Dry eye is a common, uncomfortable, and sometimes debilitating condition caused by insufficient tear production or tears of inferior quality. Dry eye affects people of all ages, and there are two main types: aqueous-deficient dry eye and evaporative dry eye. According to various sources, including the Dry Eye Foundation, more than 16 million people in the US are affected by dry eye, also known as dry eye syndrome (DES), dry eye disease (DED), dysfunctional tear syndrome (DTS), and keratoconjunctivitis sicca (KCS).

What Causes Dry Eye?

Dry eye is a general term that refers to a collection of clinical signs and symptoms related to ocular surface disease (OCD) and ocular surface pain (OCP). Dry eye can be caused by improper or insufficient lubrication of the eyes due to a defect in the moisture-producing lacriminal glands (located above the eye), dysfunction of the oil-secreting meibomian glands (in the eyelids), faulty blink function, poor tear drainage, damage to the underside of the eyelids, the surface of the eye, and even nerve damage to the cornea. View a diagram of the glands that can impact tear production.

Dry eye has many root causes, and often occurs as a side-effect from medication taken to treat everything from cancer, depression, and hormonal imbalance to allergies, acne, and other conditions. Environmental issues, such as extreme temperatures, wind, smoke, and poor air quality, can also trigger dry eye. Additionally, prolonged screen time, lack of sleep, and advanced age can contribute to the condition. Among the many medical conditions linked to dry eye are irritable bowel syndrome (IBS), allergies, autoimmune disorders, bacterial infections, Crohn’s disease, demodex mite infestation, and vitamin A deficiency.

Symptoms of Dry Eye: What to Look For

Signs of mild to moderate dry eye are watery, red, and/or irritated eyes, sensitivity to light, grittiness, or the feeling that something is in your eye.

More severe symptoms may include pain, stringy mucus in the eyes or eyelids, stinging, burning, and difficulty wearing contact lenses. Many of us will experience dry eye at some point,  but if symptoms persist despite home remedies and non-prescription treatments, see your eye doctor. Untreated chronic dry eye can permanently damage the eye and, in some cases, point to underlying conditions requiring medical attention. See additional Mayo Clinic information on dry eyes.

Dry Eye Remedies: At-Home and Over-the-Counter Solutions

Natural remedies for dry eye that require no medical intervention include warm compresses, quality sleep, limiting screen time, addressing environmental irritants, and using an eye wash.

Over-the-Counter Eye Drops and Lubricants can provide relief. However, many ophthalmologists advise against using eye drops marketed to reduce redness, as this can aggravate dry eye. What you can try at home also includes decreasing alcohol consumption, increasing caffeine intake, blinking more, taking omega-3 supplements, resting your eyes, cleaning your eyelids/lashes, staying hydrated, avoiding smoking, and using non-prescription single-dose eye drops and lubricants. Dry or overheated air inside your home can also cause dry eye, so a humidifier may be helpful during the winter months. If you sleep with a fan on, doctors recommend lubricating your eyes before bedtime.

Severe Symptoms: When to See the Eye Doctor

If symptoms persist or worsen, visit an eye doctor for a comprehensive eye examination with dilation. A visit to an ophthalmologist or optometrist for dry eye assessment begins with a detailed review of your medical history and symptoms. Your eye doctor will look for inflammation or injury of the eye and surrounding area using these and other diagnostic tests:

• Tear film stability—tests the time it takes for tears to break up.
• Tear volume—is measured by the tear meniscus test (also called the Schirmer test).
• Tear film composition— is examined using the osmolarity test to measure levels of electrolytes and chemicals in your tears.
• Ocular surface staining—applies different colored dyes to look for corneal damage.

What Causes Chronic Eye Dryness? Understanding Long-term Factors

Examining lifestyle and diet, environment, medications, and possible underlying health conditions will help you understand the long-term factors that contribute to dry eye and facilitate appropriate treatment. Maintaining healthy habits includes paying attention to eye hygiene to help reduce your risk for dry eye.

Medical Treatment for Dry Eye: Prescription Eye Drops and Medications

In-office procedures and therapies for dry eye continue to advance. Depending on the root cause of your dry eye, your eye doctor can provide relief using state-of-the-art devices and treatments that employ heat, light, probes, and massage to unclog blocked ducts or repair injury. There are also special contact lenses that can heal the surface of the eye. When non-invasive treatments fail, surgeries for dry eye include: punctal plug surgery (stoppers inserted to slow tear drainage); cauterization (using heat to shrink tissue around tear ducts to slow tear drainage); amniotic membrane implantation (transplanting ethically amniotic tissue collected during cesarean deliveries to protect the surface of the eye); and salivary gland transplant (replacing faulty tear glands with a functioning salivary gland from the lower lip). The American Academy of Ophthalmology provides a detailed list of treatments.

Blocked Meibomian Gland: A Common Cause of Dry Eye

What is meibomian gland dysfunction?Meibomian gland dysfunction (MGD) occurs when output from the oil gland in your eyelids—the meibomian gland—produces insufficient quality or quantity of the oil that works with the moisture-producing lacrimal glands to generate well-balanced tears. This can be caused by blockage or a reduction of output caused by age, trauma, some autoimmune conditions, high blood pressure, high cholesterol, contact lenses, and some eye surgery. Demodex mites can also damage or block the meibomian glands. Non-prescription topical treatments such as OCuSOFT, Oust, and Cliradex are the first line of defense against an overload of these tiny parasites that live in the hair follicles of mammals.

Treatments for blocked glands in the eyes also include home remedies mentioned above, such as warm compresses and eye washes, as well as in-office treatments using probes, lasers, “scrubbing,” or heat.

Prevention Tips: How to Avoid Eye Dryness

The American Academy of Ophthalmology recommends the following steps to avoid dry eye:

• Implement the 20/20 rule for every hour of reading or screen time: look away to a distance of 20 feet for at least 20 seconds. Blink frequently and consider using single-dose lubricant eye drops.
• If you sleep with a fan on, use a gel drop or eye ointment.

Annual eye exams with dilation are essential for maintaining healthy eyes and offer the best hope of early diagnosis and treatment. While dry eye is common, left untreated, it can lead to more serious problems. Not everyone with dry eye will experience blurred vision, sensitivity to light, discomfort, and pain, which are often associated with it, but guesswork has no place in proactive eye health. Make an appointment for your annual eye exam today!

Frequently asked questions about eye dryness

For more information about Dry Eye and answers to other frequently asked questions, visit the Dry Eye Foundation website FAQs. The foundation also highlights stories and provides vital resources and support.