Dry eyes, pains, Sjogren’s and Plaquenil.

[hipokrytus]

Hello,
I know I've written a bit too much, but I've underlined at the end the key points that I would appreciate someone's opinion on, so you might as well skip most of this.
I'm a 30-year old male, not smoking, not drinking, with the following symptoms that might be related:

1. Dry eyes – started in the autumn of 2013 burning of the eyes in various degrees, confirmed by ophthalmologists. There is some discomfort when reading and significant discomfort when looking at TV or computer screens (in the last case no amount, frequency or type of eye drops seemed to ever help). When I don’t perform any of these activities, the discomfort is quite bearable except late in the night. The problem seems to have progressed since 2013. I admit I ignored the problem for the first 6 months (didn't take any drops) which may have led to the problem number 2.
2. The left eye pain – started in the spring of 2014, quite sharp and hard to describe. At that time it was always immediately triggered when I looked at any TV/computer screens, but it also happened late in the night or early in the morning unprovoked. None of the 8 eye doctors I have been to since then discovered anything, but they never did any extraordinary tests, except perhaps an eye ultrasound once, which showed, of course, nothing.
   
   One of them (the 3^rd one, in September 2014), however, told me what I barely and inaccurately am able to recollect as ‘some residue or aftermath of a viral infection'. I was prescribed drops called Tobrosopt-DEX containing tobramycin (an antibacterial drug) and dexamethasone (anti-inflammatory and anti-allergic drug) and an antiviral eye gel called Virgan (Ganciclovir). The problem vanished immediately and completely. Two weeks after I was told to stop taking them and to start taking moisturising drops and gels regularly (this doctor was the first one who noticed my dry eyes). Note that before that I had not taken any drops except for some moisturising drops, which I had used for a week and had not brought any relief.
   
   Anyway the problem returned three months later, but in a less aggressive and regular form and has continued up to now. There have been periods when it has left me at peace, but I have been unable to account for that. Sometimes it seems like prolonged looking at screens is again triggering this, but I am not certain. Also, to complicate things, sometimes a pain of a different kind plagues both of my eyes equally, but it's rare. None of the doctors I've seen after the 3^rd one has prescribed the drugs that helped me, and I have never been able to reach that doctor again.
3. Raynaud's phenomenon – what I want to stress here is that I have this for as long as I can remember – maybe even 15 years – which makes me wonder if it can be connected, not having started at around the same time as my dry eyes.
4. Dry mouth ?? – my dentist told me I seemed to have saliva production deficiency, but I have not noticed any discomfort in this respect.
5. Light sensitivity.
6. Floaters – again I think I have always had this, thought I started noticing this 2 years ago. This mostly happens when I'm outside and in the spring seasons.
7. Myopia – at around -6 dioptres, since birth, may have progressed somewhat, but not significantly.

I feel I must also confess I spent a lot of time in front of the computer screen in the past, mostly playing computer games. This makes me wonder if this can have anything to do with my eye problems.
Things I have tried to alleviate the dryness:

• drinking a lot of liquids,
• changing diet to a more eye-friendly one,
• making sure the humidity level, where I spend most time is normal (it is, also no air-conditioning),
• having new glasses prescribed and bought,
• using supplements for eye health,
• using those special tissues to 'improve the working of' Meibomian glands.
• using different kinds of artificial tears.

I don't believe any them have brought any noticeable relief. Of course not using a computer, not watching TV, and not reading.... do help.
I read on Wikipedia about the Sjogren's syndrome and I connected the eye dryness with Raynaud's phenomenon. I went to a rheumatologist. I was told to do the anti-nuclear antibodies test, which was negative. Then I was to do some blood-work and check with an eye doctor, regarding the permission to use a drug called Plaquenil.

That eye doctor (the 8^th one I have visited for the past 3 years), who seemed to take me more seriously than all the others, gave me the permission. He also prescribed a drug called Flarex, some steroid for the eyes. This was around three weeks ago.
I've been taking Flarex for this time and noticed no effect. I admit the left-eye pain has not pestered me much, but it also had not done so two weeks before I started taking it. My concern is that it makes my pupils dilated (not immediately and not regularly), which, according to the drug's leaflet, is as equally likely to happen as some other side effects, like glaucoma. Do you think it is a good idea to continue taking it? The doctor says it's not a big deal.


I am now about to start taking Plaquenil, and this is the main reason, why I'm writing all this. Do you think it is the right stage of diagnosis of Sjogren's to take this drug? Again I am worried a bit about the eye-damaging side effects of this, though the ones reported seem to have happened after a long-term use of it.
Do you think the Raynaud's phenomenon is related to my dry eyes? I ask this because so far these seem to be the only two confirmed issues that point to Sjogren's and the former started occurring many, many years ago, while the dry eyes – about three years ago.
I apologize for the time you may have spent reading all this, but if you have any suggestions to any of my issues, I would be grateful.

[Amyfloor]

One of the very rare side effects of this drug is irreversible blindness so I would definitely not take it. My rheumy suggested it as well but since my eyes are so troubling, I will not take the chance.

[hipokrytus]

I understand you. Even if the risk is very low, I am really hesitant to take it, considering the eye dryness is the only thing that really plagues me (I assume the pains I mentioned are the result of dryness) and considering I was not diagnosed with Sjogren's yet. On the other hand, perhaps taking it for one month just to see if it helps may not be such a big deal.