Where did my tears go?

Dear Confused,

From conveying emotions to clearing debris, tears are tear-rifically versatile! What’s more, they’re the MVP of eye health, contributing to the lubrication and nourishment of the eye and helping to protect against infection. So what's going on when someone can't cry? While a health care professional or an eye care specialist is the best resource for receiving a medical diagnosis, there may be a few potential environmental explanations as well.

You mentioned that your eyes water up but there are no tears. Environmental conditions such as smoke, wind, and dry climates may cause tears to evaporate more quickly than normal. If you use contact lenses, they might cause slight irritation to your eyes that could affect tear production. Staring at screens for extended periods of time may also lead to eye strain, particularly if you don’t take breaks. Thankfully, there are a number of fairly easy solutions when it comes to improving dry eyes caused by environmental factors. Using over-the-counter eye drops daily, a humidifier in the winter, and protective eyewear in windy areas are all excellent ways to reduce dryness.

In addition to environmental factors, dry eyes may also be caused by reduced tear production (also called keratoconjunctivitis sicca in the medical field) or increased tear evaporation. Decreased tear production is a natural part of the aging process, and many people over 50 experience dry eyes some point. In fact, aging is the most common cause of dry eyes. Hormonal changes due to pregnancy, oral contraceptive use, hormone replacement therapy, and menopause are also commonly associated with dry eyes, with post-menopausal older adults being most commonly affected. Research has shown that certain types of medications, such as antidepressants and antihistamines, may also contribute to dry eyes. Finally, people with certain health conditions, such as diabetes and rheumatoid arthritis, or with nutritional deficiencies, such as vitamin A and omega-3 fatty acids, are more prone to dry eyes.

Another potential cause of tearlessness is a condition known as Sjögren's syndrome. This is an autoimmune disorder in which the body's white blood cells attack the moisture-producing glands in the eyes and mouth, resulting in dry eyes and a dry mouth. Like other autoimmune disorders, it appears to have a genetic component, but the precise mechanism that triggers the autoimmune response in some people but not others remains unclear. There’s some evidence to suggest that a bacterial or viral infection may be a trigger mechanism. Like other autoimmune conditions, Sjögren's more commonly occurs in women and in people with multiple autoimmune conditions (such as rheumatoid arthritis or lupus). Other risk factors include age, with most people being diagnosed with Sjögren's after the age of 40. Since there is no cure for Sjögren's, treatment focuses on symptom relief.

If you wish to seek assistance from a health care provider to uncover the cause of your dry eyes, there are a variety of tests and exams available. In addition to a regular comprehensive eye examination, an ophthalmologist may test the volume or quality of your tears. Volume may be assessed with a Schirmer tear test, where blotting paper is placed underneath the eyes to collect and measure tear production. Tear quality may be assessed by administering eye drops containing dyes, which allow an eye care specialist to examine the surface of your eyeballs and how quickly tears evaporate. Once a cause is identified, you and your health care provider may pursue treatment options such as eye drops, eye inserts that stimulate artificial tears, or medication to increase tear production.

Before visiting a health care provider, it may be beneficial to compile a list of any symptoms you may be experiencing in addition to the lack of tears, even if they seem otherwise unrelated. You mentioned that not being able to cry is a recent change. Have you noticed other changes along with the decrease in tear production? Have your eyes felt dry in general? Have you experienced dry mouth in addition to tearlessness? Have you experienced a shift in your emotional state? Have you adjusted the dose on any of your medications or started taking new ones? These are all questions a health care provider might ask you when attempting to figure out what's going on. Making an appointment to address these concerns may be your best bet in this situation.

Best of luck unraveling the mystery of your lack of tears!