Tear Production Variation?

[np1981]

Does tear production naturally vary during the day? Or should it be fairly constant? There are times when I feel my eyes are less moist than at other times, even if my environment hasn't changed. I know that at night, tear production goes down.

[kitty]

I don't know if any studies have been done about this, but I know that I experience my worst dryness early in the morning and again late in the day. Mid day is usually more comfortable for me, unless I am in the middle of a bad flare then it is bad all day. I have also noticed variation from day to day, with some days being better than others, often for no reason that I can find.

[np1981]

I just wonder, because there have been occasions in the past when I have gone to see an ophthalmologist who has not seen any visual signs of dry eyes, yet I had the symptoms of dry eyes (from my description) and so never had the striptest done or TBUT. Yet often I find when I am sitting in the waiting room waiting to be seen, my eyes feel a little better. But when I am out and about (like outdoors) my eyes screw up again.

None of the ophthalmologists will have seen my eyes all day, especially first thing in the morning. Yet I am wondering if your eyes have to be dry all the time to get symptoms, or whether just occasional dryness is enough to cause problems (especially at night).

It was Dr Tseng who first suggested that aqueous tear deficiency was a problem, and he was the first to even mention plugs to me. Now that I have plugs, my eyes are wet most of the time (occasionally too wet) but at other times less so, yet my symptoms (including redness) have improved. In fact when one of my plugs fell out the redness and buring came back and I was desperate to get the plug replaced.

I have had doctors here in the UK telling me I don't have dry eyes, yet the plugs are the only thing that has definately helped me.

[kitty]

I have come across a lot of research that indicates that the severity of clinical/objective signs (exam findings, TBUT) don't often correlate with the severity of symptoms reported by patients. For example, at my last visit to my doc, I rated my eye pain at an 8/10. I was having a lot of burning and discomfort. My doc said, "well, they look nice and white today". I could have strangled him. Not all dry eye patients have redness! I replied "That's because it is raining today". He said nothing else.