I Want to Cry but I Can't: How I Learned to Grieve After Dry Eye Took My Tears

Sometimes I feel inhuman.

Two years ago, well into middle age, I developed dry eyes, a common condition that sounds benign and manageable. Of the roughly 16 million Americans who have been diagnosed with dry eye, most have a mild form. For them, dry eye is harmless, and using artificial tears will soothe temporary redness and irritation.

But for those of us with severe dry eye, the condition can be extremely painful. It can also be associated with autoimmune conditions like Sjogren's syndrome and lupus. Women over 50 are particularly prone to dry eye due to declining hormones—and we're much more likely to suffer than men.

Severe dry eye is stubbornly resistant to interventions (which has not stopped tons of companies from trying to get a piece of the nearly $8 billion global market opportunity). Treatments range from the ho-hum to the bizarre: You start with wet compresses, eyelid wipes, prescription drops, and tear-duct plugs, then progress to tears made from your own blood serum, warming goggles, and a thick ointment used overnight that obliterates your ability to see.

If none of that helps, there is manual expression of blocked tear glands (the ophthalmologist wields a bright light and a pair of tweezers), testosterone tears, special contact lenses with a hole in the middle that bathe the cornea with fluid, laser treatments, and steroid drops (which can't be used long-term as they can cause blindness). It's often hard to tell if anything is working as the treatments themselves cause pain and redness. The newest innovation, much like a COVID-19 test, involves the doctor sticking a wand up the patient's nose. This is supposed to stimulate tears like a punch in the face. (I'm not anxious to try that one.)

There is currently no cure for severe dry eye, and what helps one person often doesn't help anyone else. At best, the constant need to procure and instill eye drops is a chore. The pain and blurred vision are a struggle. At worst, patients can descend into despair and even become suicidal, which I've seen firsthand. Mostly I handle this condition well, but the possibility of it growing worse scares me. I tolerate it now, but what about a year from now? Ten years?

My sister's COVID puppy recently had to have one eye removed due to a congenital inability to produce tears. As my case of dry eye got worse, I found myself envying him. (He has one good eye! The other eye doesn't hurt anymore!)

I always used to cry when I was proud of my kids. Even marching bands used to give me the happy cries for some reason. But about six months after I was diagnosed, I made the unsettling discovery I could no longer cry. I've never been much of a crier, so I hadn't noticed at first. Then I experienced a major setback that left me feeling like a failure. My eyes burned and I felt tears coming, but they never arrived. I was left with a headache and lingering sadness. I thought it might be temporary, but it wasn't. The sad reality is, I produce few tears—not to lubricate my eyes so I can see, not to vent my sorrow, and not to show my joy.

Crying gives humans a form of emotional release, according to a study in Frontiers of Psychologythe "good cry" that turns out to be difficult to live without. Beyond the lack of relief, there is a loneliness of remaining dry-eyed. It seems unnatural, even inhuman. I worry someone will notice. "You saw, ladies and gentleman of the jury, she didn't even cry."

Most adults try to avoid crying in public. But when tears are expected, it is jarring not to see them. A family from our community lost their son last winter. We were all devastated at the gathering held to celebrate his life. I avoided talking much to people so I would not get caught not crying. Whenever I see a character in a movie cry, I think, "Yeah, if that were me, the other person would be wondering why I'm not crying." There's just no good time to announce to someone else that you can't cry. And it sounds like a cop-out somehow, a failure of emotion rather than dry tear ducts.

When I was in high school, my father came down with Bell's palsy, a virus that freezes the facial muscles on one side, usually temporarily. He did recover, but in the meantime, when he tried to smile, Dad's left eye bulged hideously and his mouth remained downturned on that side, a bizarre mismatch with the other half of his face. People did not react well to the sight. (I'm sorry to say we laughed.)

So he stopped smiling. He said it was profound. We think we smile in response to feeling happy, but he believed the converse was true at least to some degree: We are happy because we smile. Psychologists have argued about this for decades, but a recent paper published in Psychological Bulletin seems to bear this out.

So, if I can't cry, does that mean I am happier? Definitely not. The pain and uncertainty are difficult. I worry about my future with this condition.I can handle this today, but what does the future hold? The pain can be hard to take. I stopped reading my dry eye Facebook group because many of the posts left me scared or full of despair. The small insult to my humanity of being unable to cry makes me feel alone at times, but I'm optimistic about the dozens of drugs and treatments coming in the pipeline.

To anyone else who suffers from severe dry eye, I say, try everything. Something will work.And while I miss the full expression of my sadness, I have lost nothing in my times of joy, which are many. I can't cry, but I smile and laugh often.

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