Just about everyone has experienced a feeling of dryness in their eyes at some point. In fact, acute exacerbations are common, with many lifestyle choices and environmental factors — like using your cellphone or being in a low-humidity environment — triggering symptoms, says Whitney Hauser, MD, an optometrist at the TearWell Advanced Dry Eye Treatment Center in Memphis, Tennessee, and the founder of DryEyeCoach.com.
But while fleeting cases of dry eye may not be too bothersome, chronic dry eye or dry eye syndrome is a completely different story.
This progressive condition goes beyond run-of-the-mill dry eyes. So much so that Dr. Hauser describes it as a “chronic inflammatory condition,” in which dry eye symptoms are prolonged, frequent, and severe. (1)
Causes and Risk Factors of Dry Eye
Dry eye is a condition marked by inadequate eye lubrication, either because tear ducts are not producing enough tears, or tears are evaporating too quickly. (1)
Tears (a mixture of water, oils, and mucus) are necessary to keep your eyes healthy and your vision clear. A layer of tears covers your eyes each time you blink, which protects your eyes from infections, keeps them moist, and washes away dust and debris. (2)
The following are some of the risk factors for dry eye: (1)
- Environmental irritants, such as wind, low humidity, air-conditioning, sun exposure, smoke, chemical fumes, or heat
- Hormonal changes in women, such as from pregnancy, menopause, hormone replacement therapy (HRT), or birth control pills
- Skin diseases in or around the eyes, or diseases of the eye glands
- Eye surgery, such as refractive surgery (LASIK) and cataract surgery
- Autoimmune disorders, such as Sjögren's syndrome, lupus, and rheumatoid arthritis
- Chronic inflammation of the eye
- Infrequent blinking or a condition called exposure keratitis, in which the eyelids don't close completely during sleep
- Various medicines, such as antihistamines, nasal decongestants, tranquilizers, blood pressure medication, Parkinson's disease medication, and antidepressants
- Excessive or insufficient vitamin intake
- Long-term contact lens wear
Types of Dry Eye
There are two types of dry eye: (3)
Aqueous tear-deficient dry eye The eyes' lacrimal glands fail to produce enough of the middle aqueous layer of tears, resulting in low tear production.
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Evaporative dry eye The eyes meibomian glands don't produce a strong outer lipid layer of tears, resulting in tears that evaporate too quickly.
Tears also have a third component — an inner mucous layer — that is produced by goblet cells and allows the aqueous layer to spread evenly over the surface of the eye. (3)
In addition to dry eye syndrome, dry eye is also sometimes known as: (4)
- Keratoconjunctivitis sicca
- Dysfunctional tear syndrome
- Lacrimal keratoconjunctivitis
- Evaporative tear deficiency or aqueous tear deficiency
- LASIK-induced neurotrophic epitheliopathy
How Is Dry Eye Diagnosed?
See a doctor if you have frequent symptoms of dry eye or if your dry eye symptoms worsen. A comprehensive eye examination can diagnose the condition. This involves an external examination of your eyes, eyelids, and cornea. (5)
Your doctor will also perform testing to measure your tear flow and the quality of your tears using a special dye for the eyes. (5)
Prognosis of Dry Eye
Regardless of severity, dry eye isn’t life-threatening. In fact, it’s highly treatable. Symptoms of mild cases can be eased with over-the-counter options, whereas chronic dry eye may require a prescription or surgery. (5,6)
Treatment and Medication Options for Dry Eye
The right dry eye treatment often depends on the cause of your condition.
For mild or occasional dry eye, artificial tears (dry eye drops) can help lubricate the eyes and relieve symptoms. The best part about artificial tears is that you don't need a prescription. (6) There are also a variety of options, including drops with electrolytes. These drops not only keep your eyes moist, but also protect the surface of your eyes. (7)
Alternatively, there are eye drops containing preservatives to prevent the growth of bacteria after you open the bottle, as well as nonpreservative eye drops. The latter has fewer additives. This is an option if you’re allergic to certain ingredients in eye drops, or if you apply artificial tears more than four to six times a day. (2,7)
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While artificial tears are sometimes the first line of defense for dry eye, more severe symptoms require a prescription from your ophthalmologist or optometrist.
