Patients often complain that even after they’ve started treatment, their painful Dry Eye symptoms don’t stop. Their symptoms may be constant or intermittent. There may be burning, pain, a foreign body sensation, or other discomfort. It can be an agonizing 10, on a scale of 1-10. Or just an annoying 1. It might be in one eye or both. In one very specific spot, or all over.
The fact is, the pain and discomfort of Dry Eye can persist despite treatment and lifestyle changes.
Here are 12 reasons why Dry Eye symptoms don’t stop and sometimes just keep coming back.
1. It’s a chronic condition
The sad truth about Dry Eye is that it’s a chronic condition. One magic pill, drop, ointment, or single treatment usually won’t fix it. Once Dry Eye symptoms set in, it becomes a question of managing them, and finding out which treatments work for you. Some conditions associated with Dry Eye, like conjunctivochalasis or a bacterial infection, can be cured. But the chronic nature of the disease requires perseverance and patience.
2. It’s a multi-factorial condition
As mentioned above, many conditions are associated with Dry Eye making it a multi-factorial disease. There’s aqueous deficiency, meibomian gland dysfunction, infection, conjunctivochalasis, demodex mites, and more. And the causes of these are numerous. There are environmental factors, life style choices, systemic diseases, plus many other factors, all of which can contribute to the disease and symptoms. So if you only address one condition, you won’t get complete relief because something else that requires treatment will still be going on.
3. The eye feels only the most prominent sensation
Once you begin treatment – effective treatment – you can expect to get some relief. But it’s important to keep in mind that the eyes only feel the most prominent sensation — one sensation at a time. So you treat one symptom and then another symptom emerges. Why? It’s possible, and even probable, that a second condition was always there, but you just couldn’t feel it because it was masked by the symptoms of the first condition.
And this can even happen to either eye. You feel only the worst thing and let’s say it’s in your right eye. You treat that and now you have discomfort in your left eye. Whatever is now happening in your left eye was probably always there, you just couldn’t feel it because of the discomfort in the right eye.
If this happens, don’t despair. And let your doctor know that there’s a new symptom that requires attention.
4. Different conditions cause the same symptoms
One of the most confusing aspects of Dry Eye is that different conditions can cause the exact same symptom. For example, even after meibomian glands are probed there can still be a foreign body sensation or pain in the exact same spot. In this case, you may need more or deeper probing. Or maybe there’s inflammation or chalasis on the surface of the eye. Maybe there’s an eye lash that’s growing in the wrong direction, or a muscle spasm in the eye lid, or something else.
But it’s impossible to say exactly what’s happening without a thorough exam and an accurate diagnosis. So if a symptom persists, it’s important to follow-up with your doctor, because she can’t help you if you don’t tell her what’s going on.
5. You haven’t been diagnosed correctly so you aren’t being treated correctly
So many of us have had this experience. We’re diagnosed with something and we start treatment, but there’s no change in our symptoms. If your doctor didn’t start with a thorough examination in the first place, it’s likely you weren’t diagnosed accurately and so you’re also not getting treated correctly. If you think this is the case, it’s best to seek care with another doctor.
Check out the information on Dry Eye diagnosis on our website and familiarize yourself with what a comprehensive exam looks like. If you’ve only had a Schirmer test without numbing drops and your meibomian glands haven’t been examined, for example, you probably haven’t had a thorough exam.
Furthermore, conjunctivochalasis is often overlooked, neither diagnosed nor treated. And the role of meibomian gland dysfunction in chronic eye pain is not yet widely accepted and understood. If not treated, both of these conditions can cause chronic eye pain and discomfort.
6. Something hasn’t been treated…yet
If you have a good doctor and are undergoing treatment for a variety of conditions, he may recommend that treatments follow a specific order. First this treatment, then that, then another, depending on your specific set of conditions.
Be open with your doctor about your symptoms. Discuss the sequence of treatments and what you can expect. Your doctor may have something planned for you that you don’t know about, but it might be something that you shouldn’t undergo just yet.
7. Something new happens
You’re going along with treatment and you’re beginning to feel better, and then suddenly something happens that sets you back. It could be an eye injury, an infection, a systemic condition, something just falling in your eye, or who-knows-what else.
When this happens, it can feel like a major set back and you can easily get discouraged. Don’t. Life happens — to our eyes all the time. Take it in stride. Address it. Contact your doctor immediately even if your next appointment is in two weeks. Deal with it now, rather than later. Think of this setback as just another leg of your journey to healing.
But we agree, these setbacks can be exquisitely frustrating.
8. You may have allergies or sensitivities to topical medications
Your prescribed treatment could itself be causing discomfort, or even harm. If you have allergies, or even just sensitivities, to your topical medications, you might feel worse — and even get worse — rather than better. Allergies and sensitivities cause inflammation, and chronic inflammation is the enemy of the meibomian gland and the ocular surface.
It’s important to tell your doctor right away if you think your medication is exacerbating your symptoms. You might have to stay on it for a while. But your doctor may have tips to minimize symptoms. Or you might have to switch to something else, or stop it altogether. Regardless, let your doctor know.
9. Systemic conditions may play a role
There may be underlying systemic conditions contributing to your symptoms – autoimmune disease, hormone imbalance, and many others. If these aren’t addressed effectively, your eyes might not feel better. Talk to your doctor about what systemic conditions you might have. Some, like age, are unavoidable.
10. Are you telling your doctor about all of your symptoms?
Be sure to tell your doctor about all of your symptoms, and be as specific as you can about what you’re feeling. Rather than saying “my eyes feel awful.” Say, “my left eye burns and feels like there’s soap in it. A 4 (on a scale of 1-10). And there’s an intermittent stabbing pain in my right eye, in the upper inner corner. An 8, that happens right when I wake up and lasts for 2-6 hours, but sometimes all day.”
It may seem like a lot of information. But the details will help your doctor diagnose your symptoms accurately. And an accurate diagnosis is always the first step in effective treatment.
11. Your doctor isn’t helping you
You may have a bad doctor. Or your doctor may be a good person and a good ophthalmologist or optometrist. But your doctor may not know enough about Dry Eye to diagnose and treat you effectively. If that’s the case, it’s best to seek the care of a Dry Eye specialist or an ophthalmologist specializing in cornea and external disease.
12. Things happen and change over time
Lots of things change over time. We age. We change our daily habits. Our bodies change. We get new jobs. We move. There’s light and darkness. Dust or pollen in the air. Car exhaust. Seasons. Seasonal allergies. Seasonal flu. Changes in temperature and humidity. Binging on Netflix. Different foods and cooking fumes. The stress of work. Too much time staring at a computer or cell phone. Staying up late. Not enough sleep. A long drive.
Anything can happen. It can happen suddenly once, over a long period, or something in between. But all of it can contribute to eye comfort or discomfort.
So whenever possible, it’s best to make choices that lead to comfort, because the stuff that causes discomfort is sometimes unavoidable.
When Dry Eye Symptoms Don’t Stop
With so many different possibilities, it’s no wonder that even after starting treatment, sometimes painful dry eye symptoms don’t stop. When this happens it’s important to persevere, follow-up with your doctor, and not lose hope. We know this can be extremely difficult, and sometimes seemingly impossible. But step by step, inch by inch, you can reach your goal. It may be a long and difficult journey. But it will be worth it when you look at your loved ones or a sunset… with relatively comfortable eyes. You’ll thank yourself.
So choose comfort. Choose hope.
Send your questions and comments to blogger@notadryeye.org.
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