When Your Eyes and Mouth Are Dry and Gritty but the Tests Are Normal

My eyes are gritty and feel as if grains of sand are in them. My mouth is often dry too, and drinking water helps only for a moment.

People like this receive artificial tears at the ophthalmologist, and at the dentist are told there's no particular problem. The tests are normal, but the dryness continues. Then it gets summed up with words like "it's your age" or "you're just sensitive."

At times like this I do not look at the dry eyes and the dry mouth each separately. I first look at a state in which the switch by which the body puts out moisture has weakened.

Why the dryness — secretion is switched on by nerves

Tears and saliva are not simply pooled and then released. Among the autonomic nerves, the parasympathetic nerve must send a signal to the secretory glands for secretion to occur. The salivary glands and the tear glands receive commands from the same system. So when the balance of this nerve tilts to one side, the eyes and mouth dry together. There is a reason these two symptoms often come together.

There are things that quietly press this switch down. When the sympathetic nerve stays switched on from tension and stress, the command toward secretion weakens. It is also common to be taking, for a long time, medications that bring on dry mouth — cold medicines, sleeping pills, some blood-pressure drugs, antidepressants. With age, the capacity of the secretory glands themselves may decline, and a state of insufficient body moisture may continue.

Up to here is established physiology. That the secretory glands are regulated by the autonomic nervous system, and that drugs with anticholinergic action dry the eyes and mouth, is well known.

From here on is my clinical interpretation. I do not see this kind of dryness as a single problem of "tear shortage" or "saliva shortage." I see it as a chain in which the balance of the nerve that switches secretion on has tilted toward tension, and that state has hardened over time so that the response of the secretory glands has dulled. This is why moistening the surface with artificial tears leaves the root behind.

So what do I do?

I look at two things together.

First, I turn the balance back toward switching on. I examine whether you are always tense, whether your breathing is shallow and frequent, whether your body doesn't relax even in bed. When this tension is lowered, the nerve toward secretion gains room to work again. I also check together whether any of the medications you take cause dry mouth.

Second, I stabilize a body in which dryness has become long-standing. This takes time. A secretory function that has been pressed down and dulled for a long time does not return overnight. Helping, even in the hours after you leave the clinic, to lower the body's tension and soothe the balance of secretion — this is the place herbal medicine takes on. Not squeezing out tears on the body's behalf, but pushing from beside it so the body regains the rhythm of secretion on its own.

When you should go to the hospital first

But dryness has causes that must absolutely be distinguished. If your eyes and mouth are dry while your joints swell and ache, or if the dryness is unusually severe and long-lasting, you should first check for an autoimmune disease such as Sjögren's syndrome. This disease is diagnosed by blood tests and by secretion tests at the ophthalmologist and dentist. The mouth also dries when diabetes is uncontrolled, and when there is a thyroid problem. Your medications may be the cause, so consultation with the place that prescribed them is needed.

I do not say that all dryness is explained by the balance of the autonomic nervous system alone. If the signs above are present, I first recommend testing at internal medicine or rheumatology.

Finally

To those who have long been told "the tests are normal, but the eyes and mouth are dry," I want to say that it is not merely the natural result of sensitivity or aging. Dryness is an honest signal that the rhythm by which the body puts out moisture has been disturbed. Let's find together where that rhythm tilted.