How dry I am: Sicca complex has many causes

Ricky Gervais at the 2011 Golden Globe Awards was anything but dry– well, except for a few dry martinis, I’m sure.

Wow, now I like humor, but I thought at times he went a liiiiitle too far to insult his guests. To paraphrase Kathy Griffin, it’s more polite to make fun of celebrities behind their backs. It amazed me that Joan Rivers said in her documentary, A Piece of Work, that it hurts to be roasted and ridiculed, but she does it because of the money.

Sicca complex (pronounced like, “I’m sick a you!”) is a combination of dry eyes and dry mouth. For people with dry eyes, an ophthalmologist probably scribbled the diagnosis, “Keratoconjunctivitis sicca (KCS)”. And for those with dry mouth, an ear-nose-throat doctor or dentist said, “Xerostomia.”

Sicca can be from a rheumatological disorder, which is why seeing the doctor is a good idea. Sjogren’s syndrome can cause sicca because of chronic inflammation that ruins the glands for tears and saliva. Sjogren’s syndrome can also occur with rheumatoid arthritis or other rheumatologic diseases. In a small percentage of patients, Non-Hodgkin Lymphoma develops with sicca.

Dry eyes can result from a slew of things besides KCS: contact lens use, allergies, low vitamin A, and impaired eyelid function. In KCS, dry eyes are worse in the evening, so watching Brian Williams on the NBC Nightly News becomes even drier that it already is. (Go, Katie Couric!)

The dry feeling is like sand in the eye— gritty– because dry eyes aren’t good for the cornea (which is skin). Itching, irritation, and pain with light can occur as well. Mucus filaments build up to make eye-wax sleepies look like glue balls.

This is interesting. Tears are still produced from crying. So Tammy Faye Bakker, may she rest in peace, would have been able to indulge in her trademark crying even if she had had KCS.

Apart from xerostomia, dry mouth can result from things including antidepressants, antihistamine, some blood pressure meds, dehydration, diabetes mellitus, and anxiety. Many older folks think they have dry mouths, but their salivary production is actually normal.

Dry mouth is bad, bad, bad for the teeth, so the dentist practically becomes a family member. About 65 percent of people with xerostomia get cavities. Many folks are shocked when I tell them they have a yeast infection– of the mouth, not down south– but infections do occur, especially with xerostomia.

Pain occurs in the mouth, especially with spicy foods (which means Korean people suffer the most because almost all Korean food is spicy). Wearing dentures with a mouth yeast infection is like getting your teeth knocked out in a boxing match.

Dry mouth can causes gum recession, and the teeth become sensitive to temperature. In another dramatic symptom, they can fly out of your mouth after you bite into something hard like a bagel.

Laryngotracheal reflux can occur from xerostomia, meaning the throat and trachea respond to the lack of saliva to cause coughing and clearing of the throat. Like GERD (gastroesophageal reflux disease), chest pains can occur– especially when lying down at night— and can cause people to wake up in a panic.

Blood tests can help diagnose rheumatologic problem(s) causing the sicca. Also a simple test in the doctor’s office can see if the eyes aren’t secreting enough tears.

Though Ricky Gervais put a lot of big wheels through the drier at the Golden Globes, he can’t say, “There wasn’t a dry eye in the room,” which is saying a mouthful.
Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, Email him with your questions.