One Day at a Time - In Hope

[AccutaneJay]

I am a 24 year-old male with severe, chronic dry eye. When I was 18 years old I underwent a single course of therapy with the oral prescription acne medication Accutane. About a year or two later I developed severe evaporative dry eye, which came in the form of intense burning, stinging, and sometimes an overall inability to keep my eyes open for more than a few seconds at a time. I have tried many different courses of treatment, including punctal plugs recently, which I am still "wearing." I attribute my condition to the permanent nature of Accutane's method of action, decreasing size of sebaceous glands and reducing overall sebum output. In other words, my eyes are not producing the fluids/oils necessary to keep my tear film stable and my eyes hydrated effectively.

I've been a caffeine consumer for the majority of my life, but have moreso recently in the past 4 years come to realize its negative impact on my health, so I began cutting back and at times completely eliminating it from my daily routine/diet. With this comes the extreme dry eye pain. I have concluded that caffeine is the only sure fire way for me to escape the horror that is my severe dry eye that ironicall I brought on all myself by using a incredibly powerful and destructive medication.

I'd be very interested to hear how others feel they respond to caffeine (I've read several articles that state methylxanthines, or xanthines help to stimulate secretions of mucin and increase goblet cell density) and their dry eye, especially since the majority of advice is aimed at complete elimination of caffeine to help aid dry eye conditions. I'd also be very interested to hear if anyone has experienced any similar problems with their use of Accutane.

Will post more later, my eyes are telling me to stop staring for now.

- Keeping hope.

[sazy123]

Hi jay,

Welcome to the zone, there are plenty of people who have severe dry eye brought on by acutane and other medications, mine was anti depressants. In fact, a lot of these people (medication-induced dry eye) are young in there 20's like you. I cant talk for accutane but i know about evapoartive dry eye from medication. Just out of interest, what type of evaporative dry eye do you think you have or been diagnosed with? Do you have many signs of it like blocked glands, and do you have any aqeous deficency? Im just interested in this at the moment, becuase young people with medication induced dry eye, dont often have that many signs- and could be the MGs not producing enough lipid, without actual blockage of the MGs (primary MGD rather than secondary MGD).

Thanks for the info in to caffine, is there anything else that you have tried that has helped you? I didnt drink cafine before dry eye, and i stay away from it now. Although i have read somewhere that it can be a protective factor for getting dry eye syndrome.

[SusieD]

Hi Jay

Im sorry you are experiencing this due to accutane. You are not the only one here for starters, theres me and a couple of others whose dry eye can be atributed to accutane.

What I find strange though is that you did not experience any dryness until after 2 years of you stopped the drug. Did you not get any dryness whilst on it or immediately after? Only this is when it has the most powerful action on your sebaceous glands - I would have thought it unlikely to suddenly shrink them down 2 years after stopping, especially if you had no dryness before this. In my case the dryness started soon after starting the drug and haven't felt right since.

Do you have aqueous deficiency also? (lack of watery part) or is it primarily lack of oil? if its the latter, that could explain things if you dont feel your plugs are helping your symptoms much.

Are you taking any supplements?

Can't really comment on the caffeine Im afraid - only drink de-caf.

[jp2084]

Caffeine

I actually cut out caffeine, and it's helped me greatly. Cut down on sugar and wheat too. It has helped a lot. Caffeine is a diuretic and the sugar and wheat are inflammatory foods.

[sazy123]

I agree after eating loads of bread last night (had to there was nothing else in) my eyes felt awfull all first part of the day.

[AccutaneJay]

Thank-you!

Thank-you everyone who took the time to reply. As I mentioned, caffeine has a profound effect on my dry eye symptoms. I just recently abstained from caffeine for two weeks, and started to experience the painful evaporative dry eye again. Just this past Friday I began drinking green tea and although the caffeine gives me irritable bowel syndrome (IBS) if I overdo it even slightly, my dry eye has progressively gotten better as the days have progressed and I have made sure to drink a small cup of tea each morning. So it has become a nightmare of decisions for me: do I suffer from dry eye and be without mental anxiety and IBS, or do I experience substantial freedom from my dry eye, but live miserably with anxiety and bowel upsets? My work tends to suffer more with my dry eye condition, so I tend to favor the tea more than the clear head and calm stomach. So, I believe the reason I did not experience dryness initially while on Accutane or immediately after because I was an active caffeine drinker in the form of soda and iced tea, etc. Time brought on the realization that caffeine was having a negative effect on me, so I began greatly reducing my consumption of it, which is when I began to experience the dryness and pain. I think that my caffeine use while on the drug kept me "above water" so to speak with regards to experiencing dry eye.

