Is dry eye causing my severe eye pain?
JAN 08, 2024
Question:
I have Sjögren’s disease and dry eye syndrome. My left eye also 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 corneal specialist said I have some sort of nerve damage related to the dry eye. A neurologist says it is cluster-type migraine. Have you heard of this?
Answer:
Patients with Sjögren's Syndrome (a condition that harms tear and saliva production) typically suffer from 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 using 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 classic dry eye would most likely be due to dry eye syndrome.
However, patients can also feel a similar type of pain from other causes, such as neuropathic corneal pain. This is when the pain fibers on the cornea fire without any pain-causing stimulus. Neuropathic corneal pain is not well understood its symptoms do not usually respond to typical dry eye treatments. Alternative therapies such as serum tears or drugs for neuropathic pain such as pregabalin or gabapentin can be tried.
Other 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, further evaluation by an ENT (ear, nose, and throat doctor), dentist, or neurologist may be needed.
This question was originally answered on Nov. 28, 2014.