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Eyes Are Tired


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#21 eldestpenguin

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Posted 09 December 2009 - 08:19 PM

I have many eye problems, and agree with others in that I am glad it came up. I actually have many neurological nuances that are directly related to being tired, but are never mentioned as symptoms (secondary or even related) of Narcolepsy.

My eyes always feel tired and heavy, like there are lead weights tied to my eyelashes. I always have dark circles under my eyes.

I frequently wake up with my eyes swollen and am unable to fully open them. This usually clears up within 30 minutes.

My eyes are always dry and itchy. I cannot cry easily, and I cannot produce very many tears.

My vision will blurr. I have noticed that this happens when I feel exhausted and when my allergies flair up.

I have ocular migraines. My right eye will actually not move properly, in cooperation with the left eye; I think the neurologist called this nystagmus. Zomig helps this, but makes me sleepy. I have found that nothing is as effective as laying down in dark silence with a cold compress on the eyes upon onset. Onset of the ocular migraine is caused by being too tired, especially if I have spent much of the day doing activities that require focus in the central plane of sight.

#22 SleepySusan

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Posted 02 February 2010 - 10:00 PM

Wow, this is so weird. I was talking with my doctor yesterday about how Nuvigil makes my eyes so dry that I just can't stand it. He was saying that he hadn't heard that about Nuvigil before, and could I already have something going on with my eyes and the drug was making it worse? I told him that I thought that was possible. But with 300 mg of Nuvigil, by late afternoon my eyes feel so horrible I just can't keep them open. And at that point what's the point of staying awake... (And 300 mg isn't enough to shake the sleepiness anyway.) Of course after I hung up I thought, hey, maybe it's because with the meds I actually keep my eyes open more instead of sleeping all day! And I have been diagnosed with dry eyes by an eye doctor, but can't remember what I ever did with the eye drops he gave me.

And then there's this issue with my eyes randomly going crossed. No idea what causes that, but fortunately it's very rare.

I did find some good OTC eye drops. They're called Rohto Hydra and they actually have menthol in them. They're a bit intense at first, but very soothing and cooling. I've tried Systane and Systane Ultra, but they don't help as much as they used to.



I have many eye problems, and agree with others in that I am glad it came up. I actually have many neurological nuances that are directly related to being tired, but are never mentioned as symptoms (secondary or even related) of Narcolepsy.

My eyes always feel tired and heavy, like there are lead weights tied to my eyelashes. I always have dark circles under my eyes.

I frequently wake up with my eyes swollen and am unable to fully open them. This usually clears up within 30 minutes.

My eyes are always dry and itchy. I cannot cry easily, and I cannot produce very many tears.

My vision will blurr. I have noticed that this happens when I feel exhausted and when my allergies flair up.

I have ocular migraines. My right eye will actually not move properly, in cooperation with the left eye; I think the neurologist called this nystagmus. Zomig helps this, but makes me sleepy. I have found that nothing is as effective as laying down in dark silence with a cold compress on the eyes upon onset. Onset of the ocular migraine is caused by being too tired, especially if I have spent much of the day doing activities that require focus in the central plane of sight.



#23 Nyx

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Posted 04 February 2010 - 02:49 AM

Wow, this is so weird. I was talking with my doctor yesterday about how Nuvigil makes my eyes so dry that I just can't stand it. He was saying that he hadn't heard that about Nuvigil before, and could I already have something going on with my eyes and the drug was making it worse? I told him that I thought that was possible. But with 300 mg of Nuvigil, by late afternoon my eyes feel so horrible I just can't keep them open. And at that point what's the point of staying awake... (And 300 mg isn't enough to shake the sleepiness anyway.) Of course after I hung up I thought, hey, maybe it's because with the meds I actually keep my eyes open more instead of sleeping all day! And I have been diagnosed with dry eyes by an eye doctor, but can't remember what I ever did with the eye drops he gave me.

And then there's this issue with my eyes randomly going crossed. No idea what causes that, but fortunately it's very rare.

I did find some good OTC eye drops. They're called Rohto Hydra and they actually have menthol in them. They're a bit intense at first, but very soothing and cooling. I've tried Systane and Systane Ultra, but they don't help as much as they used to.


SleepySusan: A few quick thoughts (I haven't read this thread in months). First, I believe many stimulants can cause dry mouth (i.e., decreased secretions; anticholinergic effects), and I do recall reading that people who take stimulants for ADHD can have such dry mouth that they have mouth sores when they wake up (and can get advanced tooth/gum decay from it). It's not exactly equivalent to tear production, but perhaps there's some impact on tears too, or maybe even just a slight dehydration in some people from some of these stimulants. I'd have to read up more on that though....

Also, when your eye doctor diagnosed you with dry eyes, did he ever mention Sjogren's syndrome? Of course, I'm not a doctor and I'm not suggesting you have this, but I wanted to mention it because it did pop up in my head when I read the past two posts in this thread. Especially because Sjogren's syndrome is an auto-immune disorder, and auto-immune disorders like to come in multiples (i.e., you might count narcolepsy given the prevailing view is that it's an auto-immune disorder (although I'm not 100% sold yet)). Here is some info on Sjogren's symptoms:

The two main symptoms of Sjogren's syndrome are:

Dry eyes. Your eyes may burn, itch or feel gritty — as if there's sand in them.
Dry mouth. Your mouth may feel like it's full of cotton, making it difficult to swallow or speak.


