Identifying the Causes of My Dry Eye Condition
What caused this? And what can I do to fix it? These have been the driving questions of my dry eye journey. Frustratingly, chronic dry eye can have many different causes, so identifying the source of my condition has been just plain difficult.
Sometimes I feel like I’m throwing darts at a dart board with all the changes I make and treatments I try, hoping one hits the mark. The reality is that my dry eye is probably a result of multiple factors working together, so there are lots of marks to hit.
Originally, when my doctor diagnosed me with aqueous deficient dry eye and I asked what could have caused it, he said that it could be an autoimmune condition like Sjogren’s syndrome. He asked me if I had any other symptoms like dry mouth or itchy ears, and I did not, so he ruled this out. But I still wanted to make sure, so the next time I had my blood work done, I asked my doctor to test for markers of the disease. The result was negative.
Though this doesn’t completely rule out the possibility of Sjogren’s, as it can take years to show up in blood work, I moved on to investigate other possible causes. In talking with my doctor and doing my own research, I’ve pieced together some possible explanations.
Prolonged contact lens use
I’ve worn contact lenses for 27 years. Over time I moved from monthlies to more breathable, high-water-content dailies, because my eyes became dryer as time progressed and wouldn’t tolerate lesser-quality ones. Studies show that contact lens wear can contribute to instability of the tear film.1
At age 42 and having worn contacts for most of my life, I recognize this as the most probable cause of my condition. For the past 5 to 7 years, I can remember complaining of dryness at my yearly appointments. At this point, the dryness was manageable. I would simply take out my contacts at the end of the day, and my eyes would be fine. Then, I never could have imagined feeling what my eyes feel like now.
Age-related hormonal changes
Age-related hormonal changes can be another cause of dry eyes, particularly in women. I am within the perimenopausal age range, so I certainly consider this as a possibility.2
In addition, oral antihistamines like Zyrtec, Claritin, and Allegra can be drying to the eyes.3 I used to take these regularly when working in the yard because within a few hours I would be sneezing and my throat would be sore. Instead, I now shower immediately afterward and use a nasal spray to clear my sinuses of dust and debris.
Digital screen use
Digital screen use can also contribute to dry eye.4 The first 14 years of my career I worked as a graphic designer and copywriter, so I was on the computer all day long. I now work as an English teacher, so I still work on the computer but to a lesser degree. Like most of society, I use my smartphone regularly, and I do notice increased eye discomfort when I use it for too long.
Environmental factors and mask wearing
When the COVID pandemic hit, my school made several protocol changes. One was mask wearing, and another was cleaning student desks during class changes. I don’t think either was good for my eyes.
The mask created a constant stream of air blowing directly into my eyes, and the aerosol cleaner that I sprayed on student desks multiple times a day had drying ingredients to which my eyes were constantly exposed. My severe dry eye issues started during this school year.
Drying face wash and irritating makeup
In hindsight, I’ve looked back at other additional actions of my own that could have contributed to my dry eye condition, and those things include using face washes with drying ingredients. I also used makeup, specifically mascara, that made my eyes itchy. I ignored the warning signs until it was too late. A couple of months before my condition became chronic, I had begun using a drying eye makeup remover. This may have been, as the saying goes, “the straw that broke the camel's back.”
I believe that the combination of these factors sent my eyes into a tailspin of inflammation. I try not to live with regret over past decisions; instead, I now see myself as a more educated and aware individual with the ability to make changes to improve my situation.
Did you know patients can experience dry eye symptoms but have healthy-looking eyes under a slit-lamp exam?