Reasons for low Schirmer except Autoimmune disease?

[wissen1]

So what can be the reasons for low Schirmer scores. I'm just 30 years old and got low Schirmer scores. Never had eye surgery.

[allskin]

Well, me too. No autoimmune disease, no allergics, just dry eye...

[wissen1]

How did you get checked? I just did blood test and it came out negative. But you don't have to be positive on the blood test though. My thoughts are spiraling around my condition getting worse. And I can't control my negative thoughts anymore. Working is not possible anymore, I'm afraid to lose my job, my future wife, my will to live.
Please tell me low tear secretion exists without having a progressive disease. It's hard enough to withstand the constant burning as it is now. Can I get some encouragement from somewhere?
I've seen a study saying average schirmer scores in different studies where between 3 and 11 seconds in HEALTHY eyes. Can you really be without pain with a Schirmer score lower than 5?

[Hokucat]

Hi wissen. Autoimmune disease is not the only reason for low tear production. The Mayo Clinic lists these reasons: Decreased tear production

Dry eyes can occur when you're unable to produce enough tears. The medical term for this condition is keratoconjunctivitis sicca(ker-uh-toe-kun-junk-tih-VY-tis SIK-uh). Common causes of decreased tear production include:

• Aging
• Certain medical conditions, including diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren's syndrome, thyroid disorders and vitamin A deficiency
• Certain medications, including antihistamines, decongestants, hormone replacement therapy, antidepressants, and drugs for high blood pressure, acne, birth control and Parkinson's disease
• Laser eye surgery, though symptoms of dry eyes related to this procedure are usually temporary
• Tear gland damage from inflammation or radiation

http://www.mayoclinic.org/diseases-c...s/con-20024129

I've also read that if one has severe MGD, it can overwork the lacrimal glands, reducing tear production. I recall you have MGD and some lost glands, so possibly this is the case for you. If I find where I read that, I'll post it here.

You could also have diet deficiencies/issues. Besides vitamin A mentioned above, things like not enough antioxidants or potassium can affect your glands. Gluten, sugar, and dairy always make my eyes feel drier, and other people have said the same.

If you do have an autoimmune disease, there is medical treatment. To get a definitive answer, especially for Sjogren's Syndrome, if it does not show in blood tests, you need a lip biopsy. If you do have autoimmune disease, a common and relatively benign first drug doctors prescribe is Plaquenil to reduce inflammation. They may also prescribe Evoxac (generic name Cevimeline) or Salagen, which stimulates salivary glands, and as a off label use can stimulate tear glands in some people. I use Evoxac and it gives me ~4 hours of eye moisture after each dose when I need it, so it is helpful.

I think I also mentioned scleral lenses to you in an earlier thread you started. It does not solve the MGD or tear problem, but if you are able to wear them it could help with daily functioning and give you some immediate comfort. I heard scleral fitters are not that common in Germany, but DryEye68GRM got his from Müller Welt contactlinsen Institut in Stuttgart, perhaps connect with him if you want to look into sclerals further in Germany. Or ask your ophthalmologist for a referral for a consult.

It's not the end of the world if it ends up you do have an autoimmune disease. I likely had severe dry eyes from it, but have been able to manage it well mainly with diet, sclerals, and sometimes Evoxac when needed. Here's a post where I listed the main things that helped me recover and manage my condition, in case there's something there that might help you.

http://www.dryeyezone.com/talk/forum...ccumulate-info

So don't focus too much on the Schirmer score. It's an indication your tear production is low, but there could be many reasons.

[wissen1]

It helps me so much hearing from someone that is affected himself and able to manage it. Because right now I'm facing a big mountain I think I am never able to climb. My life is crumbling in front of me.
The constant burning all the time...oh my god. In the german forums no one seems to have that burning over weeks constantly...

[Hokucat]

Hey wissen. You are not alone. Many of us in this forum have been where you are and got better. It may take a little while to find the thing or combination of things that works for you, because there are so many reasons for dry eyes and we are all different. You'll see several people who have been able to get their lives back under the Dry Eye Triumphs section in this forum, you may get more ideas from there.

Something that helped me through my worst dry years was Genteal Gel, day and night, this was before I finally found the key combination of things that helped me get and feel better (probing/diet-including lemon juice in green tea/sclerals). Genteal was the only thing for me that gave a little relief from the burning/stinging. My eyes were so bone dry, my eye doctor said my cornea and sclera were like sandpaper, they were surprised I never had any scratches or erosions...I think I prevented that by babying my eyes with things like the Genteal. It has different ingredients that for me were more soothing than other gels, and stays in the eyes longer. It's supposed to be preservative-free in the eye, but a few people have developed an allergic reaction to it after using it an extended period, so just a few drops per eye at a time is best. Systane Ultra and Retaine MGD are drops beneficial for MGD, and there's others, but I personally found Genteal Gel worked best for me.

