Tired of the roller coaster: could it be hormones?

[hopeful_hiker]

I’ve had moderate improvement since July. However, I have a lot of ups and downs despite better signs (TBUT 11-15s, TMH 0.20-0.25mm, no staining on cornea since February, minimal scleral staining, low osmolarity.

Last week I was feeling almost symptom-free for 4 days and pretty good for 3 days. It was amazing. I did not feel my blinks, I had tiny amounts of dryness lasting for 5-10minutes at a grocery store. If I didn’t know I had dry eyes, I probably would not even realize I had any problem.

The ups happen rapidly and so do the downs. The downs last longer. It seems to be cyclical. I have felt better the week before my period 3 times and worst midcycle usually.

My symptoms started around the time I quiet the pill in December.

Whatever the the reason for my improvement is, it breaks my heart when I start feeling worse.

Especially, this time. I felt absolutely normal and now I have scrapey blinks and occasionally pain. At night my eye started feeling rough on sclera which has not happened in a long time.

On the one hand I feel happy about having good days, on the other hand I am crushed when I get back to this mediocre or sometimes painful state.

[Topher3]

11-15 second TBUT is actually very very good. You can almost rule out evaporative dry eye as your symptom. Perhaps you maybe have an a slight aqueous deficiency and maybe that’s why you’re hit and miss when it comes to your days. ADDE is known as painful dry eye, so if you’re experiencing pain with a 11-15 second TBUT it may be that. Though there are a million causes for dry eyes so this information is all opinion. Hormones absolutely affect eyes and if your hormones are unbalanced it could 100% cause this. The reason ADDE happens as you get older and is actually due to hormones and the slowing down of the lacrimal gland. If you’re over 40 and a female dry eye possibilities become much greater. What is your diet like? Do you take vitamins? How much water do you drink? These all affect your androgen levels which directly affect tear film.

[hopeful_hiker]

Topher3 thank you for your response! I am turning thirty next year but I am sure 8 years on the pill did not help my hormones. I do have occasionally slightly low tear meniscus height (TMH) like e.g. 0.20mm. My Schirmer’s is normal but it is not a reliable test anyway. I have MDG but it improved a lot after IPL.

I think I have corneal neuropathy because serum helped and also my symptoms never match my signs. So slight aqueous deficiency can make me feel like I have zero tear film. If it was moderate tear deficiency, I imagine my TBUT would be lower and osmolarity higher.

I tested for hormones several months ago. I had out of range low DHEA and progesterone.

Do do you know anything about these tests?

I don’t know if the test was reliable and who to see about this. Really hard to get to an endocrinologist in Canada unless you have some severe symptoms. Since many don’t know about dry eye and hormone connection, I could not convince my family doc to refer me.

[MGD1701]

Did you get Sjo, skin allergy, IgE tests done?

[Guest]

Topher3 thank you for your response! I am turning thirty next year but I am sure 8 years on the pill did not help my hormones. I do have occasionally slightly low tear meniscus height (TMH) like e.g. 0.20mm. My Schirmer’s is normal but it is not a reliable test anyway. I have MDG but it improved a lot after IPL.

I think I have corneal neuropathy because serum helped and also my symptoms never match my signs. So slight aqueous deficiency can make me feel like I have zero tear film. If it was moderate tear deficiency, I imagine my TBUT would be lower and osmolarity higher.

I tested for hormones several months ago. I had out of range low DHEA and progesterone.

Do do you know anything about these tests?

I don’t know if the test was reliable and who to see about this. Really hard to get to an endocrinologist in Canada unless you have some severe symptoms. Since many don’t know about dry eye and hormone connection, I could not convince my family doc to refer me.

I was told that if you have MGD, even a slight drop in aqueous production would seem like a huge issue. That being said, I cant deny that you may have other issues. So I’d say try to pursue them. See if you can get a doctor to write you some bloodwork at different times of the month, so you can get a snapshot of your hormone levels. I don’t think that’s a bad idea if you’re seeing a pattern. I think neuropathy is possible for any of us suffering a great deal. I think even if it’s not true, pursuing it and finding out you’re ok, can be of benefit mentally.