Talk to your doctor about the immune-suppressing drug Restasis (cyclosporine). This medication relieves dry eyes by stopping inflammation that interferes with tear production. (8)
Similarly, the prescription drug Xiidra (lifitegrast) can also adequately manage the condition, says Hauser. (3)
Or you may need to temporarily use corticosteroid eye drops to reduce inflammation. Antibiotic eye drops can also reduce eyelid inflammation, helping with the secretion of oil into your tears. (3,5)
A tear-stimulating drug (cevimeline or pilocarpine) is another option for improving symptoms of dry eye, or you might have excellent results with eye inserts that release a substance to increase lubrication. (5)
Procedures that close the tear drainage holes in the inner corners of your eyelids — either temporarily (with tiny plugs) or permanently (with surgery) — may also be an option if you have dry eye. (2,5)
Closing your tear drainage holes allows the limited volume of tears to remain on your eyes longer.
Alternative and Complementary Therapies
If you prefer a natural approach to healing dry eye syndrome, consider acupuncture. A review of 19 studies found that acupuncture therapy combined with artificial tear therapy was more effective than artificial tear therapy alone for dry eyes, yet the individual study results varied. (5,9)
Home remedies, and making a few lifestyle changes, may also alleviate symptoms of dry eye.
If you take a prescription medication for another condition, check with your doctor to see if dry eye is a common side effect of this drug, says Fartash.
Improving dry eye symptoms may require switching to another medication, if possible.
You may also be better off wearing glasses if your contact lenses cause dry eye. (8)
In some people, consuming omega-3 fatty acids from supplements or foods (including fatty fish like salmon and sardines, as well as walnuts and flaxseed) reduces eye irritation, says Fartash. (2,8)
She also suggests using a humidifier to put moisture back into dry air, taking short breaks from technology to give your eyes a rest, and laying a warm, damp wash cloth across your eyelids for a couple minutes for relief. (2)
Prevention of Dry Eye
Here’s how else you can alleviate or prevent dry eye: (1,2,8)
- Wear wraparound glasses when outdoors to protect eyes from wind
- Blink often
- Don’t use a hair dryer
- Wash your eyelids with baby shampoo to help release oil into the eyes
- Remove makeup daily
- If you work on a computer, look away from the screen at least every 20 minutes
- Take an antihistamine to relieve allergy symptoms
- Drink 8 to 10 glasses of water per day to prevent dehydration
- Stop smoking
Contact Lenses and Dry Eye
With regard to contact lenses, dry eyes doesn't mean that you're no longer a candidate for contacts. But you’ll need to have a conversation with your doctor about dryness, and then choose a lens that’s comfortable to wear with this condition, such as single-use daily disposable lenses, advises Fartash.
The best contacts for dry eyes are soft lenses, as well as lenses with a low-water content, such as those made from silicone hydrogel. (10)
Complications of Dry Eye
If left untreated, complications associated with dry eye include eye inflammation and eye infections, especially if the cornea becomes damaged because of dryness. (1,6)
Conditions that can damage the cornea include corneal abrasions and corneal ulcers. Severe cases of dryness can also decrease vision, warns Fartash.
Another possible complication is conjunctivitis (pink eye), or inflammation of the conjunctiva, the mucous membrane that covers the white part of the eyes and inner surfaces of the eyelids. (6)
Depending on the severity, dry eyes can also reduce your quality of life. Blurry vision and sensitivity to light can make it hard to complete routine, everyday tasks such as driving and reading. (1) Dry eyes might also make it difficult to complete schoolwork, and your work performance could suffer.
Can Dry Eye Syndrome Cause Floaters?
If you have dry eye along with eye floaters, you might question the connection. While it’s not inconceivable to develop both eye conditions simultaneously, “floaters aren’t necessarily related to dry eyes, although both are common, especially as we age,” says Fartash.