https://www.dryeyeshop.com/mobile/ge...tube-p914.aspx

If you are not already using eye shields/goggles, these may help with the dryness, perhaps more so while having Genteal or other longer lasting drops in your eyes while wearing the shields/goggles. At night Eyeseals 4.0 and TranquilEyes are favorites, and during the day including indoors 7Eye, WileyX, and Zienna are popular. This site's Dry Eye Shop has many to choose from, and if you have questions or want to discuss these and get ideas on other things that might help you, give them a call.

https://www.dryeyeshop.com/mobile/br...ucts-c148.aspx

https://www.dryeyeshop.com/mobile/br...wear-c149.aspx

Ultimately you need to find things that can ease your discomfort, and things to address the cause of the MGD/dry eyes so you can get better. Both are important. There's many of us in this forum who want to help and provide support, so don't feel alone. Wissen, if you ever need to, you can PM me anytime. I try to log in at least every couple of days.

[wissen1]

So today I visited some famous german dry eye doctor. My glands aren't that bad after all, he even told me there's no complete dropout and my oil is far from being the worst. From the picture I've seen now, I'd rate my glands with 25% loss. Oil was expressible with moderate force. But then again my LIPCOFs got more severe, I'm on grade 2 now. Have been on 1 before.
So now I need someone with more knowledge than me. (I can't google anymore, because it drags me down again)
Have you ever heard of low tear production without any associated medical intake or any specific autoimmune disease destroying the lacrimal glands? What other reason could there be for constant inflammation? Can the inflammation really damage the lacrimal glands, causing them to produce less tears? What about lowered corneal sensitivity?
My Schirmer score is pretty low and the last weeks I'm starting to notice dry mouth more. But this could just be my mind playing tricks on me now, since I've been in therapy for anxiety disorder before.

[PhoenixEyes]

There can be a lot of reasons for reduced cornea sensitivity but if you also have punctate keratitis / epithelial defects (shown on fluorescein stain dye test) you could ask the eye doctor about neurotrophic keratitis.

http://eyewiki.aao.org/NEUROTROPHIC_KERATITIS

Someone on the Faceboook dry eye groups said their son has gotten this diagnosis recently and the doctor suspected they also had exposure keratopathy from improper lid closure at night. In that case you can try trapping in moisture during the night with a contoured sleep mask, TranquilEyes goggles, saran wrap etc. and using ointments like VitA-Pos, Xailin Night etc. Their doctor also prescribed Hylo drops for during the day, I find Hylo-Forte (aka Hylo-Gel) helpful.

For painful inflammation, if you've already tried the usual treatments like cyclosporin, artificial tears, lubricant ointments, lid hygeine, moisture chamber glasses etc. then consider giving autologous serum a go if you haven't already, eye drops made from your own blood. You can get 20%, 50% or 100% serum. There's also platelet-rich-plasma serum in some places like from the Vissum Institue in Spain. In the UK here due to NHS funding issues for serum they're also suggesting fingerprick autologous blood (sterilizing finger with alcohol wipe, pricking with lancet like a diabetic would, placing blood on inside of lower eyelid, 4x a day to begin with at least).

There's also amniotic membrane in the form of Prokera contact lenses which offer anti-inflammatory growth factors for healing the eye surface, I had the Plus version, it reset the inflammation though sadly didn't last long enough for me, others can get a longer benefit. In Italy the Department of Health also approved amniotic membrane eye drops, HAMT-EU / AMX by Dr. Emilliano Ghinelli. The makers of Prokera are also developing their own drops, Regenesol, but will be some time before it goes global (or at least I hope they do eventually).

[wissen1]

I'll be checking for serum drops. Can you use Ciclosporine and serum drops at the same time?

[PhoenixEyes]

I'll be checking for serum drops. Can you use Ciclosporine and serum drops at the same time?

Yes, I'm doing autologous blood and taking cyclosporin (Ikervis).

[wissen1]

Hokucat what's your Schirmer's actually?

[Hokucat]

Hi wissen. During my worst years I had zero tear film, my Schirmers in both eyes was zero. Since they can physically see a tear film now and my eyes feel much better, I no longer have the stinging and burning, and no longer need to use any artificial tears, they said they do not need to take the Schirmers anymore. I think it would be interesting to know what is now though and may ask about getting it next time I go. It seems when one gets better and symptoms lessen or go away, they perform less tests, which makes sense logically and insurance-wise.

As mentioned earlier, I do have some remaining dryness because I have some lost/atrophied meibomian glands, and possibly because my tear production is not optimal. So wearing sclerals helps with this.

[wissen1]

Can you go without sclerals? No artificial tears sounds insanely good.

[DryEye68GRM]

Hi wissen1. If you live in Germany (i live in Germany) and you want to try sclerals i can empfehlen/recommend you to go to Müller Welt Contactlinsen Institut in Stuttgart (Tübingen). They are spezialised for scleral lenses anf there is a competent team.

[MGD1701]

Hi DryEye68GRM
Thanks. Any idea about the price range? Do you need to replace them each year?
What are your gland/MGD grade/status and what have you tried?

I tried LipiFlow last year which helped and seems I dont need other treatments except home regimen.

Thanks!