Dry Eye Cause

[GKWhite]

I have had an issue with irritated dry eyes for several years.  The main symptom has been excessive tearing that in turn causes the upper and lower lids to become irritated and cause more tearing.  It is a vicious cycle.  

I have allergies and bad hay fever which have always affected my eyes.  As I got older, the allergic symptoms seemed to improve some.

The eye irritation reached a peak a few years ago and didn't seem to be related to allergies.  I saw 3 ophthalmologists and had all kinds of tests done.  My tear quality was poor among other things.  I was put on restasis and steroid eye drops which helped immensely with the irritation.

I eventually stopped the restasis (the steroids were of course a short course) and everything has been pretty good with only occasional issues that with a day or two of warm compresses have alleviated symptoms.  I tried to keep a mental note of what might have caused the flare.  

On a side note, I also have something autoimmune going on and I asked if it could be sjorgens because of the dry eye, however all the tests specific for sjorgens came back negative, so that was ruled out.

Fast forward and I now see a correlation to when I take Benadryl and the onset of the excessive tearing.  My puncta fluctuate in size and when enlarged seem to be irritated/itchy.  It is not necessarily noticeable on its own, but when I do massage the area to potentially clear a clogged tear duct, I certainly notice the size and irritation.

I tried to find a link between benadryl and either excessive tearing or clogged tear ducts and was not able to, but I'm wondering if anyone here has had this experience or knows of any correlation.  I'm wondering if as it is drying up my sinuses, it is thickening my tears or drying up my tear ducts and then I have irritation.  Seems possible, but like I said, a quick search didn't turn up anything.

Love to hear any comments.

Thx, Gina

[GKWhite]

Hi Dr. Hagan,

Thank you for the reply.  I do think the Benadryl is the main culprit.  It hit the last time so unexpectedly the day after I took Benadryl (I only take at night due to the extreme sleepiness).  And took a second night and my eyes just kept getting worse.

I stopped and the next day my eyes felt better and two days out, completely normal again.  

I will discus taking Restasis again with my doc.  I stopped because it didn't seem to make a tremendous difference (I took for nearly 6 months) and found the regimen a bit difficult.  Admittedly, it was probably more cumbersome due to the other medications I have to take.

I do use B&L eye wash with Boric acid occasionally which really helps and use Systane refresh or balance with great experience and occasionally use the Systane gel at night which is also nice, but occasionally wake up with puffy eyes.  They go away fairly quickly and are far better than the dry eyes.

I will read through the other posts.  Out of curiosity, can you give me a quick primer on why the puncta enlarge (with or without pain/itchy/irritation)?

Is it a normal response or an indication of a problem, infection, clogged duct?  There really is a big difference in size directly correlated to the amount of eye irritation.

Thanks again,
Gina

[2johndeereboys]

I was just dx with Sjogren's on 4/22. I am sero-negative, which means all my blood work especially the specific markers for Sjogren's came back negative.
I received my dx after a lip biopsy. I won't lie......it was NOT pleasant but from what I understand my ENT Dr's way of doing a lip biopsy was not the norm!

Best wishes and if I can be of ANY help, please feel free to contact me!!

Lisa
=

[JohnHaganMD]

Go to Dr. Hagan's home page. See name and active link under Top Eye Care Answer's scroll through the Journal Posts (about 31) and read the article on dry eyes. Benadryl DRYS THE EYE AND MOUTH.  So yes it will make your dry eyes worse. Going off Restasis was a bad thing to do. Both my wife and I are on restasis for dry eyes with wonderful results. Of course it takes 6 months for them to kick in.  There are two types of dry eye one there is no tears and other is tearing all the time (poor quality tears)

[JohnHaganMD]

The puncta in young people is generally flat with the lid and doesn't swell unless the lid swells due to infection, irritation, inflammation or allergy. In older people >60 the puncta often "sticks up" due to some atrophy of lid muscles. If your problem occured when you eye was irritated especially if you were rubbing or dabbing it with a kleenix I could understand but have explanation if the eye is not irritated. You didn't have tear duct plugs put in did you?