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Dry eye syndrome and the subsequent risk of CFS — a prospective population-based study in Taiwan (2018) Tse-Yen Yang et al

Discussion in 'BioMedical ME/CFS Research' started by strategist, Aug 11, 2018 at 10:56 AM.

  1. strategist

    strategist Senior Member (Voting Rights)

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    Background and Aim
    The clinical association between dry eye syndrome (DES) and chronic fatigue syndrome (CFS) remain unclear with less evidences. We aimed to investigate the relationship between CFS and DES using a national insurance and prospective cohort study.

    Methods
    Data from the Longitudinal Health Insurance Database 2000 was applied to estimate the incidence of CFS among patients with DES, and their age- and sex-matched controls without DES over a long-term follow-up period. All participants were CFS free at baseline, before the interval (2005–2007), but were later diagnosed with CFS. DES patients and its relative matched controls were excluded prevalent CFS before the same interval.

    Results
    We identified 884 patients with DES and 3,536 matched controls in baseline and estimated the hazard ratios for incident CFS in the follow-up period. Patients with DES had a 2.08-fold considerably increasing risk of developing CFS, compared to non-DES group. An elevated risk of developing CFS remained (1.61-fold risk) even after adjusting for age, sex, and comorbidities. There was a presence of increasing risk in DES-related CFS when CFS-related comorbidities existing (adjusted hazard ratio, 1.98, 95% confidence interval, 1.19–3.29; p < 0.01). The subsequent risk for CFS between DES and non-DES patients was significant increased with three or more annual medical visits, the adjusted risk for CFS was 4.88-fold risk (95% CI, 2.26–10.58, p < 0.001).

    Conclusion
    We recommended that physicians should be aware of the increased risk of CFS among DES patients and adequately assess the health impacts among these patients.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078132/
     
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  2. Hutan

    Hutan Moderator Staff Member

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    It's difficult to read this paper. The journal, Oncotarget, has recently been delisted by a couple of indexing agencies so it probably isn't a good journal.

    The broad idea of the study is great; using a national health database, picking out people diagnosed with, in this case, dry eyes but no CFS in the years 2005/2007 and a matched healthy control cohort and seeing how many people develop CFS over the following years. I think there is, or could have been, some useful stuff in this study. They just desperately needed a very determined editor.

    The Taiwanese national database sounds like an amazing resource that could provide all sorts of interesting data.

    I'm going to read the paper again tomorrow when I can think. My first pass suggested that their definitions of CFS may have been loose and overly focused on fatigue; there may be some mixing up with Sjogrens; but there perhaps is something there suggesting at least some people with what is diagnosed as CFS have some symptoms many years before they are diagnosed and that what is diagnosed as CFS tends to run in a pack with (other) autoimmune illnesses.

    I've been found to have dry eyes with a Schirmer test, although I hardly ever notice it being a problem, and I wear contact lenses. The paper says 70% of people with CFS have dry eyes - the reference for that would be interesting to have a look at.

    Yes, mild dry eyes doesn't rate a mention as a symptom when I'm trying to explain my illness.
     
    Last edited: Aug 11, 2018 at 1:01 PM
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  3. strategist

    strategist Senior Member (Voting Rights)

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    I often have dry eyes but it's not something I bring up because it's not that important. I have many such minor symptoms, and if I were to mention them all, I would risk being labelled as psychosomatic case.
     
    Last edited: Aug 11, 2018 at 12:37 PM
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  4. Binkie4

    Binkie4 Senior Member (Voting Rights)

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    I was diagnosed with dry eyes in about 1977 at Surbiton eye hospital. I don't know the name of the test that was used but it seemed as though they were putting litmus paper in my eyes and seeing how far the paper became moist. At the same appointment I was asked if I had arthritis ( I didn't then) and told both conditions often existed together. I don't have Sjogrens.