Now, I must mention that I am not completely sure that Accutane is the direct cause of my dry eye symptoms, especially since I did not experience them around the time I was on the medication - at which time I was wearing contact lenses, etc. If I remember correctly, someone previously responded stating that anti-depressant medication had induced their dry eye. I was on a medication called Paxil for a little less than 1 month back in 2000, which I am not sure if I can attribute the use of it to my dry eye since my dry eye started to come about in 2003, which is around the time I was taking Sporanox, an antifungal, which I now know was prescribed to me in error due to a wrong diagnosis. Perhaps the sporanox had something to do with my dry eye condition - I was on this medication for almost over a year, which is incredibly excessive for this type of medication as it is known to do harm to the liver and requires blood testing. It is amazing how much I am able to put into perspective just by participating in these threads.

Becaue the puntal plugs are not proving to be very effective, I must say that I believe my condition to be specific to my level of oil output. During a time when I was experiencing extreme dryness (no caffeine), my Opthalmic surgeon told me that when he pushed on my lower lids, almost nothing was coming out of my meibomian glands. This is why I attribute my condition mainly to Accutane, because its main course of action is atrophy of the sebaceous glands.

Caffeine is a methylxanthine (or simply xanthine). I've read several atricles in PubMed related to tests using rabbit models and topically applied methylxanthine and substantial clearance of dry eye symptoms was noted, and an almost reversing of the condition (with consistent, continual use that it). Caffeine is a one of the three well known xanthines, and I believe that a systemic effect is also possible, as evidenced by my relief with consistent consumption of caffeine. Please feel free to review the articles here:

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

Make note of the mention of secretagogue in the first article. The new ecabet sodium being developed and in current trials is the topical application of a secretagogue, which so far is producing positive results. If this product is capable of supplying symptom relief near the level I can experience by consuming caffeine systemically, I personally am placing some hope that this product gets to the market so that I can finally rid myself of having to drink caffeine and live with its rather frustrating side effects, assuming it works well and actually provides good benefit for those of use with severe dry eye.

I hope my thoughts and information are interesting and possibly helpful to anyone. I'm very interested to continue to hear everyone's reactions to what I've supplied here in the form of my own personal experiences. I think that learning and information sharing is one of the best ways to cope with this incredibly frustrating condition. Oh, I'm off to the eye doctor tomorrow morning - I don't have my hopes very high, but I'm hoping he can provide me with other treatment options outside of what I'm already doing.

I'll write back tomorrow! Take care everyone and thanks!

[Flick]

Hey Jay,

I'm also 24, dealing with dry eyes, but mine are from wearing contact lens. Sorry to hear you're having the same troubles. There's a few others on this board that have Accutane-induced dry eye, but if I had to guess I'd say yours probably isn't from Accutane. Accutane has a half-life of about 15 hours, so if your eyes were fine for a year or two after using the drug it's unlikely that it would cause problems so much later. Maybe the anti-depressant? Or the antifungal?

Wearing contact lens for many years can also cause dry eye. How many years have you been wearing them?

About the caffeine - it's great that it works for you, but I'm not sure if it is the answer many of us are looking for. With such a common and widely used drug, if it had a significant effect on tear film, it probably would have been noted by researchers by now. But everyone's different, and if it helps you it could help someone else, so thanks for sharing.

Good luck at the doctor, hopefully he/she will have some good advice or treatment.

Flick

[SusieD]

I wouldnt think it is the accutane either in your case - there seems to be a lot of other things going on that could have contributed. Its just not logical that it would cause atrophy of the glands a year, two years down the line. You obviously werent susceptible to the drug in terms of eye dryness while you were on it - if you continued to wear your contacts with no problems. It sounds like a combination of things more probably. I dont really understand how caffiene would stop you getting dry either.

Could you just clarify this a little more - are you saying that basically your eyes are comfortable when you drink coffee and dry when you dont? If your problem was atrophy of the oil producing glands - it would be highly unlikely that you would suddenly start producing enough oil and feeling more comfortable just through drinking coffee, certainly not if your glands were truly atrophied from the accutane. Theres definately something else going on.

