evidence that stress can induce dry eye and even Sjogren-like symptoms

[ringo]

Hi all,

I have always been wondering whether stress is directly related to my eye problems, and have noticed, as many others here, that stress does affect the eyes badly. I was reading about stress hormones in a medical book, and it turns out all of them have a direct impact on dryness, inflammation, and eyes.

For example, adrenaline (epinephrine) and catecholamine hormones do some of the following: accelerate the heart, inhibit the digestive system, inhibit sexual response, inhibit tear production and salivation, constrict the blood vessels in many parts of the body, and may cause hearing and vision loss . Evidence also suggests that chronic stress triggers an over-production of certain immune factors called cytokines which are the pro-inflammatory substances involved in dry eye inflammation and autoimmune inflammatory response.

The effect of stress on the immune system is similar to mobilizing a defensive line of soldiers to potentially critical areas. The steroid hormones reduce activity in parts of the immune system, so that specific infection fighters (including important white blood cells) or other immune molecules can be repositioned. These immune-boosting troops are sent to the body's front lines where injury or infection is most likely to occur, such as the skin, eyes, other mucosal membranes and the lymph nodes.Fluids are diverted from certain locations, including the mouth and the eyes.

Stress plays a role in worsening numerous skin conditions, including hives, psoriasis, acne, rosacea, and eczema, and is one of the most common causes of eczema. Unexplained itching may also be caused by stress. Evidence suggests that experiencing the stress of a traumatic event (parental divorce or separation, or a severe disease in a family member) before age 2 increases the risk of developing eczema. Stress has been implicated as a trigger for asthma.

Turns out, if you are stressed most of the time, your eyes are drier most of the time, and when you add environmental stress to the psychological stress-- there you have it-- eyes can't cope with producing enough tears.

So, to me it means that stress must be managed and kept under control by all means, but that is so hard when on top of the dry eye anxiety there are other problems in life, equally or even more serious.I do not want to see myself dependent on the sleeping pills I am currently taking-- they helped me realize how much drier and worse my eyes are when I am stressed.

I guess i will be a regular visitor to the psychologist's office as well... I am becoming stressed about being stressed...

[calli66]

Hi Ringo

Maybe they're referring to a more immediate response, i.e. if one gets stressed knowing they'll have to do some public speaking, then the mouth goes dry instantly (at least mine does). But anything you do like this, if it happens often enough, might lead to a chronic state.

One of the worst stress times in my life occurred a couple of years before my SjS diagnosis. My sister was terminally ill with a horrible debilitating disease, and the caregiving situation was impossibly difficult for our family. Sometimes I think that tipped me over the edge.

C

[ringo]

Hi Calli,

Yes, some of the symptoms occur with acute stress, but when exposure is repeated (chronic) problems become chronic too, and esp in the case of the immune system regulating inflammation--the whole organization there gets disrupted.

I am so sorry about the painful experience you went through and the loss of your sister- thank you for sharing, now I know it is not only my imagination trying desperately to look for a culprit for my condition. Just like you, I have identified a direct link between psychological trauma and chronic dryness/inflammation that I have.

I have a similar story- i mean a trauma seems to have triggered my condition: Just before my SjS diagnosis I was hospitalized for nearly three months following a simple appendicitis surgery, with burst appendix, which ended in a massive post-operational infection called peritonitis. I was at risk of losing internal organs like my reproductive organs, parts of intestines, etc. I was in extreme pain, and totally scared most of the time in the hospital, plus deprived of sleep. Soon after I was out of the hospital, and even during my stay there I had knee pains,swollen knee joints, dry eyes, and dry mouth. I was diagnosed with dry eye sndrome and the tests for Sjogren's started.

Thereafter, I had a few other traumatic events in my life, and the condition became severe after I had two consecutive miscarriages. These days, I can clearly notice that stress in my marriage or even a domestic arguments causes a tremendous reaction in my physical symptoms of dryness and soreness. My eyes even become red in seconds.

Of course, there is also the fact that the whole eye and mouth lubrication process is regulated by neurotransmitters as well, which are not only regulated by the nervous system hormones, but directly affected by the cytokines (the inflammatory substances triggered by stress). That is why we need the substitutes to these neurotransmitters-- pilocarpine and cevimeline for ex. to manage to trigger the glands to produce more tears.

