dry eyes and fosamax

[maggiemae_06]

I am currently struggling with severe dry eyes, and I am curious if there is any information on fosamax as being a contributor to this ailment.  I take fosamax once a week for osteo, and have been for about 5 years - and increasingly I notice that on the day that I take this medication, my eyes seem to be worse.....I am very anxious to receive any info/comments on this from anyone who may provide comments.  I also experience dry mouth, which I think may also be a side effect......Thanks so much.....

[John C Hagan III, MD, FACS, FAAO]

Since you're seeing your physician ask to be tested for Sjorgren's Syndrome that extremely dry eyes extremely dry mouth and often an autoimmune or inflammatory arthritis.

your dry mouth can be helped with an artifical saliva or saliva stimulant such as pilocarpine.

JCH III MD

[John C Hagan III, MD, FACS, FAAO]

So you've tried autologist platelet rich plasma therapy? You've exhaused 4 punctal closure of the tear duct openings?

JCH III MD

[JodieJ]

Apparently, Fosamax could be affecting your eyes, although this side effect occurs in only a small minority of cases (or so I've been told).  I also take Fosamax, and after reading some online information, I became concerned that it could negatively affect my recovery from retinal surgery last year.  I stopped taking it temporarily (with my doctor's consent), and it seemed to make no difference at all as far as my eyes were concerned.  I suggest that you check with the doctor prescribing the Fosamax, as well as your ophthalmologist, for advice.  

[maggiemae_06]

I have indeed exhausted all of these possibilities.  My tear test registered 2......and I am on prescription eye drops and ontiment Tobradex for bleparitis (spelling?).....I have been on this treatment for one week, and my eyes (as the swelling goes) are much better, as is the itching, burning......I now have a humidifier in my room and use eye lubricating drops many many times through out the day.  However yesterday was my Fosamax day, and I suffered the entire day with severe dry eye, at some points I feel it very uncomfortable to blink.  I had thought in the past that this medication-Foramax may have something to do with my condition, but for various reasons it was discounted.....now I am certain there is a correlation between my dry eyes, dry mouth, and this medication.  I could not believe how dry my eyes were yesterday, on a fairly damp, mild day.  

[John C Hagan III, MD, FACS, FAAO]

a Schirmer test of zero indicates that you have severe dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical compies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops.

If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 8 weeks of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes two months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. If you did not take for 8 weeks you need to restart therapy. Improvement often continues for up to 6 months.

If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.

Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.

In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.

If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.

If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise. A final new treatment that they can often do is “Autologist Platelete-rich plasma” therapy. This uses eyedrops made out of your blood products. (reference Ocular Surgery News: November 1, 2007 page 46  lead author Jorge Alio MD.

Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.

JCH III MD