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Can dry eye cause headaches? If it seems to you that dry eyes are often accompanied by headaches or migraines, this may be true. We figure out whether these symptoms can be related and what different studies say about this.

can dry eye cause headaches

What is dry eye

Dry eye is currently defined as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms, in which the instability and hyperosmolarity of the tear film, inflammation, lesions of the ocular surface and sensorineural abnormalities play etiological roles.

The dry eye is therefore considered a real disease, such as to affect the entire ocular surface system, consisting of the lacrimal apparatus, eyelids, cornea and conjunctiva. This system is now considered a unitary structure, both from an anatomical and functional point of view, so that an anomaly in one of its components inevitably affects the others.

The fundamental characteristic that gives rise to dry eye is a change in the quantity and composition of the tears, which become denser (tear hyperosmolarity) due to reduced production of the liquid component by the main lacrimal gland or due to excessive evaporation.

The increase in osmolarity in turn causes damage to the epithelial cells of the conjunctiva and the cornea, as well as the goblet cells that produce the normal mucous component of tears, and induces an inflammatory reaction of the entire ocular surface.

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Symptoms of dry eye syndrome

Dry eye syndrome manifests itself in a variety of forms. Symptoms may vary in severity:

  • burning in the eyes;
  • redness of the sclera;
  • sensation of a foreign object in the eye;
  • excessive tearing after a period of dryness;
  • discharge from the eyes;
  • blurred vision;
  • eye fatigue.

While these sensations are usually temporary, they may indicate something more serious. If the symptoms do not disappear for a long time, be sure to consult an ophthalmologist!

Can dry eye cause headaches?

Dry eyes are more common among people with migraines, headaches of varying intensity that are usually accompanied by sensitivity to light and sound. Some research suggests that dry eyes can cause migraines with additional symptoms such as nausea and vomiting.

It is not clear what causes the association of these conditions. One possible explanation is that both could result from inflammation. Studies have also shown that people with migraine have a different eyeball structure than people without it.

Common causes of dry eye pain

Common causes of dry eye pain

Migraine

Migraine is the most common type of headache that robs us of the joy of life. This is a flushing-like headache that can last up to 72 hours and is often characterized by severe throbbing pain on one side of the head and behind the eyes. Pain can also be felt in the back of the head. Other classic migraine symptoms are nausea, vomiting, and sensitivity to light, smell, and sound.

“Migraine comes from the term migraine, which means “pain in half of the head.” People with migraine have a very hard time, says Green. “This is a severe pain, and it comes in different types, that is, there are several types of headache. People may feel differently, but they all have migraines.”

Headache may be preceded by visual disturbances – flashing lights or halos around light sources. However, most people with migraines do not have these symptoms.

There are many triggers that can trigger a migraine. These include fatigue, emotional stress, lack of or excessive sleep, skipping meals, bright or flickering lights, strong odors, loud noises, certain foods, and changes in temperature and humidity.

There is also a genetic predisposition to migraine: 70% of patients report at least one close relative who also suffered from migraine.

Migraines caught early enough can be successfully treated with over-the-counter pain relievers, but there are several prescription medications that can be used both preventively and to reduce the number of attacks and reduce the pain symptom.

Chronic migraine and dry eye pain may require daily medication.

Cluster headaches

Cluster headache is a condition characterized by multiple and frequent attacks of headaches. These cluster periods can last weeks or months, followed by a period of remission when headaches do not occur for several months or years.

Cluster headache usually occurs quickly, sometimes the pain has precursors, pain can last up to three hours. Symptoms include excruciating pain (often a headache behind one dry eye) that radiates to other parts of the face, head, and neck; red and swollen eyes; and excessive tearing.

It is thought that cluster headaches may be caused by abnormalities in the hypothalamus (the part of the brain that controls many important bodily functions). What can cause pain has not yet been identified, and there is no cure for cluster headaches in the eyes yet.

Treatment for cluster headaches aims to reduce the severity of symptoms, shorten the period of cluster headaches, and prevent future attacks. Treatment options include oxygen therapy, triptan injections, and local anesthetics.

