and also significantly reduced their P-Akt signaling ability. The demodicidal 1.0% T4O concentration killed almost all the IHMGECs within 90 minutes. Reducing the T4O level by 100-fold to 0.01% still decreased the survival of IHMGECs but did not interfere with their capacity to differentiate. Overall, our results support our hypothesis that the demodicidal concentrations of T4O are toxic to IHMGECs.”

“The toxicity of TTO and T4O is not unique to IHMGECs. Investigators have reported that demodicidal concentrations and less of TTO or T4O kill human hepatic, cervical and breast epithelial, T, B, and bone marrow cells, as well as fibroblasts and peripheral blood monocytes in vitro13,14,28–31. TTO is also known to: [a] cause allergic contact dermatitis, with a 0.7% prevalence in patch-tested patients32; [b] generate secondary organic aerosols containing ultrafine particles, which may elicit inflammation and oxidative stress33; [c] contribute to the development of antibiotic resistance in human pathogens and commensals, when used repeatedly at sub-lethal bactericidal concentrations (0.1 to 0.25%)34; and [d] induce prepubertal gynecomastia in young boys29,30.”

“In our study, T4O reduced Akt phosphorylation in IHMGECs after only 30 min exposure. The P-Akt pathway is an important regulator of cell proliferation and survival44. As a large sebaceous gland that secretes through a holocrine mechanism, the human meibomian gland requires constant renewal and differentiation of meibomian gland acinar epithelial cells, which means IHMGECs are metabolically active and more sensitive to cell cycle inhibitors35. The fact that all IHMGECs were dead in differentiating medium after 5 days of treatment with 0.1% T4O further proved its toxicity in vitro.”

“The European Cosmetic Toiletry and Perfumery Association in 2002 published the following recommendation: “Tea Tree Oil should not be used in cosmetic products in a way that results in a concentration greater than 1% oil being applied to the body”47. Given that Manuka honey48, microblepharoexfoliation49 and intense pulsed light therapy50–53 have all been shown to be effective against Demodex, is it possible that these treatments could replace TTO and T4O in the future?”

“T4O, at demodicidal concentrations, alters the morphology and inhibits the survival of IHMGECs. T4O at lower concentrations also reduces the proliferation and activity of a cell survival mediator in IHMGECs.”

This work was supported by NIH grant EY05612

Conflict of interest: The authors declare no conflict of interests.

Monday, July 10, 2023

MIEBO Perfluorocyclohexane New Eye Drop

 

MIEBO, Perfluorocyclohexane opthalmic solution drops, was recently FDA-approved. Perfluorocyclohexane is a well known, chemically inert, thermally stable substance that reminds me of thick wax when I used this in the lab as an undergrad at certain temperatures. It is a relatively non-toxic, clear, waxy solid, which has a high vapor pressure and therefore sublimes (ie it goes from being a solid to a gas readily at room temperature. The company likely had to alter its chemical structure to help it stabilize as a drop at room temperature. 

It has been used for year in Europe with good results. Patients have complained of blurriness or redness (1-3% roughly). Otherwise it should help patients. 

No studies looking at meibographies before and after its use have been done. It would be nice to confirm that it does not damage meibomian glands, though I can not find a reason it would as it does not have a preservative.  Still, hopefully that study will be done as it is unleashed. 

Our first patient is starting in July 2023. Waiting to find out how she tolererates it. 

SLC

Few more notes:

1. Miebo has strong spreading properties due to low surface tension, facilitating small drop sizes and interacting with the lipophilic (ie fat or meibum) part of the tear film to form a layer at the film–air interface and prevent evaporation.

Semifluorinated Alkane Eye Drops

Perfluorohexyloctane (F6H8, NovaTears) (Novaliq, Heidelberg, Germany), in the family of semifluorinated alkanes, is a novel nonaqueous liquid, nonblurring wetting agent commercialized in Europe (EvoTears by Ursapharm) and Australia and New Zealand (AFT Pharmaceuticals) for the treatment of evaporative dry eye disease. Perfluorohexyloctane demonstrates strong spreading properties due to low surface tension, facilitating small drop sizes and interacting with the lipophilic part of the tear film to form a layer at the film–air interface and prevent evaporation.168 Steven et al. conducted an observational prospective, multicenter 6–8 week study of 61 patients with MGD and DED who received one drop of Perfluorohexyloctane four times daily. The study showed there was a significant reduction in corneal and conjunctival fluorescein staining, increase in number of expressible meibomian glands, increase in tear film break-up time, and improvement in severity of anterior and posterior blepharitis and improvement in OSDI score.169

NOVO3 (100% perfluorohexyloctane), an investigational drug in the United States, completed a Phase II study (SEECASE), a prospective, multicenter, randomized, double-masked, saline-controlled study of 336 DED patients. In the study, patients were randomized in a 2:2:1:1 manner to NOVO3 four times daily, NOVO3 twice daily, saline twice daily, and saline four times daily, respectively. The study met its primary endpoint of improvement in corneal fluorescein staining over control at 8 weeks and also showed significant improvement in symptoms.170 Two Phase 3 studies are currently taking place in the United States for NOVO3.

Thursday, November 3, 2022

Steroid Drops: what is the strongest and least strong?


