Fibromyalgia (FM) is a chronic pain disorder characterized by widespread musculoskeletal pain, profound fatigue, and cognitive difficulties often referred to as “fibro fog.” The condition stems from a dysfunctional processing of pain signals in the central nervous system, leading to heightened sensitivity. While FM is primarily known for affecting muscles and joints, it frequently impacts the eyes and visual system. Ocular symptoms and visual disturbances are commonly reported by patients.
The Prevalence of Ocular Dryness
Chronic Dry Eye Syndrome (Keratoconjunctivitis Sicca) is the most frequently reported eye complaint among individuals with fibromyalgia. Studies indicate a high prevalence, with up to two-thirds of FM patients experiencing symptoms. This dryness often presents with greater severity than typical age-related or environmental dry eye. Symptoms are usually described as a persistent gritty feeling, burning sensation, and noticeable redness.
A counterintuitive symptom of chronic dryness is paradoxical tearing, where the eyes occasionally water excessively. This occurs because the initial dryness triggers a reflex response, producing large volumes of low-quality tears that fail to properly coat the eye’s surface. The underlying cause is sometimes linked to an autoimmune dysfunction, which can mimic Sjögren’s syndrome, though patients usually test negative for specific antibodies. This tear film instability significantly compromises the eye’s natural protective barrier.
Sensory and Visual Processing Issues
Beyond physical dryness, fibromyalgia is strongly associated with sensory processing issues. Photophobia, or extreme sensitivity to light, is a highly common neurological symptom, reported by as many as 70% of FM patients. Regular indoor lighting, especially fluorescent bulbs, can cause significant discomfort or pain, often leading individuals to squint or wear sunglasses indoors.
Many patients also experience accommodative dysfunction, which is difficulty sustaining or shifting visual focus. This arises from the eyes’ focusing muscles not performing adequately, resulting in visual fatigue after short periods of reading or screen time. Visual disturbances can include temporary blurred vision, fluctuating clarity, and occasionally, double vision. These focusing issues are considered a manifestation of the central nervous system’s generalized hypersensitivity.
Why Fibromyalgia Impacts Eye Health
The primary mechanism connecting fibromyalgia to eye symptoms is central sensitization, where the nervous system becomes over-reactive to normal stimuli. This heightened state causes the nerves in the eye, particularly the cornea, to register non-painful sensations as painful or irritating. Evidence suggests that corneal nerves in FM patients may show pathological changes, known as small fiber neuropathy, which contributes to increased corneal sensitivity.
Autonomic nervous system (ANS) dysfunction also plays a role, as the ANS regulates involuntary functions, including tear production. An imbalance in this system can directly impair the quantity and quality of the tear film, exacerbating dry eye symptoms. A secondary factor is the use of certain medications prescribed for FM, such as some antidepressants, which can have an anticholinergic effect that reduces tear production and worsens ocular dryness.
Treatment Strategies and Specialist Consultation
Managing the ocular symptoms of fibromyalgia requires a multi-faceted approach focused on lubrication and environmental control. For chronic dryness, using preservative-free artificial tears frequently throughout the day is recommended to prevent irritation. In cases of more severe dryness, an eye specialist may suggest prescription anti-inflammatory drops or omega-3 fatty acid supplements.
To combat visual fatigue and light sensitivity, environmental adjustments are important, such as wearing tinted lenses or sunglasses, even indoors, to filter out painful light wavelengths. When using screens or reading, practicing the 20-20-20 rule helps prevent accommodative strain. Patients should consult both an ophthalmologist and the physician managing the fibromyalgia, as coordinated care ensures eye symptoms are not mistaken for another condition.