    I was diagnosed with PVS in 1986 and ME in 2008.
    I was prescribed liquefilm tears and viscotears gel for night use which I still use but like @strategist I wouldn't think to put it in my medical history. I do wear contact lens but stopped for a couple of years at the end of the 70s.

    How odd if there is some connection with ME/cfs.
     
  5. Amw66

    Amw66 Senior Member (Voting Rights)

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    Daughter has dry eyes intermittently since reaction to high dose vit D post glandular fever and pre diagnosis.
    Eyes often feel gritty and " don' t hold tears" . We have not associated it with ME , probably because it' s not a noted symptom- perhaps worth a poll?
     
  6. Hutan

    Hutan Moderator Staff Member

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    This figure is from the study. X axis is years from the beginning of the study, Y axis is incidence of CFS in the two cohorts. The Dry Eye cohort had 884 people (28 people developed CFS) , the no dry eye cohort has 3536 people (54 people developed CFS).
    (I haven't worked how they calculated the cumulative incidence).
    Figure 2.jpg
     
  7. strategist

    strategist Senior Member (Voting Rights)

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    Something that seems odd is that while the normal state of my eyes tends towards uncomfortable dryness, at times they are unusually moist with tear fluid for no apparent reason. Maybe that is normal? Or could indicate a subtle sympathetic/parasympathetic nerve signalling problem?
     
  8. Hutan

    Hutan Moderator Staff Member

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    This is the reference quoted by the Taiwanese paper as finding 70% of people with CFS having dry eye syndrome.

    This Spanish paper is discussed here:
    https://www.prohealth.com/library/e...-patients-with-chronic-fatigue-syndrome-32170

    The Prohealth page includes the following Editor's Comment:

    Sicca (dry eyes and mouth) is a common symptom among ME/CFS patients. The [earlier] study by Nishikai et al. referred to in [the Spanish paper] concluded that ME/CFS patients with sicca had a form of Sjögren’s, an autoimmune disease.

    The authors of [the Spanish paper], however, conclude that sicca in ME/CFS patients is largely due to anticholinergic medications (e.g. clonazepam, antidepressants, etc.). The remaining 30% of patients whose sicca is not due to psychotropic medications should be screened for Sjögren’s and sleep apnea. They argue that the presence of these conditions should not be considered exclusionary, but as comorbidities of ME/CFS.
     
  9. oldtimer

    oldtimer Senior Member (Voting Rights)

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    That's a Schirmer test.
     
  10. Dolphin

    Dolphin Senior Member (Voting Rights)

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    I haven’t read this paper. But one thing I tend to keep in mind in these prospective studies is whether some of the people likely already had CFS but just had not been diagnosed. Many people spend years before getting diagnosed.

    If that was the case, it would mean dry eyes were simply more common in CFS.
     
  11. oldtimer

    oldtimer Senior Member (Voting Rights)

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    Paradoxically, dry eyes can produce the watery component of tears (without oil and mucin) to protect them. The water evaporates fast and doesn't correct the underlying problem.
     
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  12. Mithriel

    Mithriel Senior Member (Voting Rights)

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    The tear film is a very complicated set of layers. If it is not working properly the watery layer will increase to try to protect the eye so. paradoxically, watery eyes can be a symptom of dry eye.

    Dry eye is one of these things like fatigue. It is very common so easy to dismiss but it can be very severe and it is now referred to as ocular surface disease in it's more severe form. When my eyes became bad I kept coming across references to it like those above where people said they had it but were quite casual about it. I began to wonder if I was just being a baby but then I found a forum where someone asked if doctors would remove your eyes for dry eye and I knew I had found a home.

    I have recurrent corneal erosions where the membrane has become so damaged by lack of tears that it sticks when you are asleep and rips apart when you go into REM or waken up. This was happening to me 2 or 3 times a night and the pain was excruciating. I was afraid to sleep and effectively blind so I was becoming suicidal. Luckily, I found a good consultant (the difference from ME) and by using drops, goggles and a very strict regime of caring for my eyes I only have 2 or 3 erosions a week.

