Is dry eye causing my severe eye pain?
NOV 28, 2014
Question:
I have Sjögren’s disease and dry eye syndrome. In addition, my left eye area/eye itself has stabbing pain when the balance of tears is not just right; i.e., too watery, too dry, not enough blinking, a breeze, etc. It happens immediately. A cornea doctor said I have some sort of nerve damage related to the dry eye. Neurologist says cluster family migraine. Have you heard of this?
Answer:
Patients with Sjögren's Syndrome (a condition that harms tear and saliva production) typically suffer from a severe lack of tear production and have dry eyes, dry mouth, and joint pain. If the eyes get very dry, the corneal nerves can become sensitized so that even the slightest irritation can cause pain signals to be transmitted to the brain. Some patients note burning even after instillation of preservative-free artificial tears. Windy or dry environments can also cause irritation leading to the typical feedback loop of the eyes watering. Irritation or pain that occurs in a classic dry eye situation would most likely be due to dry eye syndrome.
However, patients can also feel a similar type of pain from other causes. Some patients experience a corneal neuropathic pain, which basically means the pain fibers on the corneal surface fire without being stimulated by something irritating their eye. The cause for these patients’ symptoms are not well understood and usually do not respond to the typical dry eye treatments. Alternative therapies such as serum tears or drugs for neuropathic pain such as pregabalin or gabapentin can be tried.
Another group of patients suffer apparent dry eye symptoms from "referred pain," or pain from a nearby location that that brain interprets as originating in the eye. Commonly, sinus and dental issues can lead to eye pain. Various headache syndromes, such as cluster headaches, can cause a sharp stabbing pain originating from the eyeball. If traditional dry eye therapies fail, investigation by an ENT (ear, nose, and throat doctor), dentist, or neurologist may be warranted.