Masqueraders of Dry Eye

At masquerade parties, mystery can be really fun.  Mardi Gras is an awesome time of year to wear a costume, crazy hat, or a mask.  But, I am not a fan of mystery in my clinical practice.  Dry eye disease can often masquerade as something else because there are other diseases that have the same symptoms.  And unfortunately, patients will sometime self-treat the wrong disease for weeks or months before coming in to see me. 

One of the biggest masqueraders of dry eye disease is allergy symptoms.  Here in Louisiana, my patients will blame everything that happens to them on allergies.  And because our winters are fairly mild, something is blooming here year round.  Allergy season can really be any season.   For instance to my patients a headache = allergies, dry cough = allergies, watery eyes = allergies.  However, watery eyes are also a hallmark of not having enough oil in your tears, also known as Evaporative Dry Eye Disease, a type of dry eye. 

The second very common masquerader of dry eye disease is nocturnal lag ophthalmous.  This is simply means sleeping with your eyes not fully closed.  It happens more often than you might think.  In order to have symptoms from this lack of lid closure, your eyes do not need to be open very much.  In fact, the open space between the lids can be very small.   

Having your lids separated by just a millimeter or two can cause the front surface of your eye to dry out.  Usually, stinging, burning, and watering upon awakening are the hallmarks of this problem.  However, the symptoms can often last all day when the problem is chronic.  Eventually, blurred vision and even permanent scarring can occur. 

In this case, a patient may be self-medicating with artificial tears all day long.  However, if they never get the eyes to fully close at night, the problem will just repeat itself the next day.  They think they are having a dry eye problem when they are really having a lid closure problem.   

Luckily, once diagnosed, the problem can easily be solved by wearing a pair of sleep goggles which provide moisture to the eyes even if they are not fully closed.  My favorites are the Silicone Shields by Eye Eco.  They are available in Clear: Quartz or Black: Onyix.  The goggles gently shelter the eyes from drafts and low humidity environments.  And, they fog up, which creates a moisture-rich environment while sleeping. 

        Quartz Silicone Shield                                  Onyix Silicone Shield

Not knowing what is causing symptoms you are experiencing can be very bothersome.  And, dry eye disease is chronic and progressive, so the sooner you start treatment for it, the better.  If you are experiencing symptoms that just won’t seem to go away, it is time to schedule an exam with your eye doctor.  Allow them to take a closer look and unveil the true source of your symptoms. 

In Chapter 4 of my book Alleviate Dry Eye, I go into detail on how to check for incomplete lid closure on your own.  On page 106, you can walk through the details.  Purchase the book from Amazon here, or download Chapter 4 for free.