Does Fibromyalgia Affect Eyesight?

 This article was featured in the October 2007 edition of FaMily
by Kathy Longley

"Everything is slightly blurred, sort of misty, as if you are looking through a mild fog," Rifka told me. "The symptoms started slowly and at first weren't there all the time, it would be blurry one day and then it would go for a few days, but now it is a permanent thing and I simply can't focus clearly. I also have these terrible dry eyes, and wake up in the morning feeling as though my eyes are full of sand, stuck together and gritty."

Having never really experienced problems with eyesight myself I listened to Rifka in amazement. It wasn't until I posted a request to talk to people who have struggled with their eyesight since having fibromyalgia that I began to appreciate just how many people experience these types of symptoms. Being inundated with phone calls and e-mails soon put me right.

To Dr Mark Pellegrino, a medical expert in fibromyalgia and a sufferer himself, this response does not come as such a surprise. At his clinic based in Canton, Ohio he has diagnosed and treated over 20,000 people with fibromyalgia and says that at least 50% of them report eye problems associated with their fibromyalgia.

Reported Eyesight Symptoms
"Patients can commonly experience symptoms of eye pain, sensitivity to light, blurred vision and fluctuating visual clarity, difficulty focusing, visual overload and dry eyes," Dr Pellegrino explains. "Many patients have to change their glasses prescription frequently because of fibromyalgia-related vision fluctuations and changes in visual acuity. They also find their eyes are particularly sensitive to smoke or that environments with very dry air cause vision difficulty."

Susan can relate to changes in visual clarity, she currently owns three different pairs of glasses and uses them depending on her symptoms, which can change in relation to the severity of her fibromyalgia symptoms. "My ability to see things at a distance can vary," she explains, "sometimes I won't be able to recognise shapes of things, it all looks fuzzy and I need to use my distance glasses, whereas other times my distance vision is fine. Also, I can't focus on things for too long before they become distorted, it is as though your eyes become too tired to focus."

Lynette, who had perfect eyesight before developing fibromyalgia, also finds it difficult to focus and struggles with sensitivity to light. "I am very slow at focusing, it always takes a while to re-focus if I have been looking at something close-up and then glance up, I have to blink a few times and wait for things to come back into focus," she explains. "I also experience great sensitivity to light, even on cloudy days when you can't see the sun I will be wearing my sunglasses. If I don't wear tinted glasses I find myself really squinting, I feel dizzy and sick and it is actually painful, sort of like having really bright sunlight directly into your eyes. I struggle with fluorescent lights too and often wear sunglasses indoors."

Another more unusual symptom, but one which can be extremely frightening, is the sudden appearance of flashing lights or zigzag patterns across your vision. Rifka was quite alarmed when she first experienced white flashing lights on the edge of her vision. "I went to see my doctor as I was really worried and she sent me straight to the hospital, but they couldn't find any reason for it. I now have them continuously, though sometimes it is worse than others, and I just have to try and screen it out." Lynette has a similar experience, "I get bright wiggly lines and flashes of light in my field of vision," she says. "It can be either right across my eyes or on the edge, almost like a ring of light, similar to the aura you experience before a migraine, but the migraine never develops."

"Flashing symptoms are more common in patients who experience migraines but can still occur without the headache 'aura'," confirms Dr Pellegrino. "I don't hear this complaint as often as the other eye symptoms I have mentioned however."

What could be causing these symptoms?
Our eyes each have postural muscles involved in moving the eyeball and allowing us to focus, if these muscles are not functioning correctly due to spasms or trigger points then eyesight can be distorted.

"In order for vision to be clear, both eyes must take the same picture at the same time," explains Devin Starlanyl in her book The Fibromyalgia Advocate. "When this doesn't happen, double vision, blurry vision, and/or changing vision can result. Misalignment of the eyes can be caused by trigger points interfering with the muscles that hold the eyeballs in place. Trigger points can be responsible for contracting these muscles at different tensions. Muscle fatigue would make things worse."

Trigger points could also be responsible for the sharp pains in the eyes that some people report. Lynette experiences what she describes as 'intense stabbing pains'. "In the beginning it had me rolling around grabbing my eye it was that painful," she says. "It actually feels like someone has just stuck a pin in my eye. It does seem to be related to the myofascial pain around my facial area, I have a problem with my neck, shoulder and arm on that side and when that is bad I get the stabbing pain more often."

Susan experiences strange muscle spasms in her eyes, they suddenly close tightly four or five times in a row. "It is like you have been near a lemon and your eyes crinkle shut in response," she explains. "It only happens every now and again but there is nothing I can do to stop it, it is really strange."

