Dry Eyes

Dry eye is a condition that affects your tear film, the three layers of tears that cover and protect the surface of your eyes. You need a smooth and stable tear film to help you see clearly and comfortably. Disruptions to your tear film can cause uncomfortable symptoms, like burning, itching, watering or blurred vision.

Many different factors can prevent your tear film from working as it should and lead to dry eyes. Its causes and risk factors are numerous and complex. So, it may take a while to get to the root of the problem and figure out what’s causing your symptoms. If you have dry eye syndrome, it’s important to establish care with an ophthalmologist or optometrist to manage your condition.

Types of dry eye disease

There are a few types of dry eye disease:

• Aqueous deficient dry eye: This is when the lacrimal glands of your eyes don’t produce enough aqueous tears. These tears make up the middle, watery layer of your tear film.
• Evaporative dry eye: This is when your tears evaporate too quickly, most commonly because of meibomian gland dysfunction.
• Mixed dry eye: Some people have aqueous tear deficiency and tear instability. This means your eyes don’t produce enough tears, plus your tear film is unstable.

Symptoms of dry eye

When you have dry eye, you may feel like there’s something in your eye that just won’t come out. This can feel like a scratchy, gritty or sandy sensation. Dry eye symptoms may also include:

• Blurry or fluctuating vision
• Burning or stinging
• Feeling sensitive to light (photophobia)
• Mucus that comes out of your eye (eye discharge)
• Watery eyes (epiphora), with excess tears running down your cheeks

The symptom of watery eyes may seem confusing. But it’s a very common part of dry eye syndrome. It happens when your meibomian glands aren’t making enough oil. So, the watery layer evaporates too quickly. In response, your lacrimal glands compensate by making too much water. This doesn’t solve the underlying problem.

Dry eye causes

Causes of dry eyes include:

• Eyes that don’t produce enough tears
• Tears that evaporate too quickly
• Both of these happen together

Eye dryness may occur on its own or along with other medical conditions. In some cases, dry eye is a sign of:

• Blepharitis
• Sjögren’s syndrome
• Thyroid eye disease

Risk factors for dry eyes

Some risks you can’t control. For example, the older you get, the more likely you are to develop dry eye. But other risks you may be able to manage through lifestyle changes or adjustments to your medications. Risk factors for dry eyes include:

• Environment and lifestyle factors: Things like the weather, how much time you spend looking at screens, contact lens use, smoking or allergies can increase your risk of dry eye.
• Medications: Taking certain medications can increase your risk of dry eye, including some that treat depression, allergies, blood pressure, glaucoma, menopause and pain.
• Medical conditions: Many different neurological disorders, eye diseases, autoimmune diseases and endocrine conditions can raise your risk of dry eye.
• Surgeries: Some eye surgeries increase your risk of dry eye, including LASIK, cataract surgery and surgery on your cornea.

Complications of dry eyes

Complications of dry eyes can range from mild to severe. These may include:

• Corneal scarring
• Corneal ulcers
• Eye irritation
• Infection
• Vision problems

How doctors diagnose dry eye disease

Your healthcare provider may ask you to fill out a questionnaire to learn about your symptoms and medical history. You should be prepared to provide lots of information, including:

• Eye-related symptoms and how long you’ve had them
• Environmental factors that make your symptoms worse
• Other symptoms, including dry mouth, cavities, mouth ulcers, fatigue and joint pain
• History of eye diseases
• History of other medical conditions, including allergies and chronic viral infections

Then, your provider will give you a thorough eye exam to assess the quality of your eyes and determine what’s causing your symptoms. During your exam, your provider will look for signs of dry eye disease and check the health of your tear film.

Tests that diagnose dry eye

There’s no single test that diagnoses dry eye syndrome. Rather, your healthcare provider may use many tests, including:

• Slit lamp exam: This test checks for signs of dry eye. Your provider shines a light into each of your eyes and uses a microscope to examine your eyes and eyelids.
• Schirmer’s test: Your provider places a tiny piece of paper along the edge of your eyelid to measure the amount of tears produced.
• Tear breakup time (TBUT) test: This test checks how quickly your tears evaporate. Your provider puts dye into your eye and uses a microscope to see how long your tear film remains stable.

Your provider may also order other tests, like antibody tests, to check for underlying conditions that could be causing eye dryness.

How are dry eyes treated?

Dry eye treatment depends on the severity of your symptoms and any underlying conditions you have. You may need to try many different treatments before finding dry eye relief. Treatment for dry eye may include:

• Eye drops: There are many different types of eye drops. Artificial tears lubricate and soothe your eyes, temporarily relieving symptoms. They’re available over the counter.
• Ointments: If your eyes dry out while you sleep, you can use a thicker lubricant at night, like an ointment.
• Punctal occlusion: If your eyes don’t produce enough tears, punctal occlusion (temporary or permanent) may be a helpful option for you.
• Scleral lenses: These contact lenses come into contact with your sclera (the white part of your eye). They protect and lubricate your eyes while also correcting your vision.
• Tear stimulation: A medication called pilocarpine can stimulate tear production and may improve symptoms of dry eye disease.
• Acupuncture: Acupuncture may help improve the signs and symptoms of dry eye.
• Surgery: Your provider can surgically correct eyelid misalignment or, in severe cases, perform surgery to reduce tear evaporation.

Dry eye syndrome self-care

Your healthcare provider may suggest you start with home remedies, especially if your symptoms are mild.

• Avoid environmental triggers: These include cigarette smoke, air vents blowing toward your face, wind and allergens. It may help to wear wraparound glasses or sunglasses.
• Use a humidifier in your bedroom: Depending on where you live, your home may have very low humidity levels during the winter when you’re using the heat. A humidifier can help.
• Place a warm compress over your eyes: Purchase a heat mask for eyes at any drug store and leave it on your eyes for 10 minutes each evening.
• Give your eyes a rest: Take frequent breaks when you’re reading or using a computer. Also, try to remember to blink often to help your tear production.
• Take omega-3 fatty acid supplements: Some research shows these supplements may support tear production and help your symptoms.

When should I see my healthcare provider?

Your ophthalmologist will tell you how often you need to come in for appointments. If other medical conditions are causing your dry eye, you may need regular follow-ups with other healthcare providers, too. Be sure to go to all of your appointments so your care team can monitor your condition and help you receive treatment.

Call your ophthalmologist if you experience:

• New side effects from treatments
• New symptoms
• Symptoms that get worse

Does dry eye go away?

Dry eye is a long-term (chronic) condition. It doesn’t have a cure, but treatments can help manage your symptoms.

You may have to try several different treatments to find what works best for you. This can be a stressful process, but it’s worth the effort. Talk to your provider if your current treatments aren’t working or you want to discuss other options.