Patient: My eyes hurt after a long day at work.
Doctor: You have dry eye. Take these eye drops and call me in the morning.
Yes, the above vignette is an exaggeration. Still, you need to be more of a detective when it comes to dry eye. You might ask patients the following:
1. Do your eyes ever feel dry or uncomfortable?
2. Are you bothered by changes in your vision throughout the day?
3. Are you ever bothered by red eyes?
4. Do you ever use or feel the need to use drops?
Next, perform the eyelid exam, staining and the tear film instability tests. The results will better equip you to make recommendations to the patient.
Dry eye isn’t always a result of staring at a computer screen all day. A study was done with patients from the Miami Veterans Affairs Hospital that showed a link between dry eye and chronic pain. Participants in the study filled out questionnaires regarding post-traumatic stress syndrome (PTSD), depression, non-ocular pain and dry eye symptoms. In addition, parameters of tear film were measured. The results showed a correlation between dry eye scores and depression, not so much with tear film parameter and dry eye scores.
“Traditionally, eye specialists have treated dry eye with artificial tears or topical medications for the surface of the cornea,” said study author Anat Galor, MD, MSPH, of Bascom Palmer Eye Institute, of the University of Miami Leonard M. Miller School of Medicine. “However, even if these treatments improve some dry eye symptoms, many patients continue to report underlying ocular and non-ocular pain.”
Another study done at King’s College in London shows that dry eye is associated with chronic pain syndromes such as pelvic pain, irritable bowel, and fibromyalgia. The study of veterans and this study suggests that dry eye is just one symptom of an overall chronic condition.
In addition, persons with chronic pain may be experiencing central sensitization, which means the nervous system gets stuck in a state of high reactivity. Because of this, the person who has chronic pain can be both sensitive to touch and pain. This in turn affects pain perception and pain behaviors.
So, merely treating the dry eye symptoms doesn’t help the overall condition. It is necessary to learn what’s going on with the patient beyond his or her eyes so that the right treatment plan can be developed.