Dry Eyes: Causes

Dry eyes have many possible causes and can often be associated to a great number of different types of diseases:

Auto-immune diseases:

• Sjögren's Syndrome

• Lupus

• Rheumatoid Arthritisis, Polyarthritis, other rheumatismal diseases

• Connectivitis

• Stevens-Johnson's Syndrome

• Sarcoïdosis

• Graft Versus Host Disease (GVHD)

Neurological disorders (particularly those affecting the ophthalmic branch of the trigeminal nerve) often associated to the pathologies bellow:  

• Trigeminal neurodystrophies (loss of sensitivity due to accidents, surgery, medication, congenital diseases, etc.)

• Diabetes Mellitus

• Herpes (herpetic keratitis)

• LASIK-induced loss of sensitivity (or some other type of refractive surgery), which is also an iatrogenic cause

• Keratoplasty

• Loss of corneal sensitivity

• Neuropathic disorders affecting the lachrymal glands

• Bell's palsy

• Parkinson's

Pathologies affecting the eyelids and/or the skin:

• Meibomitis / Blepharitis

• Acne rosacea

• Seborreic Dermatitis

• Ichtyosis

• Ectropion or Entropion

• Lagophtalmos

• "Floppy eyelid"

• Blepharoplasty

Traumas suffered by:

• the lids of the lachrymal glands or channels (burns, wounds)

• local radiation therapy, chimiotherapy

• the eye and the cornea particularly (ex: keratoplasty)

Inflammation of the lachrymal channels as a result of other pathologies:

• Dacryoadenitis

• Sarcoïdosis

• Mumps

• AIDS

Infections and ocular disorders:

• Trachoma

• Allergies

• Ocular Pemphigoïd

• Exophtalmia / Proptosis

• Ptygerium /Pinguecula

• Conjunctivochalasis

Hormonal disorders:

• Menopause

• Hyperthyroïd

• Androgen difiency

Deficiencies:

•  Vitamin A (xerophtalmia)

Abuse of contact lens wear

Some Iatrogenic (medically-induced) Causes:

Beware of diuretics, antidepressants, β-blockants, antihistaminics, somnifers, analgesics, psychotrops, anticholinergics, phenothiazines, benzodiazepines such as Valium, medications containing atropine, hypotensors, isotretinoine, morphine, etc ... may cause or further exarcebate dry eyes.

Beware of preservatives in eye drops such as benzalkonium or ... which can exarcebate the symptoms of dry eye and effect the integrety of the epithelium. Too may ophthalmologists still prescribe drops containing benzalkonium to patients with dry eye or otherwise compromised corneas. Laboratories and Ophthalmologists need to adress this issue in a more consistent manner, especially when non-preserved solutions exist or can easily be produced. Please visit our website for more information on this subject: Preserve our Eyes, not our Drops!

Caution ! Do not decide to stop taking your medication on your own if you notice that you have dry eyes. However, please mention your dry eye symptoms and other medication you may take simultaneously to all your doctors and ophthalmologist in particular so that they may decide on whether or not to stop an eventual counterproductive treatment. 

Other possible causes:

• Alcohol

Some authors have mentioned idiopathic dry eyes, which means dry eyes without any other previous cause. But it seems that it may also be considered as a confession of impotence to properly diagnose a particular dry eye symdrome and its related mechanism !

Please read our Testimonials to have a better understanding of some possible causes and see a few examples of diseases leading to dry eyes.

But then, what's the explanation for the current incidence and rising numbers of dry eye state (lachrymal dysfunctions)?

Probably a better diagnostic, screening of patients and more consideration for this syndrome has enabled to doctors reaveal milder cases that weren't treated correctly before they became truly disabling. But this alone cannot explain why there is currently an exponantial rise in the number of cases. One must therefore look for other aggravating factors including environnemental factors, our new way of life and food.  

The following issues are not exactly causes but most likely aggrating factors of lachrymal dysfucntions:

Various mutilfactorial factors have been addressed by researchers including:

• pollution (notably automobile related pollution) and most liekly new pullutants such microparticules, volatile organic components, in-house or office pollution notably assembled furniture, ink and photocopiers emanations, etc, paint, resins, floor-plank, carpetting, etc).

• rise of allergies (pollution strenghens reactions through inflammation and most likely changing the properties of allergens: pollens, acarians, moulds & spores, etc).  

• Unhealthy food and way of life (including professional).

• the multiplication of artificial atmospheres (air conditioner, over-heating, interior perfumes, etc).

• cigar and cigarette smoke.

Regarding our immeadiate sourroundings and ways of life one can mention the multiplication of screen work and artificial atmospheres in our offices, and research evoke frequently the following syndromes:

• Sick Building Syndrome (actually it's the persons who are sick!), but also:

• Office Eye Syndrome (with the multiplication of screen terminal or visual display terminals).

This last syndrome has been studied thoroughly and some researchers made the following observations:

• A study by Tsubota [1] revealed that if one looks down on a screen rather than up, one reduces evaporation by 3,4 times! This is due to the respective size of the palpebral slit in both configurations.

• staring at the screen reduces blink rate and therefore favours dryness or dry spots and evaporation. Remember that blinking is meant to spread evenly the tear film.

• for some, low environnemental light and screen luminosity may also favour the reduction of blink rates. Don't work in  the dark with a bright computer screen.

See also our  Advice & Suggestions for "dry eye" sufferers.

Food may also play a role:

• including the absorption of too many saturted fat and low amounts of Ω³.

Useful reading: Nouvelle approche des sécheresses oculaires, Volume 2: Le syndrome oculaire des bureaux , les facteurs environnementaux, Collection Librairie Médicale Théa. Tsubota K, Nakamori K, Effects of ocular surface area and bink rate on dry eye. Arch Ophthalmol 1995;113: 155-8. Nouvelle approche des sécheresses oculaires, VolumeI: Le syndrome d'écran de visualisation: des anomalies mineures pour une gêne oculaire réelle, Collection Librairie Médicale Théa. Environnement Intérieur et Symptômes Oculaires, Dr. Fabien Squinazi, Laboratoire d'Hygiène de la Ville de Paris, Collection Librairie Médicale Théa.

 

 

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