Living with rare diseases and chronic conditions often brings challenges that others might not understand, especially when symptoms like fatigue don’t have an obvious cause. For many people with rare diseases, Dry Eye Syndrome (DES) is a surprising contributor to daily fatigue. This article explores the often-overlooked link between dry eye and fatigue, detailing why dry eye drains energy and how to find relief.
What is Dry Eye Syndrome?
Dry Eye Syndrome (DES) occurs when the eyes don’t produce enough tears or when the tears evaporate too quickly. Tears are essential to eye health; they provide moisture, nutrients, and protective antibacterial elements. When tear production or quality is compromised, it can lead to symptoms like:
A stinging, burning, or scratchy sensation in the eyes
Sensitivity to light
Eye redness
A feeling of having something in your eye
Blurred vision and eye fatigue
Headaches and migraines
For some, DES is a mild inconvenience, but for others, it can lead to chronic discomfort, visual disturbances, corneal damage, and even trigger migraines if untreated. The condition is particularly common among people with certain autoimmune or inflammatory conditions, which can lead to or worsen dry eye symptoms.
Although DES can affect people of all ages, certain groups are more prone to it. Contact lens wearers, for example, are four times more likely to develop dry eye than those who do not wear lenses. Similarly, prolonged use of digital devices can reduce blink frequency, contributing to the evaporation of the tear film and increasing the risk of dry eye. Women over 50 or those experiencing hormonal changes, like menopause, are also at higher risk of DES.
Recent surveys reveal that around 44% of people remain unaware that untreated dry eye can lead to complications such as corneal damage and vision loss if symptoms persist or worsen. Additionally, younger individuals are increasingly reporting symptoms of DES, likely due to high screen time and modern lifestyle factors.
Rare Disease Populations Prone to Dry Eye
People with rare diseases, especially those with autoimmune or systemic inflammatory disorders, are particularly vulnerable to DES. Some rare diseases known to frequently cause or exacerbate dry eye include:
Sjӧgren’s Syndrome: This autoimmune disease specifically targets moisture-producing glands, causing severe dry eye and dry mouth.
Lupus and Rheumatoid Arthritis (RA):Â Both diseases are systemic autoimmune conditions that can disrupt tear production due to chronic inflammation.
Sjögren-Larsson Syndrome and Familial Dysautonomia: These genetic disorders can affect the autonomic nervous system and reduce tear production.
Other Inflammatory Conditions: Conditions such as Behçet's disease and sarcoidosis may also involve DES due to systemic inflammation.
Additionally, individuals with cystic fibrosis or retinitis pigmentosa may experience dry eye due to disease progression or as a side effect of their medications. For example, retinitis pigmentosa patients often suffer from dry eye as a result of gland damage that reduces tear production, coupled with the strain of managing visual symptoms.
For people with rare diseases, addressing dry eye is essential as part of their overall care plan, as untreated DES can worsen their quality of life and lead to further complications
How Dry Eye Leads to Fatigue
Though it may not seem obvious, Dry Eye Syndrome (DES) can be a substantial contributor to fatigue, creating a cycle of discomfort and exhaustion that affects both mind and body. Understanding this link requires examining both the physiological strain that DES places on the visual system and the psychological burden it adds to daily life. Here’s a closer look at how DES can lead to exhaustion:
Constant Eye Strain and Muscular Fatigue
When the eyes lack adequate lubrication, they struggle to maintain a clear, stable field of vision, which requires extra effort from the muscles surrounding the eyes. People with DES often unconsciously squint, blink more frequently, or strain to see clearly. These repetitive muscle contractions cause not only local eye discomfort but also headaches and neck tension, which intensify physical fatigue. Over time, this strain can drain energy reserves, leading to a state of persistent exhaustion as the body works to counterbalance the discomfort caused by inadequate tear production.
Disrupted Sleep Patterns and Nighttime Dry Eye Symptoms
DES often worsens at night, partly due to lower tear production during sleep. As eyes dry out, people with DES may wake up frequently with gritty, painful sensations, interrupting sleep cycles. In severe cases, nighttime dry eye can lead to repeated awakenings or even insomnia, leaving the body and mind without sufficient rest to recover for the following day. This sleep disruption is a significant contributor to daytime fatigue and drowsiness, making it difficult to stay alert and focused. Moreover, inadequate sleep exacerbates DES symptoms, creating a vicious cycle where poor sleep worsens eye discomfort, and eye discomfort disrupts sleep.
