One of my most gratifying dry eye cases was that of a 65-year-old hospice nurse who suffered from debilitating dry eye symptoms. My patient had seen two or three doctors prior to myself, one a corneal specialist at top New York City hospital. She had tried the usual palliative therapies, punctal plugs, and cyclosporine therapy. She had given up on her contact lenses.
She did admit to working long hours, drinking little water (so she could avoid running to void frequently during working hours) and lots of coffee to keep her alert in the evening hours of her demanding shift.
She also was taking oral medication to temper her over-active bladder (OAB). Discontinuation of the OAB medication dramatically improved the signs and symptoms of dry eye in my nurse-patient.
What is overactive bladder?
Overactive bladder (OAB) is a prevalent condition in both men and women. It may have a significant impact on overall quality of life, sexual function, sleep, and mental health. OAB consists of urinary urgency with or without urge incontinence, often accompanied by frequency and nocturia (nighttime urination).1
Every time I examine a women, I think of my patient and her OAB. However, OAB is common in both men and women with equal prevalence.
The coexistence of benign prostatic hyperplasia (BPH) with OAB can worsen quality of life in men. BPH—also called prostate gland enlargement— is a common condition as men get older. The prostate gland is located beneath the bladder and if enlarged, begins to block urine flow.
An enlarged prostate gland can cause uncomfortable urinary symptoms such as a weak, slow urinary stream; a hesitancy and straining to urinate; prolonged voiding; dribbling at the end of urination; an inability to empty the bladder completely; the frequent passage of small amounts of urine; and nocturia. Other symptoms of BPH maybe the uncontrollable need to void, symptoms of urinary urgency, frequency, and incontinence.
Anticholinergic drugs that slow the bladder’s contractions, such as oxybutynin, are the mainstays of therapy for OAB. In men, it may be used in combination with BPH medication.
1. Eapen RS, Radomski SB. Review of the epidemiology of overactive bladder. Res Rep Urol. 2016 Jun 6;8:71-6.
2. Urology Care Foundation. What Is Overactive Bladder (OAB)? Available at: https://www.urologyhealth.org/urologicconditions/ overactive-bladder-(oab). Accessed 1/17/20.