Sudden Severe dry eye

Hi, five months ago I suddenly developed severe dry eye in what seemed overnight. I was perfectly fine, with not even signs of mild dry eye and in a matter of days my eyes became unbearably sore, painful, and had a menthol sensation. After extensive testing (hormonal and auto-immune) came back normal, my doctors can not figure out how a 20 year old can have such sudden severe dry eye. I am on restasis, have punctal plugs, tried steroid drops, warm compresses, lid massages, and I have not gotten relief. They said my tear break up time is low, but I don't have much meibomitis, my schmimer fluctuates every time (from 4 to 20) so the doctors say is not a really reliable measure. I am also on tetracycline and occusoft lid scrubs.

I have recently been tested for allergies, and I am highly allergic to dust, mold, my pet.. etc. But I cannot take anti-
histamines because they will dry me even more.  What do you think might be a possible cause for this painful condition?? Also, do you think allergies may be a culprit?

PS: I dont suffer from dryness anywhere else.

[Sandra M Brown, MD]

If by "menthol" you mean an odd, cool / warm, blowing sensation then you may have a condition called keratoneuralgia.  This is a VERY new concept of patients who have severe dry eye symptoms but very few abnormal findings on examination.  One thing you didn't mention was whether your corneas show "staining", but I'm betting not.  Search Boston Foundation for Sight and read what they have on the topic, and also consider contacting them - they are very friendly on the phone.  Before you plan a trip to Boston, contact Rebecca Petris at the Dry Eye Company for a recommendation for a good dry eye doctor near you, one who can "think outside the box".

As far as allergies, unless these are NEW allergies, it is difficult to blame your sudden new eye symptoms on longstanding allergies (even if undiagnosed).

The Schirmer test is very highly dependent on the skill and knowledge of the person administering it.  It is more likely that the extreme values are incorrect than that you really fluctuate that much.

[2ositos]

Hi, Thank you so much for your response.

The menthol feeling shows when I am feeeling the worst and as far as corneal staining, my doctors say it is very minimal to  none. I have already talked to the guys at Boston Foundation for Sight and tried their prosthetic lens and unfortunately it didn't work for me. My symptoms fluctuate a lot, from intense burning to just blurry vision. I have also already talked to Rebecca and I am scheduled to see Dr. Toyos for an IPL treatment for evaporative dry eye. I may also try the autologous serum drops.


As far as the schimmer goes, last time the person who measured it was a bit aggresive (aggressive) haha, so maybe the high results could have just been  reflex tears.

At the same time that my dry eye started, I also had sinus pressure, then hives and lip swelling a couple of weeks later.. so that is why I am making the allergy connection. Based on your experience, can an allergy cause dry eyes?