6 Conditions That Cause Dry Eyes

Most of us have experienced the feeling of dry eyes at some point. A question many doctors hear often in the examination room is, “What causes my eyes to be so dry?” Dry eye can be caused by a breakdown or a de-stabilization in the tear film. Our tears are actually quite complicated and are composed of many things including minerals, proteins, natural antibiotics, and a host of other chemicals in addition to water, mucus, and oil. When any one of these components is lacking or if there is too much of one of them, the tear film becomes unstable and a dry eye condition may occur. But what causes this to occur in the first place? Interestingly, a dry eye condition can be caused by changes elsewhere in the body. Here are several systemic problems or diseases that can cause or contribute to dry eyes.

1
Diabetes

Woman using eyedrops
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Diabetes is the third leading cause of blindness in the United States. Diabetes can cause changes in the nerve tissue. Tear secretion is controlled by conversations between the corneal nerves and the lacrimal gland nerves. This feedback loop becomes interrupted when peripheral neuropathy (diabetes-related nerve damage) occurs and our eyes become dry. Also, the longer a patient is diabetic with fluctuating blood sugar, the more likely they are to experience dry eyes.

2
Hormones and Aging Changes

Hormones such as androgens, glucagon, and corticotrophin all affect tear production. Cells that secrete mucus to help build a healthy tear film do not have nerves connected to them. They rely on hormonal communication with the rest of the body. When hormonal changes occur in postmenopausal women, for example, these cells may not get turned on to secrete the right amount of mucus and a dry eye condition occurs. This can also occur in women who use hormone replacement therapy and hormone-based birth control. Proteins that help make up the tear film are also known to decline as we get older. In addition, the volume of tears produced grows smaller. Furthermore, certain natural antibiotics and oxidative damage control proteins decline, creating an imbalance in the tear structure and dry eyes.

3
High Blood Pressure

It is estimated that between 67 to 75 million adults in the United States have high blood pressure. As we know, high blood pressure puts one at risk for heart attack, heart failure, stroke, kidney failure and peripheral vascular disease. Many patients with high blood pressure also experience dry eyes. However, in this condition, what causes the dry eye condition to develop has more to do with the medications used to treat hypertension that it does with the actual disease process. The two biggest classes of drugs that can cause dry eyes are beta blockers and diuretics. In addition, many patients who suffer from high blood pressure suffer from other medical problems such as diabetes, thyroid disease or anxiety and depression, all of which increase the risk for developing dry eye syndrome.

4
Lupus

Dry eye syndrome is the most common symptom in patients who develop Lupus. Dry eye disease develops in patients with Lupus because of autoimmune antibodies and immune system debris that build up in different eye tissues. This causes a dramatic reduction in the water component of the tears and instability problems with mucus production inside the tears.

5
Arthritis

 Adult and juvenile arthritis are very complex diseases of which we don’t completely understand. However, several inflammatory conditions, such as iritis and scleritis, often develop with the disease. These conditions can be painful and difficult to treat. This inflammatory component causes inflammatory cells and debris to build up in the lacrimal gland and change the eye’s surface, causing significant dryness that can lead to corneal scarring and visual compromise.

6
Sjogren's Syndrome

Sjogren’s syndrome is a complex and chronic inflammatory disease that  cause dry eyes, dry mouth, joint pain, swelling, stiffness, swollen salivary glands, dry throat, coughing, vaginal dryness and fatigue. The condition affects many more females than males and typically onsets in the fourth and fifth decades of life. Most patients develop dry eye symptoms long before a real diagnosis of Sjogren’s syndrome is made.

Source

Kabiri A, Singh D, Cooper M. Beneath the Surface: Dry Eye’s Link to Systemic Disease. Review of Optometry, 15 Sept, 2014, pp 74-76.

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