TEARS OF JOY, NOT PAIN
I first realized that something was seriously wrong during a meeting in 2009. The lights were on and the blinds up, but the room still wasn’t bright enough and the spreadsheets in front of me were fuzzy. All I wanted to do was close my eyes, hoping that when I opened them again they would stop burning.
My general practitioner swiftly referred me to a specialist, who performed Schirmer’s test — resting the end of a paper strip on each of my lower lids for five minutes. A normal human eye will saturate around 10 millimetres. Mine barely managed one. When fluorescein dye was used to examine my corneas, it highlighted multiple dry spots.
In just a few days, my tear production had almost ceased. Nothing could make my eyes feel wet. The condition is called keratoconjunctivitis sicca, or commonly known as dry eye disease — referring to the inflammation of the cornea and surrounding tissues.
Dry eye disease is thought to affect eight per cent of the U.K. population, although the condition is underdiagnosed. (In Canada, reported prevalence of the disease can range from 7.8 to 29 per cent, according to a report in the Canadian Journal of Optometry.)
The majority of sufferers are women, which experts think is related to the hormone changes
that occur during menopause. In my case, it is thought an autoimmune condition is to blame. Risk factors can include eye surgery or injury, and certain drugs such as antihistamines and antidepressants. But it can also, simply, be put down to aging.
The condition is chronic and, at the present, incurable. I had to grapple with lifelong dependence on medication and the constant fear that my corneas would crack and I would go blind.
If you are not making enough tears, you need to use a substitute to lubricate your eyes. Artificial tears, in the form of drops used multiple times a day, are the mainstay of my treatment. It is a matter of trial and error to find the formula that works for you. Your body becomes a laboratory. For me, sodium hyaluronate (brand name Clinitas), is the closest thing to natural wetness.
Soon after my diagnosis, the specialist permanently closed the lower drains (or puncta) in my eyes to keep the limited
volume of tears that I do produce in for longer. Recently, he cauterized the upper drains, too.
The procedure is done under local anesthetic, given through multiple injections around your eyes.
I was awake during the entire thing, worried the doctor would miss and accidentally blind me. Indeed, the first eye wasn’t perfectly numb and it felt like a redhot wire shooting through my skull. He had to pause to inject more anesthetic.
When I emerged, my husband Richard said, my face was white. Under my bandages, I had two black eyes. But the cautery was worth it. Now I can sometimes go as long as 20 minutes between putting in artificial tears — Clinitas, or cyclosporin drops called Ikervis — instead of five.
I make fewer tears when asleep, so my eyes are at their worst when I wake and I must reach for my drops before I open them. Each day, I apply hot compresses and wash my eyes with baby shampoo to stop the oil glands in my lids from clogging and my lashes clumping into glued spikes. I swallow fish oil because omega-3 is thought to reduce inflammation.
The question I get asked most is, “Can you cry?” Here, I must admit to a strange pleasure in sadness, because I do make tears when I weep. They leave my eyes feeling washed clean, a sensation I love.
One of the hardest things to deal with is how my condition affects others. My children cannot have the dog they want. I love the sea, but my eyes cannot handle contact with even a grain of sand. I take long detours to bypass dusty building work, wear sunglasses in the wind and ration makeup. I get infections easily, so am fanatical about hand-washing. Any tiny thing can make my eyes drier; the lids inflamed.
And driving is difficult, as you naturally blink less behind the wheel.