Strange! Ive not heard this one before. If my eyes felt better when I drank coffee I would be drinking it by the bucket load!

[southhavenjen]

I wish my eyes felt better by drinking caffeine! I've seriously had to limit the amount of coffee and Coke that I have because I can tell it is not good for my eyes. I do allow myself one cup of coffee in the morning. Aside from that it's water, water, water and maybe one diet caffeine free Coke in the evening.

[kitty]

Caffeine definitely makes my eyes burn more and increases the dryness. Because I have a very low tear volume, the diuretic effect of the caffeine only makes things worse.

[sazy123]

Jay:

You say that accutane has this effect on the sebaceous glands, do you think anti deprssants would have the same effect? becuase lack of oil appears to be my problem as well, and the problem occured just like it has for those who went on accutane (1 month only). That is really scarey that these medications could cause an atrophy. My eyes fluctuate 'now for one thing they feel quite good' so something is regulating them, which doesn't appear to be down to the weather. An atrophy might mean that they would be bad all the time (just a guess).

I think all the things you mentioned in combination are likely to cause the dryness, you may have had a really mild problem and accutane may have worsened it abit but not enough to send it over the edge, then with age and antidepressants this worsened it even more-or it could have just been the anti depressants.

I drink green tea all the time it may have helped slightly (but is also and anti imflammorty+antioxident), but havent noticed anything significant.

[SusieD]

I have never seen anything to suggest that anti-depressants would shrink your oil glands - wouldnt of thought so. Accutane is different because it is targeted at the sebaceous glands.

You say you fluctuate a lot - do you find your eyes are worse when you've been using the computer alot? Do you need to use it alot for your studies? Remember to blink regularly like everyone says - its is easy not to do this, without realising - dont stay on too long either. I need it for studies too but Ive been trying to use it in short bursts and taking regular breaks. I know it sounds simple.

If your eyes fluctuate and you do have good days - be grateful for that! I cant remember the last time my eyes had a 'good' day. Try and make a note of the things you do when your eyes feel good, (and when they're not so good) maybe this will help you to identify what helps/hinders you.

[sazy123]

Using the computer bothers my eyes like everything else its harder to do with dry eye, but after ive been on there normally doesnt feel worse after wards. I do use it alot for studies, yes.
I have tried to make a note of what helps but there really isent any pattern, theres no pattern in the weather. Im on a stricker diet now all the time antway, theres a slight difference if i drift from it, but not significant. I think its hormones that is regualting it- Im trying to see if theres a pattern with monthly cycle but as of yet havent noticed anythng yet. My eyes never feel normal but some days are more closer to normal. They have improved in the sense that i have more better days more often than before (think thats down to supplements) but the bad days are still really bad and mornings are no different. for the first 8 months i rarely had any good days either.

[sazy123]

Using the computer bothers my eyes like everything else its harder to do with dry eye, but after ive been on there normally doesnt feel worse after wards. I do use it alot for studies, yes.
I have tried to make a note of what helps but there really isent any pattern, theres no pattern in the weather. Im on a stricker diet now all the time antway, theres a slight difference if i drift from it, but not significant. I think its hormones that is regualting it- Im trying to see if theres a pattern with monthly cycle but as of yet havent noticed anythng yet. My eyes never feel normal but some days are more closer to normal. They have improved in the sense that i have more better days more often than before (think thats down to supplements) but the bad days are still really bad and mornings are no different. for the first 8 months i rarely had any good days either. so you have room to get some improvement-if u keep up with the supplements. its (not a great improvement but its something)

[neil0502]

Re: coffee

Obviously, this stuff is all exceptionally complex. There's studies on BOTH sides of each issue, the body is a very complex, tightly-woven web of systems, with each one being unique, etc., etc.

That said, I like coffee and haven't felt any difference in my DES issues during the period that I've stopped. A few things I found:

http://www.advance.uconn.edu/2002/020722/02072207.htm

http://www.mckinley.uiuc.edu/handouts/caffeine.html

Of course, this study found a significant correlation between caffeine use and dry eye:

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

...and this one didn't ... at least in 43-84 year old people:

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

To me, it's one of those "try at and see if it helps" things, but if it doesn't help ... and you like your cuppa' joe ... cheers!