health conditions that can contribute to dry eyes

 Age is one of the most common risk factors for patients who develop chronic dry eye syndrome. As you age, your tear production capabilities and tear quality diminish, which make dry eyes more common. If you are over the age of 50, you are at a higher risk of chronic dry eyes. 

Men’s and women’s dry eye disease 

 Men and women show similar signs and symptoms of dry eye disease: burning, pain, blurry vision, and foreign body sensation.  In today’s high-tech world in which our education, occupation, and entertainment are primarily screen-based, almost everyone suffers from some degree of computer vision syndrome as well. 

Beyond those basics, differences between the sexes are clear:

  • Women tend to worsen the common dry eye symptoms through extended wear of contact lenses and cosmetics. Although many men and women wear contact lenses, I find that more females than males continue to wear their lenses despite significant discomfort related to dry eye, being more highly motivated for aesthetic reasons. 

• In my experience, women typically seek help at an earlier stage in the disease process. Men tend to wait longer before seeking care and thus have more advanced disease at the time of diagnosis. I even care for some men who are on disability for their dry eye condition. 

• Some of my male dry eye patients with severe symptoms tend to have other medical conditions that cause or contribute to dry eye, including graft-versus-host disease or glaucoma (the medications for which may cause dry eye and ocular surface inflammation). 

 • Systemic problems that contribute to dry eye for my female patients include hormonal changes and autoimmune/inflammatory conditions such as thyroid disease, lupus, rheumatoid arthritis, and Sjogren’s Syndrome-all conditions that are more common in women. 

• Women tend to undergo more elective procedures involving the eye and the lids. Although LASIK is pursued by both my male and female patients in similar numbers, women seem more likely to have had other procedures that can cause dry eye to worsen, such as blepharoplasty, face lift, lash extensions (performed with toxic formaldehyde glue), and eyeliner tattoos.   

The diagnostic process is independent of gender. A thorough medical history includes inventory of both systemic and topical medications. We always have our patients complete an OSDI questionnaire to gauge their symptoms and measure osmolarity (TearLab Osmolarity Test, TearLab) and MMP9 (InflammaDry, Quidel) on an initial visit. We examine the lids for involvement of the meibomian glands.  

Thereafter, we customize the diagnostic process, which may include blood work (for autoimmune or inflammatory conditions), meibomography, topography, allergy testing, or Sjogren’s testing, according to the patient’s history and initial testing.

There is a well-known association of several systemic diseases associated with dry-eye syndrome, among them Sjögren’s syndrome, rheumatoid arthritis, scleroderma and systemic lupus erythematosus. Sjögren’s syndrome is a chronic autoimmune disease characterized by white blood cells attacking the patient’s moisture-producing glands, including the lacrimal and salivary glands. Sjögren’s syndrome is classified as either primary or secondary. Although both are systemic diseases, primary Sjögren’s syndrome causes early and gradual decreased function of the lacrimal and salivary glands and can include many extraglandular conditions. Secondary Sjögren’s syndrome occurs in people who have another autoimmune connective tissue disease, such as rheumatoid arthritis or systemic lupus erythematosus.

Antidepressants 

Several common antidepressants—including SSRIs such as Paxil and trycyclic antidepressants like Adapin—can cause anticholinergic side effects. These effects can disrupt the function of your lacrimal glands and make your eyes produce fewer tears, resulting in dry eyes.  

Antihistamines 

Antihistamines can control a wide range of allergy symptoms, but they can also diminish the aqueous layer of your tear film, leaving your eyes without moisture. Benadryl and Claritin are two examples of antihistamines that may affect your tear film this way, but even site-specific antihistamines such as Allegra can lead to dry eyes (although this is less likely).

 Acne Control 

Topical retinoid-antibiotic combination treatments have been linked to significant dry eye symptoms. These treatments include isotretinoin, which is found in the common acne control medication Accutane and its generic counterparts.

Birth Control 

It’s well-known that taking birth control medications frequently leads to dry eyes. However, taking oral contraceptives alone does not seem to affect tear osmolarity, which is a key indicator of dry eyes. It is thought that taking birth control while using contact lenses increases the risk of dry eyes in women, possibly because oral contraceptives may increase contact lens intolerance.

Painkillers 

Many common painkillers fall under the category of topical Non-Steroid Anti Inflammatory Drugs (or NSAIDs). Since inflammation is a common symptom of dry eyes, you might think that these drugs would reduce your risk of dry eye syndrome—but that isn’t necessarily true. NSAIDs can also make your cornea less sensitive and exacerbate the damage that dry eyes already cause to the epithelial cells on its surface.

Beta Blockers 

Beta blockers are an active part of many medications for hypertension and migraines. However, they also weaken the aqueous layer in your tear film and cause ocular irritation, resulting in dry and uncomfortable eyes.

Gastrointestinal Medications 

Proton pump inhibitors (PPIs) are often used to reduce stomach acid levels and prevent common gastrointestinal problems like stomach ulcers and acid reflux. However, numerous PPIs can also cause dry eyes as a side effect, including Prevacid and Prilosec.

Antipsychotic Drugs 

Phenothiazines are commonly used to medicate people with schizophrenia, but they also decrease aqueous production, which leads to dry eyes. Thorazine, which is now less commonly used for the same purposes, can also have negative impacts on aqueous production.

Hormone Replacements 

Menopause Hormone Therapy (MHT) can help prevent long-term estrogen deficiency. However, it also increases your risk of developing dry eye syndrome since estrogen affects the course of inflammation in the human body. Interestingly, the same research shows that MHT can reduce your risk of developing cataracts and glaucoma.

Chemotherapy Medications 

Dry eyes are a common side effect of cyclophosphamide, which is frequently used for chemotherapy under the name Cytoxan.

 The two main types of thyroid disease are hypothyroidism and hyperthyroidism. Both conditions can be caused by other diseases that impact the way the thyroid gland works. Conditions that can cause hypothyroidism include: Thyroiditis: This condition is an inflammation (swelling) of the thyroid gland. 

Thyroid Eye Disease (TED) Symptoms and Treatment 

Sometimes called Graves' eye, thyroid eye disease (TED) is an autoimmune response targeting the back of the eye, damaging the eye muscles. The first signs are redness, swelling, dry eyes, and pain behind the eyes. Over time, the swelling becomes more pronounced, creating the illusion of staring or bulging eyes.  When thyroid eye disease is caught early, there is a higher chance symptoms can be eased and eventually reversed. Left untreated, the disease may lead to chronic pain, vision complications, or even blindness. It's important to identify symptoms early and meet with an optometrist or ophthamologist to build a treatment regimen that works for you.

LASIK involves cutting through the cornea to create a flap, which may temporarily damage some nerves and cause a reduced sensation. Due to this loss of sensitivity, the eye may not recognize the need for moisture, so it does not produce enough tears, causing dry eye symptoms.

LASIK itself isn't often the trigger for the dry eye. 

Nearly half to three-quarters of the people reporting dry eye had symptoms of it before the surgery. 

Dry eye after LASIK typically gets better over time. 

But in rare cases, LASIK can lead to severe and chronic dry eyes.

Dry eye syndrome is a common complication of both type 1 and type 2 diabetes. It happens because of high blood sugars. When your blood sugar is high, it can cause nerve damage in your eyes which, in turn, can lead to decreased tear production. Additionally, high blood sugar can cause inflammation throughout your body.