When most people hear the term “dry eyes,” they may think of the uncomfortable condition most of us have from time to time. Our eyes feel scratchy and tired, and we feel like we can’t produce enough tears to keep our eyes moist.
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Maybe the TV commercial for the drug Restasis comes to mind, in which an attractive doctor and friendly nurses glide through a sleek medical office dispensing prescriptions and gentle explanations.
Most of us don’t think of burning, stabbing eye pain that’s so severe sufferers have lost careers, lifestyles, and even committed suicide to escape the pain.
This is the level of daily pain for some people with a condition that falls under the broad umbrella term “dry eye disease.” Sufferers use adjectives like “stabbing,” “excruciating,” “needles in the eyes,” and sadly, “hopeless,” to describe their pain.
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Worse, they are often dismissed by doctors when an eye examination reveals nothing out of the ordinary. The agony is all in your head, some doctors imply. Some even say it out loud, discussing with patients possible psychological reasons for the pain.
Sufferers, meanwhile, reach out to specialist after specialist, with little or no relief as their prospects, bank accounts, and hope of relief dim.
One Boston doctor is trying to change all that and has put his career on the line in advancing a theory that increasingly other doctors are considering. In some cases, dry eyes have nothing to do with lack of tears, and everything to do with either corneal nerve endings or the brain itself — faulty wiring sending flawed messages about the dryness of the eye. These would be causes that a doctor could not pick up in an ophthalmologic examination.
In some cases, dry eyes have nothing to do with lack of tears, and everything to do with either corneal nerve endings or the brain itself — faulty wiring sending flawed messages about the dryness of the eye.
Dr. Perry Rosenthal, 82, is the founder of the Boston EyePain Foundation. He is also an associate clinical professor at Harvard Medical School and is known as “the father of the gas-permeable lens,” as the creator of the Boston Lens system that was eventually sold to Bausch + Lomb.
Rosenthal no longer sees patients, but for years he has been challenging the accepted wisdom on the cause of “dry eyes”: insufficient tear production.
“Some patients really do have fewer tears,” Rosenthal told LifeZette, “and we know that. The question is: Why do some patients who say their eyes are dry and painful in fact have adequate tears, and yet they are suffering?”
Rosenthal’s focus is patient-centered.
“The worst thing patients can experience psychologically is when a doctor doesn’t believe them,” Rosenthal said emphatically, his voice brimming with empathy.
Rosenthal has a theory that in some cases, the problem is in the cornea — the transparent front part of the eye that covers the iris, pupil, and anterior chamber of the eye.
“My theory is that the problem for most patients is that the nerve endings in their corneas are too sensitive,” he said.
Our corneas have a much higher concentration of nerve endings than anywhere else in our bodies; that’s one reason eye pain can be so unbearable.
Another possible cause may be in the brain itself. “I believe that the real disease may be in certain parts of the brain that serves the eye, face and head,” he said.
Rosenthal’s ideas were confirmed — at least for him — in 2007 when he treated a patient with severe, stabbing pain in her eyes. When he examined her, tears readily flowed from her eyes. So what was causing her pain?
“This type of patient will hear time and time again from their eye doctor, ‘There’s nothing wrong,’ upon examination. This is because the problem is not a tear-production problem, which a doctor can easily see.”
Rosenthal has paid dearly for his singular devotion to eye pain research, and for his dogged pursuit of the truth of the causes of dry eye disease.
Rosenthal has paid dearly for his singular devotion to eye pain research, and for his dogged pursuit of the truth of the causes of dry eye disease. The founder of the Boston Foundation for Sight, he was eventually pushed out, and the ophthalmology community largely dismissed his ideas.
“I was challenging the conventional wisdom on eye pain,” he said. “So they fired me from my own foundation.”
Several professionals in this field, however, support Rosenthal’s theories.
“When I think back on how ignorant I was seven years ago, I’m appalled,” Donald Korb, clinical professor of optometry at Berkeley, told Mosaic magazine, of the causes of dry eye pain.
Rosenthal fought on, the comfort of patients uppermost in his mind.
“When I think back on how ignorant I was seven years ago, I’m appalled,” Donald Korb, clinical professor of optometry at Berkeley, said of the causes of dry eye pain.
“I have received gut-wrenching letters and emails from sufferers of dry eye disease, and my sole focus is in helping them get relief,” he said. “There are patients going around with terrible pain — some even committing suicide.”
One sufferer writes on Rosenthal’s website of her eye pain:
“It started a little over two years ago when I was 26 years old – slight burning in both eyes that rapidly became more intense and was soon joined by crippling, stabbing pain that shocked me to my very core. The agony was so unbearable that there were times I wanted to gouge my eyes out. Since then I’ve seen over a dozen ophthalmologists, several primary care doctors and have been to emergency clinics. While some doctors were simply puzzled, others were abrupt and implied that since they could see no physical signs for the pain I described, it couldn’t be real.
“It made a world of a difference to be told by Dr. Rosenthal the following words, ‘Your pain is real and I know how much you are suffering.’ (Those) few simple words (gave) me hope,” she said.
The British Journal of Ophthalmology recently published Rosenthal’s dry-eye theory, which he wrote with Harvard University pain specialist David Borsook. In his review, he laid out his case for “ocular neuropathic pain,” a dysfunction in the corneal nerve endings, and for “oculofacial pain,” that is initiated in faulty pathways in the brain.
Rosenthal said he is hopeful his work will lead to relief for the many people around the world suffering chronic eye pain.
“I believe these patients who have severe pain,” he said. “There is absolutely no question they are feeling it.”
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