The commonly reported symptom of dry eyes by people with fibromyalgia has led to the suggestion of a possible link with the autoimmune disorder, Sjögren's syndrome. Here the body's immune system attacks the moisture producing glands, like the tear glands and salivary glands, leading to symptoms of dry eyes, that can feel itchy, gritty or burning, and a dry mouth, which can affect talking, chewing and swallowing.

Interestingly, around 90% of people with Sjögren's are women and it most often occurs between the ages of 40-60 years. Like all autoimmune disorders Sjögren's can be diagnosed by looking for the presence of specific antibodies in the blood, but other tests are also used to measure the amount of tears produced, their stability and distribution.

A research study carried out at Eberhard-Karls University in Tubingen, Germany by Dr Koetter and colleagues assessed a group of 285 people with fibromyalgia for the symptoms of dry eyes and the possible presence of Sjogren's syndrome. They reported that 40 of these participants experienced dry eyes (sicca) but only 15 could be shown to have Sjögren's.1 The research group suggests that it could be the presence of chronic blepharitis (inflammation of the eyelids) and the use of tricyclic antidepressants that may play a role in developing sicca symptoms.

Dr Pellegrino sees the situation a little differently. Firstly, he has many patients who are not taking tricyclic antidepressants but still complain of dry eyes. He believes that tricyclics can certainly aggravate a pre-existing problem, but dry eyes are unlikely to be a medicine side effect. Secondly, he suggests that within the fibromyalgia spectrum there is a subset of patients who have autoimmune dysfunction and therefore are more likely to experience 'autoimmune' symptoms like allergies, chemical sensitivities, frequent infections and dry eyes.

"In the FM spectrum there are those who are 'more normal' and at the other end, those who are 'near disease'. A subset of those with FM who are near an autoimmune disease, but never go through the disease door so to speak, staying just outside the doorway, may have elevated antinuclear antibody levels, experience more rashes, infections, and of course dry eyes. These would be 'autoimmune' type symptoms but not true autoimmune disease, like Sjögren's for example, hence an autoimmune dysfunction subset."

He goes on to explain that autoimmune dysfunction is closely related to autonomic dysfunction (the dysfunction of the autonomic nervous system) known to be out of balance in fibromyalgia. Autonomic dysfunction could contribute to the fluctuating level of eye moisture which in turn would affect focusing and visual clarity.

Another factor could involve cognitive dysfunction where the person has difficulty processing or comprehending what their eyes see. "We may see things clearly, but all this information which normally gets 'automatically' processed by the brain gets delayed, distorted or detoured on its way from the eyes to the brain resulting in visual comprehension problems," explains Dr Pellegrino. "A good example of this occurs when fibromyalgia patients say they read the same paragraph over and over again but still don't understand what they just read. It is like fibrofog in the eyes, with the symptoms aggravated by fatigue and poor sleep."

Experiencing problems with your eyes can no doubt be quite scary, especially if no medical explanation is offered. Be reassured that you are not alone and there are steps you can take to help relieve these unexpected symptoms.

Kathy would like to thank Dr Pellegrino for his assistance with this article.

1. Koetter I, Kanz L, Daikeler T, Eckstein A, Terhorst T, Gunaydin I, "Assessment of keratoconjunctivitissicca in patients with fibromyalgia: results of a prospective study." Rheumatology International, 1999; 19 (1-2): 7-9. 

Treatment of Eye Symptoms

There are various steps you can take to help reduce the pain and discomfort of the eye symptoms you may be experiencing:

Sensitivity to the environment

• avoid fluorescent lights when indoors
• wear sunglasses or tinted lenses when outdoors
• avoid contact lenses if you work in a dry environment like a hospital
• avoid smoky environments

Dry eyes

• use artificial tears to keep the eyes moist
• eye 'inserts' can be prescribed that slowly dissolve and release artificial tears
• the tear ducts can be plugged (called punctal plugs) by an eye specialist to keep natural tears around longer
• review medications and change those that cause mucus drying effects
• use a humidifier during the winter and in dry areas
• before an eye test ensure that your eyes are well moisturised as fluctuating moisture can cause fluctuating visual perception due to the amount of moisture over the tear film and lens affecting light refraction

Eye pain/strain

• Gentle eye exercises can help to stretch out eye muscle trigger points: look up, down, right, left; close your eyes tight, hold them wide open; gently massage the eyeball
• anticipate eyefog and stay focused on one thing at a time to avoid getting overwhelmed
• wear the correct glasses to avoid eye strain especially when reading
• try putting clear plastic over a page to decrease print contrast
• ensure adequate lighting when reading and watch out for eye fatigue

Supplements that may help

• broad spectrum plant enzymes (biocare polyzyme forte)
• Anthocydins (procydin)
• Visionace (a multivitamin and mineral supplement that contains lutein)
• flax seed oil
• omega 3 fatty acids (for dry eyes)
• beta-carotene
• colostrum (for eyefog)
• magnesium & malic acid