If if you have an issue getting the tests, go straight to s endocrinologist. I’m not sure where you live, if you’re in the states, you can self refer to most doctors. Find a good endo and set up an appt. you can get the testing pretty easily. I’d do all hormones, testosterone, estrogen, progesterone, prolactin, t4, t3, tsh, fsh, etc. you can even get thyroid antibody tests to rule out graves or hashimotos. This would at least get you an answer or get your mind off the thought. Win win either way. The neuropathy is another issue and harder to get your info. I’d say if you’re on serum and anti inflammatory drugs, no need to push for a confocal just yet, but when treatment starts nearing an end, if things aren’t better, I would push for it. Or at least push for the idea to be considered.

I hope old you get some answers soon. My latest blood test after my testosterone was increased finally got my test levels high, but now my estrogen is high, so I’ll be getting meds for that today (anastrazole). These meds can be drying if you overdo them. So I gotta be careful here. Good luck!

[hopeful_hiker]

MGD1701

Sjogren’s: blood work and lip biopsy (Sjo test not available in my area). I do not have severe ADDE or dry mouth or any other symptoms.

Allergy test: two-three years ago. None of the allergens are present in the air right now as it is fall.

IgE: part of bloodwork ordered by the rheumatologist. Normal.

My symptoms change rapidly. From terrible to great in a day and vice versa.

[hopeful_hiker]

Dowork123 Unfortunately, in Canada you have to be referred by family docs

I have done a full thyroid panel and it came back normal.

Do you have any ideas as to why some people have high estrogen? Both men or women.

My MDG is under control I think because my TBUT is above 11s and I can see oils when I do compresses. At least I think I am on the level of a typical millennial with a computer job...

You have also had random bouts of being normal and then some relapses, right? Could you find any patterns? For me the changes are very rapid. I go to bed thinking I that I am done with this shit and then wake up to pretty much okay or normal eyes and vice versa.

[Guest]

Dowork123 Unfortunately, in Canada you have to be referred by family docs

I have done a full thyroid panel and it came back normal.

Do you have any ideas as to why some people have high estrogen? Both men or women.

My MDG is under control I think because my TBUT is above 11s and I can see oils when I do compresses. At least I think I am on the level of a typical millennial with a computer job...

You have also had random bouts of being normal and then some relapses, right? Could you find any patterns? For me the changes are very rapid. I go to bed thinking I that I am done with this shit and then wake up to pretty much okay or normal eyes and vice versa.

I can’t tell you why people have elevated estrogen for certain. I can tell you things that cause high estrogen, at least in men. I believe in women, the same things can cause an increase in testosterone, but that can then be converted into estrogen. So even women with elevated testosterone will most likely have elevated estrogen too by default. So, high body fat is one reason. Body fat causes testosterone to aromatize into estrogen. The leaner you are, the leaner you will stay. The heavier you are, the heavier you will stay. Food choices, certain foods increase estrogen and lower testosterone. Sugar for example, Is known to lower testosterone levels. Certain medication can increase/lower hormones. Marijuana use increases estrogen in men. So bad that some guys get gynecomastia. Hormones are like dry eye, there are so many factors, how do you peg it down and manage it properly? My estrogen was too high because my testosterone was too high this last doctor visit. So we are spacing my shots out from 7 days to 10 now. That should get things in line, if not, I’ll use an aromatase inhibitor.

Let me add, it’s not always the numbers, but the ratios. Meaning, you could have estrogen in range, but testosterone too low in relation to the estrogen, that you will exhibit signs of high estrogen. Are you following me? There’s a ratio let’s call it 10:1 for a hypothetical scenario. If that’s thrown off in some way, one number could be good and the other bad. You will have side effects of that. It’s a balancing act that’s almost impossible to manipulate with exogenous hormones. You do your best but you’ll always fail to replicate what the body needs.