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pippistrellodaqua, Optometrist
Category: Eye
Satisfied Customers: 134
Experience:  Specialty in contact lenses, medical eye management, LASIK
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Dry eyes, not able to spot the cause of headaches.

Customer Question

Hi, I've been diagnosed with severe eye syndrome, my ophtalmologist says it is related to the meds I am taking for anxiety, 75 mg of venlafaxine (dropped from a 225mg dose) and 1mg of clonazepam (daily), the point is that I have constant headaches and I don't know where they come from, my psych says it is related to the anxiety and that could be cephalalgias, while the opthalmologist blames venlafaxine for having my eyes totally dry. Since I've been trying to cope with it, but it's pretty hard to deal with it, yesterday I was inserted two Herrick plugs on my lacrimals, still see no difference. I use a lot of eye drops, which aren't nothing quite a relief, Schirmer tests from my ophtalmologist result always on 0 for both eyes, so she says I'm not producing tears. The weak point of it all is on my job I have to work 8-9 hrs with a computer, even adjusting the contrast whasoever I can't see any difference. What I have to do? as far as I know, all antidepressants cause dryness such dry mouth, dry eyes... and so on, I don't see the point on switching to another one if the main cause of the headaches are not the anxiety but the eyes... maybe stopping talking to the psych and stopping the treatment would improve my eyes? What would you advise? Are my headaches caused by the anxiety or it's a direct effect from the dry eye? Would you go and check to a neurologist? Sorry for all the questions. Many thanks.

Submitted: 3 years ago.
Category: Eye
Expert:  pippistrellodaqua replied 3 years ago.
I am happy to assist you today.

Dry eye is a very common concern which can cause severe symptoms and even damage to the front surface of the eye. It can contribute to pain and even headaches. You're correct in that many medications can make your dry eye worse. I always suggest that we treat the dryness aggressively prior to considering switching or discontinuing medications for other problems. From what you have reported you are beginning the more aggressive treatments for dry eye. Punctal plugs work well in many cases, but they can take several weeks or longer for the effects to be noted. You have tried many of the common eye drops for dry eye, but I do not see that you have tried Restasis (cyclosporine.) Restasis is a fantastic medication which combats the inflammatory reaction associated with and responsible for dry eye. I would strongly recommend Restasis as well as giving the plugs a few weeks to start working. At this point I do not recommend searching out a neurologist nor do I suggest discontinuing the antidepressants. These are considerations which should be evaluated only if you've used Restasis and plugs and still suffer from dry eye.

I will be available to answer any follow-up questions you may have.

Please don't forget to offer a positive rating once your question has been answered fully.

Also, please note that the information here does not replace an examination and should be used as educational purposes only.
Customer: replied 3 years ago.

OK, I will go on with the plugs, another question is that restasis is not available on my country (I have already asked to the pharmacist) is there any kind of substitute just to have a relieve or to start producing tears? (btw I'm from Spain) thank you again pippistrellodaqua,

Expert:  pippistrellodaqua replied 3 years ago.
Unfortunately Restasis is a one of a kind drop. There are no other drops that work in the same mechanism of action. There is a steroid drop which cuts inflammation (via a different route) called loteprednol (Lotemax) which I often use for very short term treatment of dry eye. This drop can be used four times daily for 7 days. Long term consequences of loteprednol exist so it should not be used longer than 7 days. I wasn't aware that Restasis isn't available in Spain. I did read some posts about obtaining Restasis in Paris. Not sure how reliable the information was, however. Please let me know if you have further questions or follow-up concerns. Please don't forget to leave a positive rating once your question has been answered fully. Thanks again and best of wishes to you.
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Customer: replied 3 years ago.
I've tried FML (Fluorometolone) as a steroid (by doc's advice), it didn't work quite well, I don't know if I'd give a chance to loteprednol or just buy by internet Restasis, If it's that good I would try to get if from Andorra or France... :) thank you for your advice. Best wishes to you too. Have a nice day.
Expert:  pippistrellodaqua replied 3 years ago.
Sounds good. Best of luck to you.