Looking back, I can almost say for certain which stressful traumatic events tipped me over the edge and then accelerated the worsening of my condition. For myself i know for sure that stress and trauma are the cause of what I am going through with my eyes. I wish I could find something that can reverse this effect- may be an intensely positive emotional experience?

For now, I find the greatest relief from cyclosporine A. I think it has even brought a consistent improvement, I mean it is not like with other medications-- one day you feel better, and the next you are back to square one. Even long time on steroid drops did not achieve anything close to the relief that cyclosporine provides.o, I am more hopeful these days...but not much less stressed unfortunately with other issues.

Do you think that being continuously stressed, or even occasionally, can actually prevent improvement even with medications?Do you think tat medications like tranquilizers/sleeping pills, etc. really remove stress (meaning remove the effects of stress on the immune system for ex.) or just dumb the experience of it?

[odydnas]

Stress isn't clearly understood by the scientific community, in terms of what it effects, how long it effects, and how to even measure stress. But we do know that chronic stress = bad, and can pretty much affect most aspects of your physical and emotional health.

I've always had irritated eyes, but it really worsened when my mom was diagnosed with cancer, and it continued to get bad after she passed away. I wouldnt be surprised if my eye problems were triggered from dealing with that.

In terms of reversing the long term effects of stress, I think that is still a medical mystery. But it doesn't hurt to work on reducing stress in your life such as exercising regularly, meditating, yoga, massages, etc. I've heard some miracle stories related to this area. I do know that when I am deep into my yoga poses, my eye pain and discomfort lessens in intensity.

[ringo]

Hi Odydnas,

Thank you for sharing-- i am sorry about what you have been through and the loss of your mum... I cannot even start to imagine the amount of stress an experience like this can cause, and I definitely agree that it was a major factor in the causing and worsening of your condition.

It looks like most of the non-Lasik induced dry eyes are the result of a profound psychological trauma and/or chronic stress.

Personally, I have found that massages and swimming greatly improve my sense of well-being.I also made a few trips to places I have always wanted to visit (ex. Tiger Temple in Thailand), during which time I was able to stop focusing so much on my eye troubles. Contact with animals helps a lot as well. Still, the greatest benefit comes from these sleeping pills, and I am concerned that I will have to taper them off soon.

May be I should learn more about yoga and start practising it. I have always been suspicious of the benefits of alternative medicine-- once i tried acupuncture treatment for quite a lot of sessions, and it did nothing for my eyes or overall well being. I will continue looking for alternatives to the sedative pills.

Have you ever tapered off sedative medications? How did that affect your condition?

[Sammy B.]

Ringo - did you find something that works for your insomnia yet? Sounds like you may have. And please try not to view being on a medication for stress/insomnia as a failure. I think there is too much importance placed on trying to "keep up with the Joneses" or to make it appear that we're all normal and perfect, when in fact we all have our flaws and that's OK. Hey, things could be worse... At least you aren't Tiger Woods right now....

I also believe that more people than we realize are taking some sort of anti-anxiety medication. It is more prevalent than we think.

I think the bigger picture might be that those of us who experience repeated bouts of significant stress can eventually be pushed into adrenal failure. Once your "fight or flight" reactions have been used over and over again, the body literally enters into a constant state of stress. It doesn't have the mojo to continually enter into "fight or flight" and then exit that stage anymore. Our glands, which you have pointed out control our tear output among other things, cannot function normally during this time. Just like anything, stress can become a chronic disorder.

And I also think the majority of us on this site can attest to the fact that we notice our dry eye symptoms more when we are stressed. Either this means that stress is physically manifesting itself in the form of health problems (i.e., if you had a bum knee, your knee may hurt more when you're stressed), or perhaps when we are stressed we are just more down on life in general (i.e., it is easier to be stuck in the "woe is me" mindset), therefore more aware of our problems. Could also be a combination of both.

Either way, and this is easier said than done, we must try to find ways to reduce or eliminate the stresses in our lives.

