Vision Health Library
Dry Eye Disease: Symptoms, Causes and Treatment
Dry eye disease occurs when the eyes do not produce enough tears or when the tears evaporate too quickly or fail to properly protect the surface of the eye. The result can be irritation, burning, fluctuating vision and persistent discomfort.
Dry eye is common, but it is not always as simple as having eyes that feel dry. The tear film is an important part of maintaining a smooth, healthy eye surface and clear vision. When that tear film becomes unstable, symptoms can range from mild irritation to chronic inflammation and significant visual discomfort.
What Is Dry Eye Disease?
Every time you blink, tears spread across the front surface of the eye. This tear film lubricates the eye, washes away small particles and helps keep the cornea smooth and clear.
Dry eye disease develops when there are not enough tears to maintain this protective layer or when the tears themselves are not functioning properly.
Some people primarily have reduced tear production, while others produce tears that evaporate too rapidly. Many patients have a combination of both problems.
Common Symptoms of Dry Eye
Dry eye symptoms can vary considerably from one person to another.
- Burning or stinging
- Scratchy or gritty sensation
- Redness
- Blurred or fluctuating vision
- Sensitivity to light
- Eye fatigue
- Discomfort while wearing contact lenses
- A feeling that something is in the eye
- Excessive watering
Excessive tearing may seem unusual in someone with dry eye, but irritation of the eye surface can trigger reflex tearing. These tears may temporarily flood the eye without providing the stable lubrication needed for lasting comfort.
What Causes Dry Eye Disease?
Dry eye can have many causes. Aging is one of the most common factors because tear production and tear quality can change over time.
Other contributing factors may include certain medications, medical conditions, hormonal changes, contact lens wear and previous eye surgery.
Environmental conditions such as wind, smoke, air conditioning and dry indoor air may also cause tears to evaporate more quickly and make symptoms worse.
Meibomian Gland Dysfunction and Evaporative Dry Eye
Along the edges of the eyelids are small oil-producing glands called meibomian glands. These glands produce oils that form an important part of the tear film and help prevent tears from evaporating too quickly.
When these glands become blocked or fail to release enough healthy oil, the tear film may break down too quickly. This condition is known as meibomian gland dysfunction, or MGD, and is a common contributor to evaporative dry eye.
Patients with meibomian gland dysfunction may experience burning, irritation, fluctuating vision and eyelid discomfort in addition to the typical symptoms of dry eye.
Screen Time and Dry Eye
Long periods of computer, tablet and smartphone use can contribute to dry eye symptoms because people tend to blink less frequently when concentrating on a screen.
Blinking helps redistribute tears and oils across the surface of the eye. When blinking becomes less frequent or incomplete, tears may evaporate faster and the eye surface may become irritated.
Taking regular breaks from screens and making an effort to blink normally may help reduce symptoms related to prolonged digital device use.
Contact Lenses and Dry Eye
Contact lenses rest directly on the tear film, so problems with tear quantity or quality may make lenses increasingly uncomfortable.
Some people first recognize dry eye because their contact lenses become uncomfortable later in the day or cannot be worn as long as they once could.
An eye doctor can evaluate whether the symptoms are related to dry eye, the type of contact lens being worn or another condition affecting the eye surface.
Medical Conditions and Medications
Certain health conditions can contribute to dry eye, including diabetes, thyroid disease and autoimmune disorders such as Sjögren syndrome and lupus.
Some medications may also reduce tear production or make dry eye symptoms worse. These can include certain antihistamines, antidepressants and medications used to treat high blood pressure.
If medication may be contributing to dry eye, patients should discuss the issue with their physician rather than stopping a prescribed medication on their own.
How Is Dry Eye Diagnosed?
A dry eye evaluation begins with a discussion of symptoms, medical history, medications, contact lens use and environmental factors.
The eye doctor may examine the surface of the eye and eyelids and evaluate how much tear fluid is being produced and how long the tear film remains stable after blinking.
Testing may also help determine whether reduced tear production, excessive evaporation, eyelid problems or meibomian gland dysfunction are contributing to the symptoms.
Treating Mild Dry Eye
Artificial tears are commonly used for mild dry eye. These lubricating drops supplement the natural tear film and may provide temporary relief from burning, grittiness and irritation.
Some patients who need drops frequently may benefit from preservative-free formulations, particularly if preservatives themselves become irritating.
Moisturizing gels or ointments may also be useful for certain patients, particularly when symptoms are worse at night.
Managing the Environment
Simple environmental changes can sometimes reduce dry eye symptoms.
- Avoid direct air from fans or air-conditioning vents
- Use a humidifier when indoor air is very dry
- Wear sunglasses outdoors in windy conditions
- Take regular breaks during prolonged screen use
- Stay adequately hydrated
- Avoid smoke and other eye irritants when possible
Treatment for Meibomian Gland Problems
When blocked or poorly functioning meibomian glands contribute to dry eye, treatment may focus on improving the quality and flow of the oils produced by the eyelids.
Depending on the condition, an eye doctor may recommend warm compresses, eyelid hygiene or additional treatments designed to improve gland function and reduce inflammation.
Prescription Dry Eye Treatment
Patients with persistent or more significant dry eye may require treatment beyond over-the-counter artificial tears.
Prescription eye drops may be used to address inflammation or improve tear production, depending on the underlying cause of the condition.
Because dry eye can develop for different reasons, the treatment that works for one patient may not be appropriate for another.
Punctal Plugs
Tears normally drain through tiny openings located near the inner corners of the eyelids. In some patients, an eye doctor may recommend small punctal plugs that partially block these drainage openings.
By slowing tear drainage, the natural tears and lubricating drops can remain on the surface of the eye longer.
Why Chronic Dry Eye Should Not Be Ignored
Dry eye can affect more than comfort. An unstable tear film can interfere with clear vision, contact lens wear, reading, computer work and other everyday activities.
Severe or persistent dry eye can also lead to inflammation and, in some cases, damage to the corneal surface.
When to See an Eye Doctor for Dry Eye
Occasional dryness may improve with simple lubricating drops or environmental changes. Symptoms that persist, worsen or repeatedly interfere with daily activities deserve a more complete evaluation.
Significant redness, eye pain, sensitivity to light or noticeable changes in vision should also be evaluated rather than assumed to be ordinary dry eye.
At Choice Vision Care & Wellness in Wellington, Florida, Dr. Salvatore DeCanio can evaluate the eye surface, tear film and eyelids to help identify the cause of dry eye symptoms and determine an appropriate treatment approach.