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Depression And Dry Eye Disease: Research Finds New Connection
June 14, 2023 – Doctors often note that patients with dry eye disease (DED) report low moods. Now, new research shows that the connection between dry eye disease and depression may actually be quite common.
It's estimated that 5% to 50% of people globally have DED; more than 16 million Americans have been diagnosed with the condition. Dry eye disease happens when you don't have enough tears covering your cornea, or your tears evaporate too fast, according to the Cleveland Clinic.
A relationship between depression and dry eye disease has been previously established, but the specifics of patients' symptoms is now becoming more clear. A new study from Saudi Arabian researchers found that out of 401 people surveyed, 36.7% had DED, and 23.7% were diagnosed with depression, stress, or anxiety.
A recent study also found that patients who have been diagnosed with depression have more severe symptoms of dry eye, which can in turn upset them emotionally.
"Depression isn't simply 'in the mind' – it's a multi-system condition that can affect many systems in the body, and disrupts their normal functioning," said Howard L. Forman, MD, a psychiatrist with Montefiore Health System and an associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine in New York City.
Twenty-nine percent of U.S. Adults surveyed this year said they've been diagnosed with depression at one point in their lives.
"Dry eye disease can hinder the daily enjoyment of life, which can worsen the symptoms of depression," said Deepinder K. Dhaliwal, MD, a licensed acupuncturist and a professor of ophthalmology at the University of Pittsburgh School of Medicine. "Whether dry eye disease causes depression or depression causes dry eye disease is a chicken-or-the-egg, but the two conditions are definitely related."
Patients with these conditions can work with their doctors to make the changes they need to improve depression and DED symptoms.
What Are the Symptoms of Depression?
Symptoms of depression can range from mild to severe, and they may indicate the condition if they last 2 weeks or longer, according to the American Psychiatric Association. Signs include:
"Depression can be worsened by lack of sleep, as can dry eye," said Dhaliwal, who's also director of refractive surgery and director of the Cornea Service at UPMC Vision Institute, and founder and director of Center for Integrative Eye Care at the University of Pittsburgh. A Chinese study found that during the stressful days of the COVID-19 pandemic, lack of sleep increased DED symptoms in the people being studied, which in turn made them feel more depressed and anxious.
What Are The Symptoms of Dry Eye?
According to the National Eye Institute, dry eye may cause:
What Is the Physical Link Between Depression and Dry Eye Disease?
The exact mechanism has not been fully established. But inflammation in the body may be one key cause.
"Inflammation on the ocular surface can indicate a higher risk of depression," Dhaliwal said.
Researchers think that SSRIs – antidepressants that increase serotonin in your system and reduce depression symptoms – may also increase inflammation, which, in turn, can worsen DED symptoms.
"Some antidepressant medications work by blocking signals between nerve cells, which can reduce the eye's natural response to proper tear film production," said Jennifer, Tsai, OD, a board-certified optometrist and founder of LINE OF SIGHT, an eye care practice in New York City. "As a result, this reduces the amount of tears produced, and leads to dry eye."
Lifestyle may be another important factor.
"Depression and dry eye can often be linked due to external changes," Tsai said. "Depression can change your habits, resulting in increased screen time and poor eating habits, for example. These changes can lead to increased tear evaporation and, inevitably, dry eye."
Research has also found that depression can cause changes in the way a patient processes pain, leading to more severe DED symptoms. This can create chronic physical discomfort, which also impacts your emotional state.
"Experiencing difficulty keeping your eyes open, or experiencing blurry vision, can hold you back from activities that bring you joy," said Forman. "This can lead to more social isolation, and less fulfilling days."
What Can You Do to Improve Symptoms When Depression and Dry Eye Disease Happen at the Same Time?
Take note of the circumstances that seem to make you feel worse. Talking with a therapist about emotional frustration you feel can be very helpful. Also, "if you develop dry eyes shortly after starting a medication, absolutely let your doctor know about it," said Forman.
You won't need to discontinue medication you need, however.
"We never stop antidepressants, because depression is a debilitating disease," said Dhaliwal. Instead, a new type of medication may be warranted. And your doctor can help you focus on improving ocular symptoms.
"Non-pharmaceutical treatments for dry eye – such as warm compresses and lid hygiene – can help a lot," Dhaliwal said. "Omega-3 fatty acid taken by mouth can not only help with dry eye, but with mood, too."
Blinking exercises can help lubricate the surface of your eyes. You can also reduce stress through acupuncture, staying physically active, and eating a healthy, balanced diet.
As Dhaliwal sums it up: "All of these steps can help you feel better, and take better control of your life."
Dry Eye Disease: Causes, Risk, Symptoms And Treatment
Dry eye disease, a common yet often underestimated condition, may seem like a minor inconvenience, but extends beyond simple discomfort, potentially leading to reduced quality of life and visual impairment. In this article, we delve into the intricacies of dry eye disease, exploring its causes, symptoms, available treatments, and preventive measures.
Most of us have had dry eyes at some point in our lives. This is a condition in which you do not generate enough tears to keep your eyes moist and safe from injury. This creates inflammation in the eyes, which causes discomfort.
What Exactly Is Dry Eye DiseaseDry eye disease, also known as keratoconjunctivitis sicca, occurs when the eyes do not produce enough tears or the tears evaporate too quickly.
Dr Aloka Sharma, Eye Specialist at Max Super-speciality Hospital, Kochi, said, "Tears play a vital role in maintaining eye health, providing lubrication, nourishment, and protection against infection. When the tear film is compromised, the delicate ocular surface becomes exposed, resulting in dryness, redness, and irritation".
