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  • Chris Thiagarajah MD

Diseases that can be misdiagnosed as Dry Eye in Denver...Are you getting wrong treatment?



Are you being treated for dry eye without any relief of symptoms even though you may be taking eyedrops very frequently? Is your dry eye very bad in one eye and nonexistent in the other eye. You may not have dry eye itself in Denver. Dry eye disease is extremely common in Colorado and in the United States. Data shows that 55% of the population may have dry eye disease and in Colorado that rate is expected to be higher because of the elevation and dry air. That being said, there are several diseases that may present with the symptoms of dry eye disease early on and could potentially be missed. This weekend I gave an oculoplastic lecture on this topic in Lone Tree Colorado. Early symptoms of dry eye disease include tearing, foreign body sensation, irritation to the eye, and blurring of vision. Diseases in the oculoplastic surgeon practice that crossover with these symptoms are the following:

Graves Disease

Tear Duct Blockage

Lacrimal Gland tumors

Eyelid malposition

Floppy Eyelid Syndrome

Graves Disease

This is an autoimmune disease characterized by bulging of the eyes, double vision and eyelid elevation (retraction). Early symptoms of Graves disease include foreign body sensation, irritation to the eyes and redness of the eyes. Testing for Graves disease involves evaluating motility, Hertel measurement and other tests of the immune system.

Tear Duct Blockage

Tear Duct Blockage is characterized by tearing. This is the same symptoms that is seen in dry eye disease. In tear duct blockage the tearing is caused from the tear duct or drainage system of the eye being blocked. In dry eye there is an increased production of tears from the dryness of the cornea. Both patients will complain of tearing but often patients with tear duct blockage with complain of tears going over the cheek. Patients with dry eye will complain of a wet eye but no tears going over the cheek.

Eyelid Malposition

Any eyelid position problem such as eyelid turning out, in, or being too high (retraction) can cause the eye to be dry and have dry eye symptoms. This is a different situation in that the patient does actually have dry eye but the dry eye is caused from the eyelids allowing too much water to evaporate from the eye surface.

Tumors of the Lacrimal Gland

Tumors of the lacrimal gland or even autoimmune problems of the lacrimal gland can caused decreased tear production and dry eye. In those cases it is common for patients to have dry eye in one eye with the affected lacrimal gland and a normal opposite eyelid. Bulging of the eye may be something to look for as well.

Floppy Eyelid Syndrome

This disease is probably one of the most underdiagnosed problems for patients with sleep apnea. Often they are diagnosed with dry eyes. Patients with floppy eyelid have loose eyelids that flip over while they sleep. Also the eyelid is loose or not able to close properly. In those cases, the patients will have corneal dry eye problems or surface problems with their eye. Their symptoms will include foreign body sensation, tearing, irritation and blurring of the vision. Floppy eyelid syndrome is treated by tightening of the eyelids, treating the sleep apnea itself and helping the patient’s eyelids.

If you have dry eye and are not 100% sure if that is the diagnoses ask your doctor to look into these other options. Though it is uncommon for doctors to miss these diseases that can mimic dry eye disease, they are something to look into when dry eye disease is not fitting your symptoms.


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