Vision Related Issues

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There are widespread anecdotal reports of eye pain, twitching, floaters, blurred vision, vision loss, and difficulty wearing contacts among fibromyalgia patients. In turn, these are all important considerations in developing an effective comprehensive fibromyalgia management plan. Unfortunately, despite the frequent reports of eye-related symptoms by fibromyalgia patients, there is very little information available in the scientific literature regarding any eye complications associated with fibromyalgia. This can make finding proven and effective treatment strategies difficult to determine, due to the lack of research related to the eye effects of fibromyalgia. Such a situation underscores the importance of accurately tracking all treatments and symptoms. By doing so, fibromyalgia patients can more easily identify possible causes of their eye symptoms and develop targeted approaches to individualized management thereof.

Research Regarding Eye-Related Symptoms of Fibromyalgia

A 2009 study measured the tear production and sensitivity of the corneas of 20 fibromyalgia patients, including 18 women and two men, and 18 control subjects (including 16 women). Patients who had a history of eye infection, eye inflammation, glaucoma, use of contact lenses, use of eye medications, or those who had undergone eye surgery were not eligible to participate. Each participant completed a questionnaire to assess their symptoms of eye discomfort, environmental triggers, and degree of vision impairment. To test their corneal sensitivity, each participant was exposed to a series of pulses of gas applied directly to the eye using a small probe. Different types of stimuli – including mechanical, chemical, and thermal – were used. In addition to the instrumental measures of each participant’s reaction, each individual was asked to describe the sensations evoked by each stimulus. Following analysis, the researchers found that 18 of 20 fibromyalgia patients reported eye discomfort and eye dryness to varying degrees of severity, versus none of the control subjects. Although the researchers noted that some patients in the study were taking antidepressants, a side effect of which is decreased tear production, they found no correlation between the two and do not think that eye dryness due to medication use could explain the findings. In addition, the corneal sensitivity analysis showed that the fibromyalgia patients were much less sensitive to the chemical and thermal stimuli when compared to controls, which the authors suggest may be either a cause or an effect of the documented decreased tear production (Gallar et al., 2009).

A 2007 study by Bazzichi et al. examined the association between thyroid abnormalities and thyroid-related immune system dysfunction in 120 fibromyalgia patients. Among the fibromyalgia patients identified to have thyroid-related immune dysfunction, 19 (43%) reported experiencing dry eyes. In 1999, Gunaydin and colleagues also investigated the presence of dry eyes and other eye-related symptoms among 285 patients with fibromyalgia. This study found that 40 patients reported symptoms consistent with dry eyes, 15 of which could be definitively diagnosed as having keratoconjunctivitis sicca (KCS; dry eye syndrome). Eight of the 40 patients were taking low-dose antidepressant therapy and seven of them met the criteria for a diagnosis of KCS. The researchers felt that the antidepressant use may have likely been the cause of the dry eyes in those patients, and suggest that fibromyalgia patients do not have a greater incidence of eye-related symptoms than the general population (Gunaydin et a l., 1999).

Medication Side Effects

A variety of medications that exert their effects on the central nervous system have the potential to cause eye-related side effects, including glaucoma, blurred vision, and decreased ability to perceive colors and contrast. Among these include tricyclic antidepressants (such as amitriptyline and imipramine) and selective serotonin reuptake inhibitors (SSRIs), which are commonly prescribed to treat depression and other comorbid conditions frequently experienced by fibromyalgia patients. Other possible culprit medications include benzodiazepines (such as Ativan) and certain anti-seizure medications (such as carbamazepine and topiramate). In addition, of the three drugs currently approved by the US Food and Drug Administration for the treatment of fibromyalgia, blurred vision as a potential side effect of Lyrica (pregabalin).

Other medications beyond those described above also have the potential to cause vision disturbances, including some pain medications (both over the counter and prescription), as well as common treatments for cold and flu symptoms, allergies, and headaches.

Treatment and Prevention

Eye- and vision-related problems associated with fibromyalgia can be treated in a variety of ways. If they are ultimately determined to be side effects of a medication, switching to a different medication may help to alleviate the symptoms. In the case of persistent dry eye, tear replacement drops (available both over the counter and in prescription strength) can be used to temporarily provide relief. If symptom monitoring and tracking reveals that eye problems are associated with a certain environmental or occupational exposure (such as tree pollen or air fresheners), avoidance of those specific triggers may help to improve symptoms.

For individuals whose vision problems are determined to be the result of cataracts, glaucoma, or macular degeneration (vision loss in the center field of vision), utilizing current medically-proven treatments for these conditions can help to restore vision and improve associated symptoms. In addition, a variety of natural therapies have been investigated for the treatment of these conditions, some of which have shown considerable promise. Hyaluronic acid, lutein, various B vitamins, and vitamin A may all be of benefit in the treatment and prevention of cataracts (Goa & Benfield, 1994; Hankinson et al., 1992; Cumming et al., 2000). Ginko biloba and marijuana have shown possible benefit for the treatment of glaucoma (Quaranta et al., 2003; Merritt et al., 1980). Macular degeneration may possibly be helped by a variety of vitamin supplements, including B, E, and C, as well as the supplement docosahexaenoic acid, lutein, and eicosapentaenoic acid.

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References

1.        Bazzichi L, Rossi A, Giuliano T, De Feo F, Giacomelli C, Consensi A, Ciapparelli A, Consoli G, Dell’osso L, Bombardieri S. Association between thyroid autoimmunity and fibromyalgic disease severity. Clin Rheumatol. 2007;26(12):2115-2120.

2.        Zaccara G, Perucca P, Gangemi PF. The adverse event profile of pregabalin across different disorders: a meta-analysis. Eur J Clin Pharmacol. 2012;68(6):903-912.

3.        Arain AM. Pregabalin in the management of partial epilepsy. Neuropsychiatr Dis Treat. 2009;5:407-413.

4.        Gallar J, Morales C, Freire V, Acosta MC, Belmonte C, Duran JA. Decreased corneal sensitivity and tear production in fibromyalgia. Invest Ophthalmol Vis Sci. 2009;50(9):4129-4134.

5.        Günaydin I, Terhorst T, Eckstein A, Daikeler T, Kanz L, Kötter I. Assessment of keratoconjunctivitis sicca in patients with fibromyalgia: results of a prospective study. Rheumatol Int. 1999;19(1-2):7-9.

6.        Goa KL, Benfield P. Hyaluronic acid. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing. Drugs. 1994;47:536-566.

7.        Hankinson SE, Stampfer MJ, Seddon JM, et al. Nutrient intake and cataract extraction in women: a prospective study. BMJ. 1992;305:335-339.

8.        Cumming RG, Mitchell P, Smith W. Diet and cataract: the Blue Mountains Eye Study. Ophthalmology. 2000;10:450-456.

9.        Quaranta L, Bettelli S, Uva MG, et al. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology. 2003;110:359-362.

10.     Merritt JC, Crawford WJ, Alexander PC, et al. Effect of marihuana on intraocular and blood pressure in glaucoma. Ophthalmol. 1980;87:222-228.

Natural Medicines in the Clinical management of Eye Disorders: Age-Related Macular Degeneration, Cataracts, and Glaucoma. National Medicines Comprehensive Database. Accessed June 26, 2012.

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