Causes and Risk FactorsSeveral factors contribute to the development of dry eye disease. Some common causes and risk factors include:
According to Dr Sharma, the symptoms of dry eye disease can vary in intensity and may include:
Preventing dry eye disease involves adopting healthy habits and protective measures:
Dr Aloka Sharma offers some advice on how to avoid dry eyes and this syndrome. You can keep your eyes healthy by following these guidelines.
What Does Eye Herpes Look Like?
In addition to causing cold sores, the herpes simplex virus (HSV) can cause sores to appear on the eyes. When herpes symptoms affect the eyes, it is known as eye herpes, ocular herpes, or herpetic eye disease.
Eye herpes may be a cause for concern because it can have uncomfortable symptoms. In rare instances, eye herpes can affect the deeper layers of a person's eyes and their vision.
In this article, we examine the types of herpes that can affect someone's eye and the symptoms that may occur. We also look at the diagnosis of eye herpes and the treatment options.
There are two major types of HSV:
Type 1Herpes type 1 (HSV-1) commonly affects the face and is responsible for symptoms that include cold sores, which some people refer to as fever blisters.
According to the American Academy of Ophthalmology, HSV-1 is more likely than HSV-2 to cause eye infections.
Type 2Herpes type 2 (HSV-2) is the sexually transmitted form of the virus. While this type mainly causes symptoms on the genitals, it can also affect the eyes.
A person will typically contract either form of the virus as a result of skin-to-skin contact with someone who already has the infection.
The virus often lays dormant in the nerve cells and can travel along the nerves to the eye upon activation.
Most people have contracted the virus at some point in their lives, but not everyone gets symptoms as a result.
When a person gets herpetic eye disease, they can experience a variety of symptoms. These can sometimes occur in both eyes, but they usually affect one eye more than the other.
Some of the symptoms depend on the affected part of the eye. Examples of these symptoms include:
Sometimes, a person may also experience herpes sores on top of the eyelids. These may resemble a rash with blisters. The blisters will form crusts that usually heal within 3–7 days.
If the herpes virus affects the cornea, the inside of the eye, or the retina, a person may find that their vision becomes reduced.
Typically, eye herpes does not cause a lot of pain, even though a person's eye may look painful.
The symptoms of an HSV infection affecting the eye may be very similar to those of the varicella-zoster virus, which causes chickenpox. However, a varicella-zoster infection is more likely to result in a rash with a distinctive pattern that occurs in only one eye.
Another condition that can have similar symptoms is pinkeye, which is also known as conjunctivitis.
Share on PinterestFever and stress may trigger a dormant virus to start reproducing.Image credit: Burntfingers, 2015.The herpes virus can spread via the nasal secretions or spit of a person with the infection. The likelihood may be higher when a person has a cold sore.
The virus within the secretions can then travel through the body's nerves, which can include those in the eye.
In some cases, the virus enters the body and does not cause any problems or symptoms. Doctors describe this form of the virus as lying dormant.
Certain triggers can sometimes cause a dormant virus to start reproducing and cause eye irritation. Examples of these triggers include:
The herpes virus can be highly contagious. However, not everyone who contracts or comes into contact with the herpes virus will get eye herpes.
Ophthalmologists, or eye doctors, diagnose herpetic eye disease by taking the person's medical history and asking them about their symptoms. They may ask the person when they first noticed their symptoms and what makes them worse or better.
The ophthalmologist will also conduct a physical examination of the eye. This examination will involve using a special microscope known as a slit lamp to visualize the eye's surface and, potentially, the eyelid.
These professionals can usually diagnose eye herpes by looking at the sores. If the infection has reached the deeper layers of the eye, they will need to use special instruments to measure the eye pressure. They will also need to inspect the deeper eye layers whenever possible.
As part of the diagnosis, an ophthalmologist may also take a small cell sample known as a culture from a blistered area. They will then send this sample to a lab for testing for the presence of HSV.
For the most part, eye herpes affects the transparent front part of the eye. This condition is known as epithelial keratitis.
If eye herpes affects the deeper layers of the cornea, it is known as stromal keratitis. This condition is more concerning to eye doctors because it can cause scarring on the cornea, which can permanently affect a person's vision.
No cure currently exists for herpetic eye disease. Instead, an eye doctor can prescribe medications that reduce the effects and symptoms of the condition. The location of eye herpes tends to determine the treatment options.
EyelidsDoctors will prescribe topical ointments, such as an antiviral or antibiotic ointment, for a person to apply gently to their eyelids.
While antibiotic ointments will not treat the herpes infection, they will keep other bacteria from entering the open, blistering areas of the eyelid.
Outer eye layersIf the eye herpes only affects the outermost layers of the eye, a doctor may prescribe an antiviral eye drop or an oral antiviral medication, such as acyclovir (Zovirax). These help reduce the effects of the virus and could reduce the duration of symptoms.
Deeper eye layersIf the herpes virus has affected deeper layers of the eye, an eye doctor may prescribe antiviral eye drops and oral medications.
They may also prescribe steroid eye drops. These help reduce eye inflammation that could lead to increased eye pressure.
PreventionAs eye herpes can cause further infections, some doctors may recommend taking antiviral medicines on a regular basis to reduce the risk of getting eye herpes again.
Recurrent herpetic eye infections can lead to greater eye damage, which is why doctors want to prevent their recurrence.
Doctors may recommend that a person take an antiviral medication a few days before they have surgery so that they can prevent the stress of the surgery from triggering a herpes outbreak.
According to the American Academy of Ophthalmology, doctors diagnose about 50,000 new cases of eye herpes each year in the United States. While there is no cure for eye herpes, treatment can reduce the duration of symptoms.
If a person has recurrent eye infections or starts to experience vision loss, they should seek an appointment with an eye specialist for an assessment and advice on additional treatments.
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