Sinus infections

The sinuses are the air-filled spaces of the skull. They are located behind the nose, forehead and cheeks, as well as behind the dry eyes. A sinus infection (sinusitis) is a common cause of pain, including headaches in the eyes.

Migraine is often mistaken for a sinus infection headache. Treatment for sinus headaches includes treating the underlying infection with prescription antibiotics and decongestants.

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Ophthalmic diseases that because headaches located behind the eyes

Finally, there are a number of eye diseases and other problems that can cause dry eye pain. Among them:

Glaucoma

Glaucoma is an eye disease in which the optic nerve is damaged, causing loss of peripheral vision, blurred vision, difficulty adapting to darkness, and halos around light sources.

A special type of glaucoma, acute angle-closure glaucoma, can cause nausea and severe headache behind the eyes. If you experience these symptoms, you should contact your optometrist immediately.

Sclerite

Scleritis is a severe inflammation of the sclera, or outer covering of the eyeball. It is most often caused by autoimmune diseases. Symptoms include headache behind the eye, red or pink eyes, tearing and blurred vision, and photosensitivity.

Optic neuritis

Optic neuritis, or inflammation of the optic nerve, is accompanied by dry eye pain or headache behind the eye, blurred vision, loss of color vision, flies, nausea, and loss of vision.

Graves’ disease or Graves’ disease

Basedow’s disease is an autoimmune disease associated with malfunctions in the thyroid gland. Graves’ disease affects the eyes, they become very bulging, redden, the eyelids retract, the patients have limited ability to move their eyes, the image doubles, and sometimes there may be loss of vision. In some cases, Graves’ disease can also cause eye pain.

Dry Eye Diagnosis

The diagnosis of dry eye is suspected during the ophthalmological examination based on the symptoms reported and the observation of the ocular surface with the slit lamp and, more particularly, the finding of a reduced thickness of the lacrimal menisci, that is the layer of tears present between the lid edge and the surface of the eyeball.

The diagnosis is confirmed and clarified with some tests:

  • evaluation of the break up time of the tear film , that is the period of time in which dry areas are formed on the surface of the cornea between blinks and the next; this examination can be performed after instillation of a fluorescent dye and observation of the appearance of areas not covered by tears (dry spots) in the blue light of the slit lamp; the test can also be carried out with special equipment that does not require the instillation of the dye;
  • Schirmer’s test : evaluates the length of the soaked portion of a strip of paper inserted in the conjunctival fornix, between the lower eyelid and the eye, over a certain period of time, generally 5 minutes;
  • tear osmolarity test : allows a quantitative evaluation of the degree of alteration of the tears;
  • evaluation of the conditions of the epithelial surface with the help of particular colors (fluorescein, lissamine).

In the forms linked to inflammation of the eyelid glands if the meibomian disturbances are more evident in the morning; it is also possible to observe engorgement of the excretory ducts located at the edge of the eyelids immediately behind the emergence of the eyelashes. On the other hand, when a reduced production of tears prevails, the tear meniscus appears very reduced and the symptoms typically worsen over the course of the day.

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How dry eye is treated

Treatment of dry eye varies according to the stage of the disease and the extent of the disturbances . In milder forms, it may be sufficient to avoid unfavorable environmental conditions and use tear substitutes based on hyaluronic acid, cellulose polymers or other substances such as trehalose, to be instilled at regular intervals, even before symptoms reappear.

With the persistence of the condition of dryness, the appearance of suffering of the epithelial cells and inflammation, requires the use of anti-inflammatories, generally not very aggressive cortisones, which act mainly on the surface, or cyclosporine, and of re-epithelializing substances, in drops, gels or ointment. The presence of inflammation of the eyelid glands (meibomitis), which is the most important cause of dry eye from excessive evaporation, requires specific treatments, from simple warm moist compresses to the application of pulsed light devices.

The therapy should be set by the ophthalmologist, on the basis of the characteristics and intensity of the clinical picture, and periodically re-evaluated, to adapt it to the evolution of the pathology over time. It is also necessary to exclude any concomitant allergic forms or overlapping infections.

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