Is there a link between dry eye syndrome and depression?

                I didn’t have to wait until my ninth decade to appreciate how annoying dry eyes can be. And I was flummoxed by the plethora of products on pharmacy shelves that promise relief for a problem that affects about 1 in 5 adults. Perhaps you, like me, are among the many who have tried various over-the-counter remedies that did not help or sometimes made matters worse.

Dry eye problems become increasingly prevalent with age. But since my mid-30s, I have been coping with a mild form of this condition and, despite intermittent visits to health professionals, have gotten only limited relief. With all the “extra” time I had to read for pleasure during the pandemic, the gritty feeling in my chronically dry eyes rendered this diversion anything but pleasant. Other common complaints linked to dry eyes include itching and undue sensitivity to sun and bright lights, all of which I suffer from.

In an online survey published in January, two-thirds of respondents reported having symptoms of dry eye, and of those, more than one-quarter said their symptoms were made worse by wearing a face mask. But Dr. Ira Udell, a professor of ophthalmology at the Zucker School of Medicine at Hofstra/Northwell, said that while masks may indeed cause ocular discomfort, an association between mask-wearing and dry eye per se is unlikely, given that exhaled moisture when wearing a mask fogs glasses and, if anything, the increased humidity would raise moisture levels around the eyes.

A more likely explanation of those findings is an association between dry eyes and pandemic-related stress. In two studies of veterans, researchers found strong links between dry eye syndrome, post-traumatic stress disorder and depression.

What causes dry eyes?

I have recently learned just how complicated it can be to keep my eyes moist and free of irritating dryness, a need made more challenging by an ever-greater reliance on screens for work and play. When people stare at computer screens for hours on end, they blink less often, resulting in tired, distressed and dry eyes.

Inadequate lubrication of the ocular surface can also result in blurry vision, a symptom that has repeatedly prompted me to get my vision checked, only to find that my current prescription hasn’t changed even though words on a page are less clear.

Although dry eye problems are most common in people older than 50, they are also increasing among young adults, which experts attribute to the ubiquity of smartphones and computers. Younger people are also more likely to wear contact lenses, the prolonged wearing of which may also cause dry eye.

Dry eye is a hallmark symptom of Sjögren’s syndrome and other autoimmune disorders that impair the body’s lubricating tissues. Dry eye also commonly occurs temporarily following cataract surgery; Lasik eye surgery, which reshapes the cornea to improve vision; and blepharoplasty, an operation to correct drooping eyelids.

Some people develop chronically dry eyes because their lids don’t close completely during sleep. If you suspect this may be your problem and you live alone, you might invite a visitor to check your eyes when you are asleep, Udell suggested. A cellphone photo would be useful to show to your doctor.

How does the eye stay lubricated?

Think of the tear film that coats and lubricates the eye as a three-layer sandwich, with each layer produced by different glands. The meibomian glands in the upper and lower eyelids create an oily outer layer that stabilizes the film. If the film breaks up too quickly, blurry vision is the likely result. Next are two sets of lacrimal glands that supply the watery tears. Innermost is the mucin layer that attracts water and helps to spread the tear film over the surface of the cornea. Even if the tear supply is adequate, a mucin deficiency can impede wetting of the cornea and damage its surface.

Both the meibomian and lacrimal glands have receptors for the sex hormones, androgen and estrogen, and a decrease in hormone levels likely explains why dry eye problems increase in women at menopause and in men who are treated with anti-androgen therapy for prostate cancer. Indeed, the most common cause of dry eye is evaporation of moisture from the eyes from dysfunction of the meibomian glands that results in instability of the tear film.

What can you do to relieve dry eyes?

Environmental conditions that can exacerbate dry eye problems include smoky or excessively dry air, which can result from indoor heating and air conditioning. Long before the pandemic, I began wearing eyeglasses when outdoors, especially on windy days and always when riding my bicycle, to protect my eyes from dryness and grit. A variety of glasses are available to block out wind, glare and airborne irritants.

If you swim, be sure to wear goggles to prevent salty or chemically treated water from irritating your eyes.

Another practical measure that Udell emphasized is applying warm compresses to the eyelids morning and night to assist meibomian gland function. I gently wash my eyelids from the nose outward with a warm washcloth every night. Repeat the washcloth cleanse if you wake up in the morning with “sleep in your eyes,” then apply artificial tears.

Use of artificial tears several times a day is essential for most cases of dry eye. Although no product precisely mimics the composition of natural tears, many are helpful if used regularly, Udell said. He suggested trying various products one at a time to find one that is most effective for you. You could start with a low-cost generic product and, if that doesn’t help, try the brand name version, he said.

However, if over-the-counter remedies and the practical measures described above fail to bring adequate relief, consult an eye specialist. There are prescription products and special glasses that create a high-humidity moisture chamber around the eyes, among other remedies, for severe cases of dry eye.