Q & A: Dry, Itchy Eyes in an Emaciated Patient

Q. One of my very thin, almost-emaciated patients with chronic anorexia nervosa (AN) has recently been complaining of dry and itchy eyes. Can this be related to her AN?

A. Actually, yes. Recently, physicians at the ACUTE Center at Denver Health, an inpatient program specializing in the medical treatment of severely and often critically ill patients with AN, described 5 cases of emaciated patients with “lagopthalmos,” a condition in which the eyelids fail to close, which results not only in dry and itchy eyes, but which also risks corneal injury. The condition is thought to result from a combination of dehydration and inanition resulting in orbital fat atrophy. In addition to rehydration and nutritional therapy, which definitively reverse the condition, the immediate recommended treatment is hourly use of preservative-free eye drops and taping the eyelids shut at night (Arch Ophthalmology 2012; 130: 928). Of course, the patient should also be seen by an ophthalmologist.

— J.Y.