The brain making you think you have dry eye.

[emmamounteet]

Hello,

I'm Dianne. I had an accident with weed killer in 2006. I've had severe dry eye ever since. A local opthalmologist tests the dryness in my eyes, and as late as last January my eyes were found to be dry. Another opthalmologist is telling me that my dry eye is caused by my brain telling me in certain situations that I am going to have dry eye and then I believe I have dry eye when I don't. I don't believe this is true for my situation. Are there any others out there that can comment on the brain telling you your eyes are drying, and your eyes feeling dry, even when they are not.

Of course, as I said, my eyes are coming up dry for tests that opthalmolist do on them.

[Nikki]

hi,

It doesn't make sense to me that an ophthalmologist can tell you about your brain function when his expertise is in the realm of ophthalmology and not neurology or such.

I think what he is getting at, however, is that you can feel dryness with the absence of clinically-detected dry-eye. So - even though you may have normal shirmers, whatever other tests - your eyes feel dry.

I would read studies by Dr. Perry Rosenthal (Corneal pain without stain, is it real?) - and perhaps see Dr. Rosenthal for a consult. Corneal neuralgia is a separate condition when your eyes can feel pain with the absence of obvious markers of corneal dryness or eye dryness. Basically, it appears to me that what you're feeling is pain -- and, that can be a separate condition than the dry eyes. Something that 99.9% of ophthalmologists would disagree with. so, even though you can treat the dryness, you can still have a separate phenomenon of pain going on... which is elusive to treat.

I'm just a patient - but those are my thoughts -

Scott

[Rebecca Petris]

I think it depends entirely what they mean when they say it. I mean, doctors who aren't interested in pain will brush patients off by finding some way to tell them it's "all in their head". On the other hand, we have to remember that pain really does happen in the brain, no matter what's triggering it (a dry eye or something else).

I have come across an awful lot of people who have been through a severe dry situation of some sort and where even after they have - according to medical opinion - recovered, they retain the sensations they had when there were clinically in a worse situation - including things like symptoms with specific triggers.

What causes this? None of us really knows. Some doctors thankfully are starting to dig into it to figure it out (like Dr. Rosenthal). I think there will be a lot of theorizing for a long time before we get better answers. Even getting doctors to engage in the discussion is progress.

[Chemia]

I have come across an awful lot of people who have been through a severe dry situation of some sort and where even after they have - according to medical opinion - recovered, they retain the sensations they had when there were clinically in a worse situation - including things like symptoms with specific triggers

Rebecca very interesting. I am in that class where the doctor I saw at the Mayo clinic could not see any clinical signs of dry eyes yet I was in so much pain and with worse symptoms than when I had actual dryness. I was told it was "ghost pain" or sometimes referred to as "phantom limb pain". The doctor who was a neuro-opthamologist did assure me the pain was very real, and somehow the nerve signals continue to fire even though the area has healed. Of course that does not help my pain either. He suggested I try some pain meds or trycyclic antidepressants.

[socratese]

let me know how the neuro pain treatments go. chemia.. I am about to try them. Dr. Rosenthal diagnosed me with corneal/scleral neuropathy a month ago and I have been spreading the info since then on the forums and elsewhere. I see I have already got some people interested in this new explaination. Sometime when your nerves are damaged or injured even so slightly it can cause them to go into hyper sensitive mode when they regenerate. This is the best explaination I have been able to find in my research. This happens with a lot of chronic pain patients and is usually in a limb or joint IE chronic back pain.
typical therapy is electric therapy, siezure meds, anti depressants,

[Chemia]

Socratese, after leaving the Mayo Clinic and returning back to NC, I saw a neurologist for a year and he tried controlling the pain through the use of drugs such as lyrica, neurontin, indep, paxil, cymbalta, tramadol and others I cannot remember. I also tried migraine meds and had a couple of MRIs performed in that 2 year time frame. The pain meds were not a solution really because I would have had to been on high dosages to get a small amount of relief, and since I was working full time in a profession that required me to be alert and foused, I found I could not handle them. I eventually quit taking any pain meds. I also experimented with xibrom and that did not help either. What works great for me during sleep is ambien. I take 5 mg and sleep through the night and feel no pain until I open my eyes. Then the pain is ongoing and ranges from moderate to extreme. By evening, I am ready to collapse from the pain. Weekends are beter since I sleep in and work only when needed.
I should also mention that I tried accupuncture and did not get positive results. This has been going on for 3 years now and to be honest I have reached a point in my life where I have accepted the pain and it has become part of my life.
I spent so much time and money going to several doctors (20 in total) and receieved no benefit. I tried the sclera lenses at Duke Medical but did not help with the pain. I spent several hours having thorough eye exams done and several fittings, but unfortunately it was not a solution.
I suppose you should try different treatments and hopefully you may find something that works. In my situation, I would rather spend my time and money doing things I once enjoyed and focusing on getting my life together.

[socratese]

Im going to try different things. maybe some of these meds will help me. even then its still going to be hell. I would rather not spend the money either, but my life is on hold as long as I have this problem. You know I guess I can stand the pain as long as I don't have to deal with too much PLUS the eye pain which I am right now thanks to my very stressfull job and workplace that is the worse thing for my eyes. Sometimes I personally think that it's just not worth all the pain and mental stress regret and trouble if theres no end in sight. I think its harder on young people like myself, mentally. We just have such high aspirations, expectations out of life, building independence, self worth, and have a lot of social needs.

[Chemia]

Young or old, pain is a challenge both physically and mentally. In the end, the solution may lay not in a pill, but ones attitude. I am not a fan of prescription pain meds and I am now convinced after trying them that they are not the answer.

[socratese]

depends on how much pain you are in. I used to avoid all medications and pills. I used to think I would go most of my life not taking all that poison. Now that I am in, sometimes, unbearable discomfort I will do almost anything to just get a break from it. some narcotics help me quite a bit.

[Rowanberry]

There are different aspects to this.

"Somatisation" is an idea that is becoming very popular in medical circles. The theory for dry eye pain would be that we may have had a physical problem at one time but now we are so anxious about having it again we interpret normal bodily sensations as a sign something is wrong. The treatment of choice is Cognitive Behavioural Therapy (CBT) to re educate our thought processes.

The believers in somatisation think that people have symptoms that are "medically unexplained", a phrase that is fine in itself until it is used in practice to mean "no medical explanation is possible" not, like dry eye, that no one has investigated it enough to find the medical explanation.

It is a very satisfying theory for a doctor faced with a patient they do not know how to treat as it puts the onus on that patient to sort out the problem for themselves once it is explained to them. If they go on suffering it is their own fault.

OSD, where pain and discomfort can seem out of proportion to anything a doctor can see during a simple eye exam, is very easy to dismiss as somatisation.

More scientifically, continuing to have pain after the initial problem has healed is possible because of the way pain signals work. The nerve carries a message to the brain which then interprets the sensation. When something is wrong with the cornea we have evolved to get a loud clear signal so we do something about it. After a signal like that the brain gives a priority to any more signals coming in so it is very possible that we will still get a loud pain signal when the problem with the eye is not so bad.

Pain killers given early and used in large enough quantities can stop the brain becoming alerted in this way so, even though we don't like to give in to pain, adequate pain relief is important if it is possible. Using drugs and techniques to damp down pain is always worthwhile.

I am very fortunate as my consultant believes in dry eye problems and takes me seriously.

R