April 15, 2022 - Written By: Maria Arini Lopez, PT, DPT
About 3 years ago, I went to my eye doctor for a routine exam. She asked me if I had any concerning symptoms that had started since our last visit. I mentioned to her that by the end of the day every day, my eyes felt like they were burning and had sand in them. She tested me for dry eye and sure enough I had it!
What is Dry Eye?
Dry eye is a common condition caused by lack of adequate tear production to sufficiently lubricate the surface of your eyes or by increased tear evaporation from the eye surface.
Lack of adequate tear production may be caused by many factors, such as:
Aging
Hormonal changes
Side effects of certain medications including antihistamines, decongestants, antidepressants, hormone therapy, birth control, and those used for Parkinson's disease, high blood pressure, and acne
Contact lens use which may desensitize the nerves in the cornea (the clear, outer layer of the eye)
Nerve damage following laser eye surgery (often a temporary issue)
Autoimmune conditions including Sjogren's syndrome, lupus, scleroderma, rheumatoid arthritis, sarcoidosis, thyroid disorders, and graft vs. host disease following organ transplantation
Allergic eye disease
Inflammation of the eyelid glands which secrete tears
Increased evaporation of tears from the surface of the eyes may be caused by:
Decreased blinking during certain occupations requiring concentration (driving, reading, working at a computer)
Inflammation of the eyelid or nerve damage affecting normal movement of the muscle that closes the eyelid— both preventing full closure of the eyelid over the eyes
Eye allergies
Environmental factors including wind, smoke, dry air
Vitamin A deficiency
Preservatives in some eyedrops (this seems contradictory to me since eyedrops are supposed to relieve the dryness, not cause it)
My eye doctor mentioned that prolonged periods of time staring at electronic device screens (computer, smartphone, TV) can contribute to the development of dry eye. When we use these devices, we tend not to blink as much as we would otherwise. Blinking helps bathe the surface of the eyes evenly with tear fluid to prevent them from drying out.
According to my eye doctor, another factor contributing to dry eye is lack of vitamin D. If we are using electronic devices, chances are we are not outside exposing our skin to the sun—a natural source which increases our Vitamin D levels. Studies recently found that Vitamin D decreases eye surface inflammation and improves necessary factors for adequate coating of tear fluid on the eye surface.
Studies have also proven that there is a genetic component to dry eye. My mother also has this condition. Women are more likely to be affected by dry eyes due to hormonal influences.
Why is Treating Dry Eye Important?
What I didn't know is that dry eye contributed to another symptom that I had had for years without detectable cause – fatigue. While dry eye was not the only reason for my fatigue, it certainly contributed to it. As soon as I started treatment for dry eye, I noticed incremental changes in my fatigue levels too. It is amazing how something so small can impact how we feel daily.
One recent study found that individuals with dry eye syndrome have an increased likelihood of developing chronic fatigue syndrome compared with individuals who do not have dry eye syndrome.
How do You Treat Dry Eye?
Obviously, I am not an eye doctor, so my advice is that you should pay a visit to your eye doctor to be evaluated for dry eye. If you do have dry eye, see what they recommend for your treatment.
I can tell you what my doctor instructed me to do. First, she had me start taking an Omega-3 supplement that included DHA, EPA, and Vitamin D3. She recommended an oil-based eyedrop called Retaine which I use 3-4 times daily. She also provided me with a foaming eyelid cleanser to make sure my eyelids remain clean and free from irritants. She suggested that I try to be more mindful about blinking throughout the day, recommending that I blink hard 5 times each hour to stimulate tear production (although this is hard to remember sometimes). Lastly, she gave me an eye compress which I heat up in the microwave for 20 seconds and put on my eyes for 10 minutes at the end of my day. She said I could use this as frequently as I wanted. During the winter, I tend to use the warm compress more often (3-4x/week) since the air is drier than in the summer. I also use a humidifier in my bedroom at night, especially during the winter.
I started out doing this eye routine every day at first and within a week, I noticed a change in my symptoms. My eyes no longer burned or felt grainy, and my fatigue had improved. When I returned for a check-up in three months, she tested me again for dry eye and my results had improved significantly with treatment! I still use the eyedrops and supplements every day, but I do not use the warm eye compress as often as when I initially started the treatment.
I hope that this information helps those of you suffering from daily chronic fatigue. While I acknowledge that dry eye is not the only reason for fatigue, I do know the importance of addressing all factors that can possibly contribute to your fatigue. Dry eye was one reason that I personally overlooked.
References and Resources
Dry eyes - Symptoms and causes. Mayo Clinic. Accessed March 30, 2022.
Seeking dry eye relief: Could dry eye syndrome be genetic? Drs. Campbell, Cunningham, Taylor, and Haun. Published November 15, 2019. Accessed March 30, 2022.
Sridhar U, Tripathy K. Commentary: Dry eye syndrome and vitamin D deficiency. Indian J Ophthalmol. 2020;68(6):1026-1027. doi:10.4103/ijo.IJO_398_20
Yildirim P, Garip Y, Karci AA, Guler T. Dry eye in vitamin D deficiency: more than an incidental association. Int J Rheum Dis. 2016;19(1):49-54. doi:10.1111/1756-185X.12727
Chen CS, Cheng HM, Chen HJ, et al. Dry eye syndrome and the subsequent risk of chronic fatigue syndrome—a prospective population-based study in Taiwan. Oncotarget. 2018;9(55):30694-30703. doi:10.18632/oncotarget.25544
Maria Arini Lopez, PT, DPT
Maria Arini Lopez, PT, DPT, CSCS, CIMT, CMTPT is a freelance medical writer and Doctor of Physical Therapy from Maryland. She has expertise in the therapeutic areas of orthopedics, neurology, chronic pain, gastrointestinal dysfunctions, and rare diseases, especially Ehlers Danlos Syndrome.