Ask the Expert: Light Sensitivity and Headaches With Sjögren’s

“I’ve been experiencing light sensitivity and have been getting more headaches. Is this common with Sjögren’s?”

Most people who have Sjögren’s will have dry eyes, also called keratoconjunctivitis sicca. Sensitivity to light (also known as photophobia) is one of the common symptoms experienced by people who have dry eyes, though not everyone with dry eyes experiences light sensitivity. However, dry eyes alone do not commonly cause headaches. The most common cause of light sensitivity and headaches would be migraine headaches. If your headaches are primarily located on one side of the head, then there is a good chance that this problem could be related to migraine rather than to dry eyes. Migraine headaches are also often associated with nausea, sound sensitivity, and typically get worse with physical activity. If these apply to your headaches, then you should ask your doctor if you may have migraine headaches, which require treatment different than that used for Sjögren’s dry eyes. 

If your headaches primarily occur after computer work, then the possibility of “Digital Eye Strain” should be considered. The American Optometric Association (AOA) also calls this “Computer Vision Syndrome.” Having poor ergonomics and posture while performing prolonged computer work can cause strain on the joints and muscles of the head, neck, and shoulders which can, in turn, lead to muscle tension headaches. Dry eyes also typically worsen during computer work. While concentrating on computer work, blinking is reduced by a third or more, resulting in increased evaporation of the moisture covering our eyes. Common symptoms of Computer Vision Syndrome include headaches, blurred vision, dry eyes, eyestrain, and neck and shoulder pain. Both the AOA and the American Academy of Ophthalmology recommend abiding by the 20-20-20 rule: take a 20-second break every 20 minutes during computer work to view something 20 feet away to help minimize this problem. Other things you should do while performing computer work include concentrating on blinking more often, using artificial tears frequently, using an anti-glare computer screen protector, using a desk humidifier, and positioning your computer screen so that the center is 4-5 inches below eye level.

Some patients who have Sjögren’s can have other problems with their eyes that can cause light sensitivity but are much less common than dry eye. Inflammation of the white portion of the eye (the sclera) is called scleritis, and inflammation of the colored portion of the eye (the iris) is called iritis (or anterior uveitis). Both of these cause light sensitivity and usually cause the sclera to become red or pink, causing eye pain rather than a true headache. These two conditions are also treated differently than dry eyes.

The best person to sort out these possibilities is an eye doctor, either an ophthalmologist (a medical doctor, MD; or a doctor of osteopathy, DO) or an optometrist (optometry doctor, OD). If you have been diligent with treating your dry eyes with artificial tears every few hours, using a humidifier, not smoking, staying hydrated, etc. and the light sensitivity and headaches continue, I would recommend that you call and see your eye doctor as soon as possible for appropriate evaluation. The correct treatment depends upon identifying the actual cause of your symptoms.

By Donald Thomas, MD

This information was first printed in the Foundation's patient  newsletter for members.