Dry eye can cause intense pain. For most people who have dry eyes, including most people who experience severe pain, the standard treatments typically recommended by eye doctors provide relief. Some people, however, have tried artificial lubricants, eyelid treatments, and punctal occlusion and yet continue to experience incapacitating pain. The purpose of this Web site is to provide information that might be useful to people for whom the standard treatments are inadequate.
The following table briefly describes dry eye and some of the conditions that can cause or increase dry eye pain. A person can have one of these conditions, several in combination, or all of them.
|Condition||Description *||Diagnosed By|
|Chronic dryness of the conjunctiva and cornea due to inadequate tear production or tear evaporation, or both. The conjunctiva are the thin mucous membranes that cover the eyeball and the inside of the eyelids. The cornea is the clear window on the front of the eye. Dry spots can develop on the cornea. Eyes can be painful even when the cornea appears white. Sometimes pain is perceived as photophobia (aversion to light). Complications can include infections or ulcers of the cornea.||Ophthalmologist or optometrist|
|Allergic inflammation of the conjunctiva (membrane covering eyeball and inner eyelids). Triggering allergies can include house dust, mold, mildew, animal danders, dirty air from heating or air conditioning systems, and so on. Many eyedrops for allergic eyes can increase dry eye and therefore make dry eye pain worse. Conversely, eyedrops for dry eye that contain preservatives or methylcellulose can cause an allergic eye reaction (either immediately, or after a couple of weeks). If you have both dry eye and allergic eye, be sure your doctor is aware of both conditions.||Allergist|
|Chronic blepharitis||Inflammation of the margins (edges) of the eyelids.||Ophthalmologist or optometrist|
|Chronic meibomianitis||Inflammation of the oil-secreting glands of the eyelids. Meibomianitis is actually a type of blepharitis (see preceding row). If eyelids are not kept clean, dry eye pain can increase and frequent styes can result.||Ophthalmologist or optometrist|
|Vitamin A deficiency||
Inadequate conversion of carotene to vitamin A,
or difficulty with absorption, storage, or transport of
vitamin A. Vitamin A deficiency can cause or worsen dryness
of the conjunctiva and cornea. Vitamin A deficiency
can also cause impaired night vision.
Caution Too much vitamin A can be toxic. For an eyedrop that might help, see Custom Eyedrops.
|Ophthalmologist or optometrist|
|Sjogren's Syndrome||A chronic autoimmune disease in which the body's immune system mistakenly attacks its own moisture-producing glands. Dry eye, dry mouth, and fatigue are typical symptoms. Sjogren's can also affect other organs, such as the kidney, lung, liver, GI tract, and peripheral or central nervous system. Men and women, young and old, can develop Sjogren's, but women outnumber men, and it is more common among middle-aged and older people.||Rheumatologist|
|Estrogen or androgen deficiency||
Estrogen deficiency (usually due to menopause or hysterectomy)
can cause dry eye or worsen existing dry eye. Taking a hormone replacement
therapy (HRT) drug such as Prempro, can increase dry eye pain even
more — the Journal of the American Medical Association
(JAMA, 2001; 286:2114-2119) reports substantial worsening of
dry eye symptoms in people using HRT. In addition, insufficient production
of the "male" hormone androgen (which, like estrogen, occurs in both men
and women) is reported to impair the function of both the lacrimal and
meibomian glands (article by Dr. Stuart S. Kassan in Sjogren's Syndrome
Foundation newsletter, February 2002).
In other words, sex hormones clearly play a role in dry eye, but how to effectively treat this aspect of the problem is still under investigation.
|Ob/Gyn (women), urologist (men), rheumatologist (men and women)|
|Lasik surgery or radiation treatment||In addition to the above organic causes, for some people dry eye can also be caused or made worse by some types of corneal surgery, including lasik surgery (see Medications & Surgery), or by radiation treatment.||For lasik, eye surgeons. For radiation, doctors who prescribe radiation treatment.|
|*These descriptions are synopses of information from the Merck Manual, MEDLINEplus, and the Sjogren's Syndrome Foundation.|
Oddly, some people go from doctor to doctor for years asking for help with eye pain or photophobia without receiving a diagnosis of dry eye, much less being offered any treatment options. If this is true for you, request that you be tested for each of the above conditions.
Tip for those with dry or allergic eyes! If other eyedrops irritate your eyes, try Allergan's Refresh Lubricant Eye Drops in the single-use, preservative-free, sterile containers (active ingredients: polyvinyl alcohol 1.4% and povidone 0.6%). Be sure to ask for the product that contains polyvinyl alcohol and povidone, not Refresh Plus — Refresh Plus contains methylcellulose, which can cause an allergic or sensitive reaction for people with allergic eyes. Refresh Lubricant Eye Drops should be available in your local grocery or drug store. If not, ask them to order some (be sure they don't order Refresh Plus). You can also find them at MedShopExpress.com or at Drugstore.com.
Tears are made up of three layers:
|Mucous layer||The first is the mucous layer, which provides an anchor for the other layers. The mucous layer is produced by goblet cells located in the white of the eye and in the inner surfaces of the eyelids.|
|Watery layer||The second is the lacrimal (watery) layer, which sits on top of the mucous layer. The watery layer is produced by the lacrimal gland betweeen the eye and the eyebrow. Lacrimal gland tear production slows down during sleep, which is why dry eyes can feel worse when you first wake up.|
|The third is the meibomian or oily layer, which is the top layer and which serves to prevent evaporation of the watery layer. The meibomian layer exudes oil from the 23 oil glands that line the inner edge of the eyelid.|
Each of the three types of tear gland can produce insufficient tears. In addition, the meibomian glands can experience chronic inflammation, which blocks the oily tears from entering the eye. In both cases (insufficient tears or chronic inflammation), dry spots can form on the cornea. These dry spots, which are not visible to the naked eye and do not necessarily make the eyes appear red, cause pain.
If you are reading this Web site, you are probably already familiar with the eye doctors (ophthalmologists and optometrists) who treat dry eyes. If you have severe dry eye pain unrelieved by the standard treatments, you might have experienced some frustration in getting the help that you need.
Remember that you are your own best detective. Although you must find a doctor who is willing and able to advise you, you must also assess what works and does not work for you. What helps one person might help you, or it might not. As you continue to search for useful information, be sure to judge everything that you read with a critical eye — including this Web site.