- Rose

[calli66]

Do you think that being continuously stressed, or even occasionally, can actually prevent improvement even with medications?Do you think tat medications like tranquilizers/sleeping pills, etc. really remove stress (meaning remove the effects of stress on the immune system for ex.) or just dumb the experience of it?

Sorry, I don't have any basis for an opinion on these things. With autoimmune or Sjogren's-like conditions there must be other factors than stress---I always wonder why it is that women are so disproportionately affected...

I have never used sleeping pills, but I think it's OK to use them when other things are not working. I go to a dance/exercise class 3 times a week which really helps me. I tried yoga, but I'm not very flexible and so I always felt I was "failing" at it...I got really sore and then was not looking forward to doing it.

I think what affects me personally---some of my autoimmune problems---started many years ago when I had dysentery. Since then, I don't digest food very well and have many food intolerances, vitamin deficiencies, etc. That's what I'm trying to stabilize now, with the help of a dietician. Seems to be working.

Ringo, you've been through so much. I do know that it takes a long time for the mind and body to heal, and I have faith that it DOES heal.

Calli

[howdryiam]

Stress and diet

They are belived to be linked to many disorders - including autism

I had and still have stress - thinking I have a dry mouth, etc - if I am working, I don't think about it - so it doesn't bother me...

Stress kills

[ringo]

Thank you all for sharing-- it is amazing how much better it feels when I know that I have found genuine understanding for what I am going through...even my closest people are unable to relate like you do. Often times I am called "the biggest moaner" by the people I love most, and that only adds to my frustration.

Rose- I am using clonazepsam and it helps me sleep for around 6 hours on average. Also, when I wake up, I do not wake up with a sort of "scare" and anxiety that I do when I cannot sleep properly, and that helps tremendously to focus on my daily activities and be more functional.

I also agree with you that in my case stress has become like a constant-- I never feel completely out of it; I am more jumpy and anxious than ever, and the life before dry eye with all the events that surrounded its occurrence, is like a distant dream, sometimes I think it was another person living it-- a cheerful, full of life and hopes person, who no longer exists.
I have been trying to get back to that person-- I don't know how long it will take me, but I must never give up on it-- I have tasted despair and it is much more destructive than stress.

Calli- I also do have faith that no matter how long it takes, our bodies and minds can heal, and this is what has kept me from sinking into despair which often creeps on me. Thank you for sharing about a dietician-- I have been thinking about going to one for a long time, I will add him to the list of my doctors soon. Also, dancing classes must be a fun way to keep fit, and get your mind off the troubles.

You mentioned the interesting fact that women are more affected by Sjogren's than men-- i think stress also affects female hormones in more ways than it does men's; but you are right, it must be a combination of factors, and stress is a part of them.In my case, I know for sure that severe physical illness, and the physical and psychological stress related to it, started the whole dry eye inflammatory disorder.

It is interesting what howdryiam said-- that when not working, does not think about stress. In my case however, work on the computer in the highly air-conditioned office full of glare and bad lights, worsened my eyes so much, that the stress was elevated to absolutely unbearable levels.

I just jad to quit an excellent job and career-- it has been almost a year now-- without any clear idea when or how I will be able to resume working, and will I ever find a job in an excellent company like what I used to have.

I am completely dependent on my husband right now, and that puts stress on him too, and on our relationship; so now he is moving to another job with a bigger income, and he also has to go through changing residence, and all-- thanks God he does not blame me for it....at least not openly.

I pray everything gets better...and things normalize with my health and life-- I pray for all of us to be healthy again. How I used to take for granted my health before, never ever realized that it is the most important thing I will ever have.

In the meantime am so grateful for your support,will continue taking the sleeping pills and my other mediations, visit the doctors, and hope for the best...

[patrick]

hi, ringo

lately i've been very stressed,and my eyes (lasek induced dryness)haven't ever been as bad as right at this moment. this is also caused by a lack of sleep that i'm suffering of the past few months. the good thing of all this is that i've come to realise that once the stress and the lack of sleep are under control the whole situation with the eyes are fairly managable. just stop the stress and live a healthy life. it is almost impossible i know,but once you get a grip on the unhealhty stress it for sure will improve your situation. it is a long road,but these things need time. it will get better. have faith!

patrick...