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“Sometimes loose cells or fibers clump together within your eye fluid and cast a shadow onto the retina, which we see as floating dark specks or blobs known as eye floaters,” she explains. (11)
Above all, leaving dry eye untreated can disrupt your daily life, leading to a lower standard of living.
Asians and Dry Eye
Although dry eye can affect anyone, research finds that people of Asian descent may have a predisposition to dry eyes. (13)
A study published in January 2019 in The Ocular Surface investigated the difference in eye dryness, tear film quality, and ocular surface of 103 Asian participants and 103 white participants. They found that the Asian participants had more severe dry eye symptoms compared with white participants. (13)
This is likely due to poorer meibomian gland function in Asian people. This gland is responsible for secreting fluid. Researchers also observed a “higher degree of incomplete blinking” among the Asian participants, which may further contribute to the predisposition to dry eyes. (13)
Resources We Love
Favorite Orgs for Essential Dry Eye Info
American Academy of Ophthalmology
The AAO provides detailed information on symptoms and causes of dry eyes. You’ll also find tips on prevention and treatment, as well as patient stories, related articles, and answers to common questions about dry eyes and ophthalmology.
Dry Eye Foundation
The Dry Eye Foundation is committed to improving the lives of people with dry eyes. It's an excellent source for encouragement and advice on how to cope. The site features a dry eye glossary, personal stories, and helpful articles.
National Eye Institute
The National Eye Institute also provides an abundance of resources to help you cope with dry eyes. You can learn about symptoms, prevention, and causes. Additionally, the site offers links to the latest research, videos, and printable books and flyers.
Favorite Online Support Networks
Not a Dry Eye
This blog is dedicated to bringing awareness to dry eye syndrome. It features a collection of personal stories, coping tips, the latest research, and answers to common questions related to eye health.
Dry Eye Zone Forum
Although many people live with dry eyes, you might feel as if you're alone — especially when dry eyes impacts the quality of your life. The Dry Eye Forum, however, provides a place to connect and receive support from those who understand your struggle.
Favorite Resource for Telemedicine
Got a question about dry eyes? EyeCareLive is a platform that allows eye doctors to expand their practices online. Use the service to get a visual acuity test, discuss your eye concerns, and receive e-prescriptions.
Additional reporting by Joseph Bennington-Castro.
Editorial Sources and Fact-Checking
- Dry Eyes: Overview. Mayo Clinic. September 24, 2020.
- Boyd K. What Is Dry Eye? American Academy of Ophthalmology. September 22, 2020.
- Facts About Dry Eye. National Eye Institute. July 5, 2019.
- Adler R. Understanding Dry Eye Syndrome. All About Vision. June 2019.
- Dry Eye: Diagnosis. Mayo Clinic. September 24, 2020.
- Dry Eye Syndrome. NHS Choices. December 17, 2018.
- Robertson D. Artificial Tears: How to Select Eye Drops for Dry Eyes. Mayo Clinic. February 12, 2019.
- Dry Eyes: A Hallmark Symptom of Sjögren’s. Sjögren’s Syndrome Foundation.
- Kim B, Kim M, Kang SH, Nam HJ. Optimizing Acupuncture Treatment for Dry Eye Syndrome: A Systemic Review. BMC Complementary Medicine and Therapies. May 3, 2018.
- Chalmers R, Long B, Dillehay S, et al. Improving Contact-Lens Related Dryness Symptoms With Silicone Hydrogel Lenses. Optometry and Vision Science. August 2008.
- Eye Floaters: Overview. Mayo Clinic. August 28, 2020.
- Eye Health Statistics. American Academy of Ophthalmology.
- Craig J, Lim J, et al. Ethnic Differences Between the Asian and Caucasian Ocular Surface: A Co-Located Adult Migrant Population Cohort Study. Ocular Surface. January 2019.
- Javadi M, Feizi S. Dry Eye Syndrome. Journal of Ophthalmic and Vision Research. July 2011.
- Peck T, Olsakovshy L, et al. Dry Eye Syndrome in Menopause and Perimenopausal Age Group. Journal of Mid Life Health. June 16, 2016.