Dry Eye Syndrome: More Than Just a Nuisance
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Dry Eye Syndrome: More Than Just a Nuisance

Steve, a 42-year-old computer consultant, was frequently told that his eyes were red. Because of the redness and because his eyes often felt dry and uncomfortable, Steve visited his eye doctor, who made a diagnosis of dry eye syndrome. When Steve casually mentioned that he was also having trouble with some stiffness in his joints, the eye doctor wasn't surprised. He knew what Steve didn't—dry eyes can be related to autoimmune diseases, such as rheumatoid arthritis.

Dry eye syndrome and rheumatoid arthritis (RA) affect millions of people worldwide, and both can be painful and debilitating. Both conditions can interfere with numerous aspects of daily living such as reading, working on the computer, or participating in outdoor activities.

What Is Dry Eye Syndrome?

Dry eye syndrome—clinically known as keratoconjunctivitis sicca is a decline in the amount or quality of tears that bathe the eyes. Tears protect against eye infections and are important for normal eye health. If your tears are of poor quality for whatever reason your eyes will water excessively to compensate. Pain and redness are not necessarily related to dry eye syndrome, but should be checked by an eye doctor. Although the symptoms of dry eye syndrome can come and go, they become more persistent as the condition worsens.

What Causes Dry Eyes?

Anything that interferes with tear production can lead to dry eye syndrome. Some of the most common causes include:

  • Aging
  • The tear glands' output slows with age and the quality of tears decline with age.
  • Medications
  • Antihistamines, decongestants, and drugs used to control blood pressure, Parkinson's disease, and a host of other disorders can slow tear production or change the chemical composition of tears.
  • Health problems
  • Allergies or illnesses such as Lupus, Sjogren's syndrome, Rheumatoid Arthritis, and Hyperthyroidism can all cause, or worsen, dry eyes. So can inflammation of the tear-producing glands.
  • Environmental conditions
  • Wind and dry heat speed the evaporation of tears.
  • Lifestyle
  • Staring at a computer screen for several hours a day can cause dry eye syndrome. So can driving, reading, and wearing contact lenses, all of which make you stare or blink less frequently. Jogging or skiing without glasses or other eye protection also dries the tear film.

What Are the Symptoms?

The symptoms of dry eye syndrome include:

  • Dry eyes that feel gritty
  • The sensation of a foreign object in the eye
  • Burning sensation
  • Sensitivity to bright lights
  • Contact lenses that feel uncomfortable
  • An inability to produce emotional tears
  • Blurred vision

The Connection Between Dry Eye Syndrome and Autoimmune Diseases

Rheumatoid arthritis
Because people with dry eye syndrome have more rheumatoid factor in their blood than people without dry eye syndrome, doctors believe that dry eyes may be connected with rheumatoid arthritis (RA). Some doctors consider dry eye syndrome to be a complication of RA. Of all people with RA, 18-38% have dry eye syndrome. But the development of dry eye syndrome doesn't predict the severity or duration of RA. And it's important to remember that although there are many types of arthritis, only rheumatoid arthritis is associated with dry eye syndrome.

RA is characterized by joint inflammation that causes pain, stiffness, warmth, redness and swelling and usually affects the wrist, hand joints, elbows, shoulders, neck, knees, hips, and ankles. The onset of RA in adults is usually between the ages of 40 and 60, although it can occur in children and younger adults as well. The pain and inflammation can be chronic—over a prolonged period of time—or intermittent, with flare-ups from time to time. The diagnosis of RA is made via physical exam and a blood test for rheumatoid factor.

Sjogren's syndrome
In Sjogren's syndrome, the body's immune system turns against itself and attacks glands that produce moisture, such as tear glands in the eyes and saliva glands in the mouth. It affects approximately two to four million Americans. Symptoms include:

  • Dry eyes/mouth
  • Swelling
  • Difficulty chewing or swallowing
  • Dry cough
  • Cavities
  • Oral yeast infections
  • Dry nose, throat and lungs
  • Fatigue

Medical Attention Is Important

RA and dry eye syndrome can get progressively worse, and over time, can cause permanent damage. Untreated RA can lead to loss of movement and deterioration in lifestyle, and untreated dry eye syndrome can lead to loss of vision.

At this time, there is no known cure for either dry eye syndrome or RA.

  • Treating dry eye syndrome
  • If you have mild dry eye syndrome, over-the-counter ointments, gels, drops, or artificial tears might help. Use them when your eyes feel dry, or before you do something that causes the dryness. If you use artificial tears more than four times a day, though, most ophthalmologists recommend that you use preservative-free brands, which are less likely to damage eye tissue.
    If your symptoms are moderate to severe, your ophthalmologist might elect to insert tiny silicon plugs into small ducts in the corner of each eye. This closes the duct and prevents your tears from draining away. The procedure is done under local anesthesia in the physician's office and takes only a few minutes. For people with severe dry eye syndrome, these ducts can be permanently closed using a laser or heat. Alternatively, people with severe dry eye can now be treated with a prescription eye drop.
  • Treating RA
  • As far as RA is concerned, over-the-counter aspirin-like drugs and the application of cold or heat can help control the pain, but none of these treatments changes the progression of the disease. Your doctor might also prescribe drugs that reduce the inflammation. It is important to diagnose RA early in the course of the disease, because treatment is most effective prior to destruction of bones or joints.
  • Anti-inflammatory drugs
  • Since the underlying cause of both rheumatoid arthritis and dry eye syndrome is inflammation, similar anti-inflammatory drugs can be used to treat both conditions. However, medications for rheumatoid arthritis are typically taken orally whereas medications for dry eye syndrome must be applied to the eye.
    If you, like many people, are nervous about putting drops in your eyes or have trouble with your aim, there are "drop guides" you can purchase at your local pharmacy. These easy-to-use, pain-free devices help guide the drop into the eye and prevent the medicine from being wasted when you miss.

Be Proactive

Here's how to protect your eyes by preventing tears from evaporating:

  • Use a humidifier on hot and dry days.
  • Drink plenty of water.
  • Avoid drafts from air conditioners or fans.
  • Protect your eyes from wind.
  • Blink more often.
  • Take a short break from staring at the computer monitor every 20 minutes.
  • Position the computer monitor below eye level. This enables the upper eyelid to cover more of the eye.

Seek medical attention if:

  • Your joints are painful and swollen.
  • You use artificial tears numerous times a day.
  • Artificial tears relieve dryness and discomfort only temporarily.
  • You find it difficult to wear your contact lenses.

RESOURCES:

American Academy of Ophthalmology
http://www.aao.org

National Eye Institute
http://www.nei.nih.gov/

CANADIAN RESOURCES:

Canadian Family Physician
http://www.cfpc.ca/cfp/

Canadian Ophthalmological Society
http://www.eyesite.ca/

References:

Dry eye syndromes. Schepens Eye Research Institute website. Available at: http://www.eri.harvard.edu/htmlfiles/dryeye.html.

Stern ME, et al. The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. Cornea. 1998;17(6):584-589.

Uhlig T, et al. Sicca symptoms, saliva and tear production, and disease variables in 636 patients with rheumatoid arthritis. Ann Rheum Dis. 1999;58:415-422.



Last reviewed January 2008 by Alexander J. Anetakis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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