    Do not neglect dry eyes it can become very bad and prevention is much better. I do think it came from my ME but there is a suggestion that it is autoimmune. the other possibility is that the sensors in the eye which continually keep the tear film in balance go wrong.

    This paper seems a bit iffy to me. Dry eye is too wide a category and so is CFS and it doesn't take into account sudden infectious onset. Much more likely they are detecting Sjorgren's.
     
  13. JamBob

    JamBob Established Member

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    Interesting paper. I developed very severe dry eyes around the same time as the onset of ME and haven't been able to wear contact lenses since. I tried asking the ophthalmologist about it but they just said it might be autoimmune due to also having T1 diabetes and just told me to use eye drops. I don't think I have Sjogrens as I make normal amounts of saliva.

    I found the one thing that helps my dry eye symptoms is Starflower Oil.
     
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  14. oldtimer

    oldtimer Senior Member (Voting Rights)

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    I developed quite severe dry eyes well before I had ever heard of ME or CFS. It was just one of the laundry list of things going wrong which I suspect were part of the slow onset. Who knows. Dry eyes are so common.

    So far I've been given a few choices of diagnosis. A rheumatologist thinks Sjogren's syndrome is a possibility, a dermatologist treating me for rosacea fancies ocular rosacea, and an ophthalmologist, who was most helpful, just shrugged and sighed, provided me with punctal plugs and warned me to only use eye drops containing no preservatives. Cyclosporine drops will be the next to try. I would be interested to hear if anyone has had experience with these.

    I've chosen not to reveal my ME/CFS diagnosis but rather have symptoms treated, so I can only guess what reaction that would have elicited:rolleyes:

    ETA: Interesting study, but there are a lot of mights and maybes, especially regarding co-morbidities.
     
    Last edited: Aug 12, 2018 at 2:07 AM
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  15. Forbin

    Forbin Senior Member (Voting Rights)

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    I suppose sometimes dry eyes are just dry eyes, but they are connected to a variety of conditions, including autoimmune diseases. They're also connected to inflammatory bowel diseases like Chron's and chronic ulcerative colitis (which seem to show gut microbiome distributions similar to those seen in ME/CFS).

    My only real issue with dry eyes occurred about 20 years after onset, when I developed severe conjunctivitis (GPC), probably triggered by a combination of dry eyes and contact lens use leading to mechanical friction on the conjunctiva of the eye. The initial symptom was increased light sensitivity, eventually followed by really bad and persistent eye pain (well after I stopped using the contacts). It took about 2 years before it seemed safe to go back to contact lenses.
     
  16. AndyPandy

    AndyPandy Senior Member (Voting Rights)

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    I’ve developed dry eyes over the past year or so. Tested by optometrist. I have to use a lubricant many times a day and before bed otherwise it’s unbearable.

    I’ve recently notched up 7 years with ME.
     
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  17. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    I've had dry eyes for many years. For a long time I had the watery form where I produced so much liquid that it ran down my face on occasion, but my eyes still felt very dry. But over the years that watery stuff has dried up too. And now I can be woken up by the pain of an eyelid sticking to my eyeball. Keeping my eyes free of gunk with eye wash and then replacing the missing tears with preservative-free eye drops has helped. But if it gets much worse I will have to stop the self-help treatment and try and get some help from the medical profession. I'll put that off as long as possible though.
     
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  18. strategist

    strategist Senior Member (Voting Rights)

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    I wonder if dry eyes may be related to low blood volume. Does anyone's dry eyes get moist when they drink salt water?
     
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  19. Yuno

    Yuno New Member

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    My ME got worse in stages and with every one of those stages my dry eyes got much worse as well, so in my case there is a clear connection.
     
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  20. Trish

    Trish Moderator Staff Member

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    Hi @Yuno, welcome to the forum.
     
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