Hydration and Dry Eye Disease
As many of you now know by now, I begin every dry eye patient analysis by breaking down their problems into ATD (Aqueous Tear Deficiency – a tear quantity problem) or MGD (Meibomian Gland Dysfunction – a tear quality problem). I’ve posted heavily on these two typically separate issues (though they do frequently overlap) and you can find a lot of this information, here for ATD: https://www.eyethera.com/search?q=ATD&f_collectionId=5f1772c75adebf1951219a32
and here for MGD: https://www.eyethera.com/search?q=MGD&f_collectionId=5f1772c75adebf1951219a32
When the Schirmer’s test reads below 10mm (https://www.eyethera.com/blog/what-do-dry-eye-tests-mean-part-7-tear-volume-and-how-we-measure-it?rq=Schirmer) the first question I ask my patient, is “how much water do you drink in an average day?” Many times, I hear: “Probably not enough” – and then hear about their busy lifestyle and how they don’t have time to drink water (which then requires they spend precious minutes in the restroom, frequently peeing it out). Some admit to living off Red Bull or other “energy drinks”, coffee, sugary or diet sodas (laced with caffeine) and an alcohol-laced drink or two, to unwind at the end of a long day.
Apart from my own experiences with poor hydration (I fit into the first camp – of “probably not enough” much of the time – so do as I say and not as I too frequently do), I also have a clinical case I can share. Early in my research into MGD, I was enrolling patients into a study where I had to exclude significant ATD, so I could be sure I was benefiting the oil issue (knowing the treatment would not address water issues). A nurse who was also a young mom was interested in the treatment, having been diagnosed with dry eyes and she came to the office early in the morning, having just dropped her kids off at school. I found a Schirmer’s of 3 and 4mm as part of her screening exam. Anything less than 6 was a disqualification and I was sorry to tell her this. I then asked how much water she’d had that morning and the answer was none – just a cup of black coffee. I asked her if she wanted to try a simple possible solution by going home and drinking as much water as she could do over an hour or two and to then return for one more checkup. She readily agreed and when she returned approximately two hours later, she noted she’d drunk several tall glasses of water. Her Schirmer’s had jumped to 7 and 9mm, so we were able to enroll her (and she got the help she was looking for from the heated expressions she had as a part of the study – so this all ended on a happy note).
Since that fateful occasion, I’ve seen this pattern repeated and can say from these experiences that hydration is a powerful tool serving those with ATD (and its many iterations). While water exists in sodas, coffee, energy and other caffeinated sports drinks as well as alcohol, the caffeine and alcohol itself are also powerful “diuretics” – products that make us pee. I call this “anti-water” as any things forcing our kidneys into overtime are also going dry us out more. This is also true for medications with that effect (or side effect) – of which the list is long and not always intuitive. (Always worth checking the side effect profiles of any medications you are on – though check with your health care professional who prescribed it before stopping or altering how you’re taking those medications).
If the Schirmer’s is below 6 and especially closer to zero, the next question I ask (assuming there are no other red flags in the amount of water they drink or the number of diuretics they take), is whether they also have a dry mouth. (The clinical pearl I learned in training, is – “If someone offered you a Saltine or other dry cracker without any liquid to wash it down, do you think on an average day, you could easily chew and swallow it, or is your mouth to dry for that?”) If the answer is, “I don’t think I could swallow that,” or, “I might choke on it,” then I might recommend testing for autoimmune causes for ATD (like Sjogren’s) – see my series on this beginning here: https://www.eyethera.com/blog/sjogrens-disease-autoimmune-dry-eye-part-1?rq=autoimmune%20dry%20eye
Upwards of 70% of our body weight comes from water, so hydration is a key element to life itself. Hydration experts have counseled me that a good reference point for the optimal amount of water to drink in a day, is to take your body weight in pounds, divide that number by half and then put the word ounces after that number. As someone 6’3” and almost 200 pounds, that means drinking almost 100 ounces of water in a day! Fortunately, foods with high water content, juices and sodas without caffeine, and “mocktails” all count towards that goal. Mayo Clinic has a good post about how much water (and how to get it) – along with more general health information relating to why hydration is important, that you can find here: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256 Of note, they recommend even more water:
“ How much water do you need?
Every day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you must replenish its water supply by consuming beverages and foods that contain water.
So how much fluid does the average, healthy adult living in a temperate climate need? The U.S. National Academies of Sciences, Engineering, and Medicine determined that an adequate daily fluid intake is:
· About 15.5 cups (3.7 liters) of fluids a day for men (just over 120 ounces!)
· About 11.5 cups (2.7 liters) of fluids a day for women (just over 90 ounces!)
These recommendations cover fluids from water, other beverages and food. About 20% of daily fluid intake usually comes from food and the rest from drinks.”
Bottoms up!
To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:
(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020
(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463