Topical ophthalmic steroids placed in descending order of potency:

§  prednisolone acetate 1% (most potent)

§  dexamethasone 0.1%

§  betamethasone 0.1%

§  prednisolone sodium phosphate 0.5%

§  fluorometholone 0.1% (least potent)


        More Data:

Durezol (Pro)
Generic name: difluprednate

Lotemax 0.5%
Generic name: loteprednol

Ozurdex (Pro)
Generic name: dexamethasone

Retisert (Pro)
Generic name: fluocinolone

Lotemax SM 0.38%
Generic name: loteprednol

Maxidex (Pro)
Generic name: dexamethasone

Flarex (Pro)
Generic name: fluorometholone

Eysuvis 0.25%
Generic name: loteprednol

Alrex 0.2%
Generic name: loteprednol

PredForte 1%
Generic name: prednisolone acetate

Inveltys 1%
Generic name: loteprednol

FML Forte Liquifilm 0.1%
Generic name: fluorometholone

Triesence (Pro)
Generic name: triamcinolone

Ocu-Dex
Generic name: dexamethasone

Iluvien (Pro)
Generic name: fluocinolone

FML S.O.P. (Pro)
Generic name: fluorometholone

Xipere (Pro)
Generic name: triamcinolone

Vexol
Generic name: rimexolone

Trivaris (Pro)
Generic name: triamcinolone

Prednisol
Generic name: prednisolone

Pred Mild (Pro)
Generic name: prednisolone

Pred Forte (Pro)
Generic name: prednisolone

Omnipred (Pro)
Generic name: prednisolone

Ocu-Pred-A
Generic name: prednisolone

Ocu-Pred
Generic name: prednisolone

Inflamase Forte
Generic name: prednisolone

FML Liquifilm
Generic name: fluorometholone

FML (Pro)
Generic name: fluorometholone

Fluor-Op
Generic name: fluorometholone

Econopred Plus
Generic name: prednisolone

Dexycu (Pro)
Generic name: dexamethasone

Dextenza (Pro)
Generic name: dexamethasone

AK-Pred
Generic name: prednisolone

Suspension comes in 0.12% and 1%

Solution

 

 

Tuesday, August 31, 2021

The Cremers Homeschool

 

Yes we did homeschool at least 1 child for the last 20 years. It seems like it went by in a flash though some days were very tough. Now that one of our sons is at Columbia and another is at Harvard, we feel we did not let them down academically which was a fear early on: both my husband and I worked full time for many of the last 20 years. We just have 4 more kids to get through high school, Lord willing ;)

This is the short & sweet version of how we did it. I have written about this in another blog so will resurrect that soon.

1. We used the Robinson Curriculum: homeschooled 15min/day. It works but we did find that dad must be involved to tell kids to "shut up & do your work!"

We followed their book list but excluded books contrary to our faith. 

https://www.robinsoncurriculum.com/rc/curriculum-contents-list/

As soon as we found the Heights School Book Reading list, we quickly moved to this dad-approved list:

https://heights.edu/parents/heights-books/

We printed out vocabulary words & drilled the kids.

2. When our older sons hit 5/6th grade, we moved for the best school in the World: our opinion. The Heights is a lifesaver! Would do it all again. 

3. When we homeschooled we used the following:


A. For Reading: we love the McGuffey Readers! Reading Comprehension at its core. 


https://amzn.to/3zzHzYr





B. For Math: which was the hardest. They did 1 chapter per day 6 days a week. 

In later years, we had the younger kids do just odds or evens: don't tell my older sons.
This can take 15 min to 4 hrs depending on the state of the child and the currency you use for motivation. 

Every child has a currency. We had no tv nor video games so if they wanted screen time, they had to finish their math. 


C. For History: we had kids listen to this whole series. When they were old enough to do the workbooks we did some of them but never completed a full workbook.


D. For Writing: 
We used Learning without Tears (aka Writing without Tears): because heaven knows there were tears early on...mostly from me!







E. For Faith: 
We loved the below set which we still have! I love re-reading them to our kids even though they are older now. I have personally learned so much about simple techniques to increase virtue in myself & the kids: though it is a constant struggle.


G. For Science: we did a lot of nature walks, nature study, cooking (a lot!), gardening. 
WE love Montessori & Charlotte Mason. 
We did a lot of activities with other homeschooling parents: Lord bless the Archangels of Miami and Homeschooling groups in Boston, Miami, Maryland, Virginia!

We studied big, happy families and tried to take notes to try to replicate as much as we could how it could be done. Though we failed a lot!... We tried each day to make our home a happy, cheerful home. And I learned to stop talking about cadavers, disease, and death "all the time" at the dinner table.

Saturday, December 26, 2020

Best Schematic Explaining Complexity of Dry Eye Disease I could find so far

 

Best Schematic Explaining Complexity of Dry Eye Disease I could find so far.
Dry Eye Disease is complex and hard for some to understand why simple drops do not help or can make things worse. 

Below is a good schematic: the best I could find thus far. But notice how the ones sponsoring it do not mention Biologic options (ie, Autologous Serum, Platelet Rich Plasma, etc.)





https://www.pharmaceutical-journal.com/download?ac=1071315