Especially Common in CFS & Fibromyalgia
This study found decreased tear production in 90% of those with fibromyalgia. Experience has shown that dry mouth is also common, aggravating dental and digestive problems. In those who suddenly get a bunch of dental cavities along with their CFS/FMS, dry mouth is the usual cause. This occurs because saliva is critical for preventing dental infections.
Dry eyes and dry mouth (called "Sicca Syndrome") is addressable. It is caused by autoimmune disorders that injure the glands that make tears and saliva, but also is aggravated by nutritional deficiencies and many medications. Some doctors who are not familiar with CFS/FMS immediately think of an autoimmune disease called Sjogren’s syndrome — and go chasing the wrong problem. Though Sjogren’s syndrome can cause CFS/FMS, it is less common, and a Sjogren’s diagnosis should be confirmed with an SS-A and SS-B blood test and a simple biopsy. If you have widespread achiness and fatigue with insomnia, think fibromyalgia.
How to Address Dry Eyes and Mouth
Check Your Medication(s)!
Many medications used in CFS/FMS cause dry eyes and mouth — and alternatives can be used that do not have this side effect. Bring this up with your doctor at your visit and ask your pharmacist if any of your medications are likely to cause dry eyes or mouth. The most common culprits include:
- Antihistamines — Including Benadryl, Zyrtec and Claritin. Benadryl and other antihistamines are often found in over the counter sleep aids.
- Antidepressants — Elavil is a major trigger of dry eyes and mouth, but most antidepressants can cause this problem. Cymbalta and Savella, though used for fibromyalgia pain, are also antidepressants.
- Birth Control Pills — May cause dry eyes as a side effect. However, pregnancy is also known to cause dry eyes. Testosterone cream applied to the upper eyelids was reported to help those with dry eyes, but I have not been able to confirm this finding.
- Diuretics — These drugs are mostly used to address high blood pressure.
- ACE Inhibitors — Angiotensin-converting enzyme inhibitors are mostly used to address high blood pressure.
- Acne Drugs — Including Accutane and high-dose vitamin A.
Address Nutritional Deficiencies
- Add fish oil — this is especially important.
- B vitamins and magnesium (already present in a good multivitamin powder).
Symptomatic Relief for Dry Eyes
- The medication Restasis eyedrops.
- Plugging up the tear draining ducts (in severe cases).
- Discuss with your eye doctor.
Symptomatic Relief for Dry Mouth
- Drink sips of water throughout the day as needed.
- Avoid sugar and sodas. Dental problems can be severe with dry mouth, and eating a lot of sugar can make these much worse
- Lemon juice (e.g., lemonade made with 3 and 1/2 cups of water, 1/4-1/2 cup of lemon juice, and about 50 drops of Stevia to taste). Lemon juice stimulates saliva flow. Do not use lemonade containing sugar (if it has more than 5 calories it has sugar) as it can rot your teeth.
- Suck on sugar free lemon drops or other hard candy or chew sugar free gum. Be sure these are sugar free!
- Ask your dentist about saliva substitutes.
Report: Decreased Corneal Sensitivity and Tear Production in Fibromyalgia
Juana Gallar1*, Celia Morales2, Vanesa Freire2, M. Carmen Acosta1, Carlos Belmonte1, and Juan Antonio Duran3
To investigate corneal sensitivity to selective mechanical, chemical, heat and cold stimulation in fibromyalgia (FM) patients.
Twenty FM patients (18 female, 2 male; 51,9±2,3 years old) and 18 control subjects (16 female, 2 male; 51,7±2,4 years) participated voluntarily in the study. Subjective symptoms of ocular dryness were explored and Schirmer's 1 test was performed. The response to selective stimulation of the central cornea with the Belmonte gas esthesiometer was measured.
The majority (18 out of 20) of FM patients reported dry eye symptoms, being the ocular dryness score significantly higher than in healthy subjects (2,3±0,1 vs. 0,05±0,02; p<0,001). Schirmer's test values were significantly reduced in FM patients compared to those of the control group (10,5±,2 mm and 30,6±1,6 mm, respectively; p<0,001). Mean corneal threshold sensitivity to chemical stimulation (31,16±2,04 %CO2 FM; 15,72±0,67 %CO2 control) to heating (1,87±0,11 °C FM; 0,99±0,05 °C control) and to cooling (-2,53±0,11 °C FM; -0,76±0,05 °C control) were increased in FM patients while threshold to mechanical stimulation did not vary significantly (123,0±8,0 ml/min FM; 107,8±4,4 ml/min control).
The reduced corneal sensitivity of patients with fibromyalgia is attributable to a moderate decrease of corneal polymodal and cold nociceptor sensitivity, that may be the consequence or the cause of the chronic reduction in tear secretion also observed in these patients.