Cognitive Load and Mental Fatigue from Visual Discomfort
DES can also lead to cognitive fatigue by overloading the brain. The brain continuously compensates for blurry or distorted vision caused by dryness by working harder to interpret the visual input. This process requires more cognitive energy, leaving patients feeling mentally fatigued, especially after tasks that demand visual focus, such as reading, driving, or using a computer. When blurry or distorted vision forces the brain to "work overtime," it not only wears out cognitive resources but also causes increased stress and mental exhaustion by the end of the day, contributing to overall fatigue.
Reduced Motivation and Mental Drain Due to Chronic Discomfort
Persistent eye discomfort from DES often drains emotional resilience. When a person experiences constant irritation, it can be difficult to stay motivated and positive. This chronic, low-level pain can reduce productivity and the capacity to focus on daily tasks. Over time, the ongoing discomfort leads to frustration, lower morale, and diminished motivation. This mental drain exacerbates physical fatigue, as the body feels the compounding effect of physical discomfort and psychological weariness. For individuals managing rare diseases, DES can further reduce the energy available to cope with other health-related challenges, deepening the cycle of fatigue and diminishing quality of life.
For patients with rare diseases—who often experience pre-existing fatigue as part of their condition—DES can intensify these effects, making fatigue an unrelenting challenge that impacts both physical energy and mental well-being. Understanding this connection emphasizes the importance of effective DES management strategies for maintaining energy levels and overall health.
Factors that Exacerbate Dry Eye and Fatigue
Multiple external and internal factors can aggravate DES symptoms and fatigue. By understanding these triggers, individuals can better manage their symptoms.
Screen Time and Digital Eye Strain: The prevalence of digital devices means that prolonged screen time has become a primary contributor to DES. Focusing on screens reduces blink rates, drying out the eyes faster and causing discomfort. This strain can intensify fatigue, as the eyes and brain work harder to keep up with prolonged focus.
Environmental Conditions: Dry climates, air conditioning, and exposure to wind or smoke can aggravate DES. Heated or air-conditioned indoor environments tend to be low in humidity, which can quickly dry out eyes and increase discomfort.
Diet and Nutritional Deficiency: Low intake of certain nutrients, particularly omega-3 fatty acids, can worsen DES symptoms. Omega-3s play a role in tear production and anti-inflammatory processes. Diets low in these essential fatty acids may reduce tear quality, leading to more severe DES symptoms.
Medication Side Effects: Many medications, especially antihistamines, antidepressants, and beta-blockers, can reduce tear production as a side effect. For patients with rare diseases who may rely on these medications, managing DES alongside medication needs can be particularly challenging.
Estimates indicate that dry eye syndrome affects tens of millions of Americans. Notably, a 2023 report from the American Academy of Ophthalmology highlights that DES cases are projected to increase as screen time and environmental stressors continue to rise in modern lifestyles. Additionally, a significant proportion of people with dry eye find it challenging to get effective relief, underscoring the need for improved awareness and treatment strategies among high-risk groups like the rare disease community.
Managing Dry Eye to Reduce Fatigue
Effective management of Dry Eye Syndrome (DES) requires a multi-faceted approach, combining lifestyle changes, environmental adjustments, and, in some cases, medical intervention. Below are some strategies for managing DES:
Lifestyle Adjustments
Limit Screen Time with the 20-20-20 Rule
Prolonged screen time is a major contributor to DES, especially as blinking tends to decrease during focused tasks. Adopting the 20-20-20 rule—taking a break every 20 minutes to look at something 20 feet away for at least 20 seconds—can alleviate eye strain. This practice helps relax the eye muscles, reduces dryness, and promotes healthy blinking.
Optimize the Work Environment for Eye Comfort
Creating an eye-friendly environment can prevent the exacerbation of DES. Increasing humidity in indoor spaces (especially during winter months when heating systems dry out the air) can make a significant difference. Using a desk humidifier, especially near workstations, helps maintain moisture in the air, reducing the evaporation of natural tears. Additionally, avoid direct exposure to fans, heaters, or air conditioners, as these can quickly dry out the eyes.
Incorporate Omega-3 Fatty Acids for Tear Quality
Diet plays a role in eye health. Including foods rich in omega-3 fatty acids—like fish, walnuts, chia seeds, and flaxseeds—has been shown to improve tear quality and reduce inflammation. Omega-3s may help to stabilize the tear film, keeping the eye surface moisturized for longer periods and reducing discomfort for those with DES.
Environmental Modifications
Maintain Optimal Lighting
Bright, direct light—especially from screens or overhead lighting—can intensify eye strain and worsen DES symptoms. Soft, indirect lighting and anti-glare screen filters can help reduce strain. Adjusting screen brightness and contrast to levels comfortable for your eyes also minimizes dryness associated with extended screen time.