And some more background generally:

Sjogren's (SHOW-grins) syndrome is a disorder of your immune system often defined by its two most common symptoms — dry eyes and a dry mouth.

Sjogren's syndrome often accompanies other autoimmune disorders, such as rheumatoid arthritis and lupus. In Sjogren's syndrome, the mucous membranes and moisture-secreting glands of your eyes and mouth are usually affected first — resulting in decreased production of tears and saliva.

Although you can develop Sjogren's syndrome at any age, most people are older than 40 at the time of diagnosis. The condition is much more common in women. Treatment focuses on relieving symptoms, which often subside with time.


Taken from: http://www.mayoclini...yndrome/DS00147

On an unrelated note, about the crossed eyes, does that just happen when you're tired, or absolutely randomly even when you're not tired?

Now, I think this abstract is much more helpful than my ramblings above. The paper is from 1992, and I didn't look up each drug to confirm everything, but it's some good food for thought if anyone reading this thread is taking any of these medications and having eye issues (I bolded the text I thought most applicable):

Optom Clin. 1992;2(4):73-96.
Ocular side effects of selected systemic drugs.
Jaanus SD.

Numerous systemic drugs produce adverse effects that involve the eye. Pigmentary inclusions of the lids or conjunctivae or both may be caused by a variety of drugs, including amiodarone, chlorpromazine, and gold salts, while conjunctivitis and blepharoconjunctivitis have been associated with isotretinoin, sulfonamides, salicylates, and antineoplastic agents. Dry eye complaints may be caused by antihistamines, beta-receptor blocking agents prescribed for cardiovascular problems, antianxiety agents, and tricyclic antidepressants. Several drugs have been well documented as causes of keratopathies and/or lenticular deposits, including chloroquine and hydroxychloroquine, chlorpromazine, gold salts, systemic corticosteroids, nonsteroidal antiinflammatory drugs, and the antiarrhythmic agent amiodarone. Visual acuity may be decreased by transient changes in refractive error caused by sulfonamides, the antifungal agent metronidazole, thiazide diuretics, and carbonic anhydrase inhibitors. Dilation of the pupil may be caused by anticholinergic drugs, antihistamines, antidepressant agents, and central nervous system stimulants such as cocaine, methylphenidate, and amphetamines. Nystagmus, diplopia, and extraocular muscle palsies have been associated with central nervous system depressants, antihistamines, barbiturates, and elevated blood ethanol concentrations. Intraocular pressure can be elevated in susceptible individuals by long-term use of topical or systemic corticosteroids. Numerous drugs have been associated with retinal toxicity, including chloroquine and hydroxychloroquine, thioridazine, tamoxifen, and talc, which may embolize to the retinal circulation when administered by long-term drug abusers. The antituberculosis agents ethambutol and isoniazid have been implicated as causes of reduced acuity, visual field defects, and disturbances of color vision. Optic neuritis and retrobulbar neuritis may result from the use of chloramphenicol. This paper describes these and other adverse ocular effects that may be encountered when examining patients who are taking systemic drugs.


Ugh. It's really late and I just stumbled onto a bunch of papers that would be good to cite but I've really got to get to sleep. For anyone that thinks that was a tease, knock yourself out. Here's the citation and a blurb:

Psychopharmacology (Berl). 2005 Sep;181(3):537-49. Epub 2005 Oct 12.
Does modafinil activate the locus coeruleus in man? Comparison of modafinil and clonidine on arousal and autonomic functions in human volunteers.
Hou RH, Freeman C, Langley RW, Szabadi E, Bradshaw CM.

....Clonidine exerted sympatholytic and sedative effects, whereas modafinil had sympathomimetic and some alerting effects. Modafinil may activate noradrenergic neurones in the LC involved in arousal and pupillary control, without affecting extracoerulear noradrenergic neurones involved in cardiovascular and salivary regulation.


And apparently 600 medications can have anticholinergic effects (i.e., could cause decreased tear production): http://www.clinicalg...osis-and-Treatm . On that note, I'm off to bed. Sorry for such a meandering post, but hopefully someone will find something interesting in it.

#24 SleepySusan

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Posted 08 February 2010 - 01:03 PM

Nyx, it's hard to say if my eyes go crossed when I'm tired or just randomly, because I'm ALWAYS tired. But it seems to be much more frequent when taking Provigil or Nuvigil. I just can't accommodate to near objects and then far objects, or the other way. Plus my cataplexy was way worse on Nuvigil, so it's not a great drug for me. I was thinking that maybe the Nuvigil caused my eyes to be so uncomfortably dry because when I take it I keep my eyes open more, but the Ritalin doesn't seem to bother me that way.

I take several meds with anticholinergic effects, so having dry eyes isn't anything new. But my eyes just go crazy on Nuvigil, and 300mg isn't nearly enough to shake the sleepiness for me. No future in increasing that drug for me. I do need to schedule an appointment with the eye doctor...

Thanks for answering.