Wear Wrap-around Glasses Outdoors
Protecting your eyes from wind and environmental irritants (such as pollen and dust) can help prevent the symptoms of DES from worsening. Wrap-around glasses create a physical barrier that shields the eyes from drying out, particularly useful on windy days or in harsh sunlight.
Medical Treatments
For those with persistent or severe DES, medical interventions may be necessary:
Artificial Tears and Gels for Moisture Support
Over-the-counter lubricating eye drops or gels can provide temporary relief by adding moisture to the eyes. It’s important to select preservative-free options for frequent use, as some preservatives may irritate the eyes. Thicker gels or ointments may be helpful before sleep, as they tend to provide longer-lasting moisture overnight.
Prescription Eye Drops: Cyclosporine and Lifitegrast
For cases where inflammation is a contributing factor, doctors may prescribe cyclosporine (Restasis) or lifitegrast (Xiidra). These drops work to reduce inflammation and help the body naturally produce more tears. It may take several weeks of consistent use to notice improvement, but these treatments are often effective in managing chronic DES symptoms.
LipiFlow Thermal Pulsation Therapy
LipiFlow is an in-office treatment that uses heat and gentle massage to clear blockages in the meibomian glands (glands along the eyelids that produce the oil layer of the tear film). By improving oil flow, LipiFlow can help stabilize the tear film and provide long-term relief from DES symptoms. This procedure may be especially beneficial for patients with meibomian gland dysfunction (MGD), a common cause of DES.
Punctal Plugs for Tear Retention
For individuals whose eyes drain tears too quickly, punctal plugs can be inserted into the tear ducts to slow drainage. These tiny, biocompatible devices help retain natural tears on the eye surface longer, providing moisture and reducing dryness. This option is typically reserved for patients who have not responded to other treatments and can be an effective method for maintaining hydration in the eyes.
Autologous Serum Eye Drops
In more severe cases, doctors may recommend autologous serum eye drops, which are made from the patient’s blood and contain growth factors that promote healing on the ocular surface. This specialized treatment can be particularly beneficial for patients with DES that result from autoimmune conditions or other complex health issues.
Developing a Restorative Sleep Routine
Given the link between DES and disrupted sleep, establishing a sleep-friendly routine can further alleviate fatigue associated with DES.
Use a Humidifier in the Bedroom
Placing a humidifier in your bedroom helps to maintain a higher level of moisture in the air overnight, reducing the likelihood of waking up with dry, irritated eyes. This is especially beneficial for individuals who experience increased dryness while sleeping.
Limit Screen Exposure Before Bedtime
Reducing screen time in the hour before bed minimizes further eye strain and prepares the eyes for rest. The blue light emitted from screens can also interfere with melatonin production, making it harder to fall asleep. Using blue light filters on screens or glasses that block blue light can help mitigate this effect if you must use screens before bed.
Practice Relaxation Techniques for Stress Management
Relaxation techniques, such as meditation, deep breathing exercises, or progressive muscle relaxation, can help reduce overall stress levels, which in turn can alleviate DES symptoms and support better sleep. Since stress can exacerbate DES by increasing inflammatory responses, relaxation practices contribute to both mental calmness and physical symptom management.
Consider Eyelid Hygiene Before Bedtime
Cleaning the eyelids before bed can help prevent oil and debris buildup around the eyelash base, which can clog meibomian glands and worsen DES. A gentle eyelid scrub with a warm washcloth or commercial eyelid cleanser removes these residues and keeps the glands functioning properly, promoting tear stability.
By integrating these lifestyle, environmental, and medical strategies, those with DES can better manage symptoms and reduce the associated fatigue. Regular consultations with an eye specialist are recommended to tailor treatment plans to individual needs, especially for patients with underlying health conditions, such as rare diseases, that may complicate DES management.
Conclusion
Dry Eye Syndrome is more than just an eye condition—it has broad implications for daily life and energy levels, particularly for those in the rare disease community. By understanding how DES contributes to fatigue, individuals can take proactive steps to manage their symptoms and improve their quality of life. Conscious adjustments, dietary improvements, and medical treatments can collectively make a difference in reducing the physical and mental burden of dry eye. With increased awareness and a tailored approach to care, managing DES is not only possible but essential for enhancing overall well-being. As awareness of dry eye’s far-reaching impact grows, both patients and healthcare providers can work together to mitigate the condition’s effects, leading to better outcomes and a more manageable daily life.
References
https://www.aelo.com.au/blogs/dry-eye-intro/the-impact-of-dry-eyes
https://mycorneacare.com/dry-eye-disease/why-it-matters/dry-eyes-impact-physical-and-ocular-health/
https://www.verywellhealth.com/dry-eye-syndrome-facts-6188248
https://www.ophthalmologytimes.com/view/understanding-prevalence-demographics-dry-eye-disease
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