What Is Dry Eye? Causes, Symptoms, Treatment, and Prevention

Dry eye syndrome, or dry eye disease, is an all-too-common condition in which your eyes do not produce sufficient tears to stay wet, or your tears evaporate too fast.

Tears are a natural lubricant for eyes, and a lack of them leads to consistent redness, burning, itching and irritation. It can also lead to watery eyes, blurry vision, an ultra-sensitivity to light and difficulty seeing under certain conditions (too much light or too little light).

Artificial tears, medicated eye drops and other medicated eye lubricants are the first line of treatment for dry eyes, although doctors can prescribe therapeutic contact lenses for more serious cases.

Dry Eye

Tears serve as a natural eye lubricant, and a lack of tears tends to inflame eyes and damage their surface over time.

Dry eye syndrome, or dry eye disease, is an all-too-common condition in which your eyes do not produce sufficient tears to stay wet, or your tears evaporate too fast.

Tears serve as a natural eye lubricant, and a lack of tears tends to inflame eyes and damage their surface over time. 

To have dry eyes is usually to be uncomfortable, to have burning or stinging eyes, to have a sensitivity to light and to have difficulty seeing under some conditions.

People who experience this syndrome are typically counseled to keep eye drops on hand for consistent lubrication.

Dry eye is one of the most common conditions that eye doctors deal with. In fact, 25 percent of patients report symptoms of this condition. 

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Dry Eye Symptoms

Dry eye symptoms can run the spectrum from insignificant to severe, with both eyes usually affected. The typical symptoms include dryness, itchiness, burning sensation, and eye irritation that worsens as the day goes on. Other symptoms include pain, redness, tiredness, pressure, and a pulling sensation in your eye.

It may feel as if you have a speck of dirt in your eye because dry eye syndrome can damage your eye’s surface and increase sensitivity and discomfort when exposed to bright light. You may also have a stringy discharge from your eyes.

Dry eyes can cause your eye to water due to irritation, which you would think is a good thing. But, these reflex tears do not necessarily fix the condition because they do not have the lubricating properties necessary to prevent dry eye.

There are some things that can promote dry eye symptoms such as being on the computer, prolonged reading, watching television, or driving. Dry eye symptoms also increase in dusty, smoky, windy, dry, and low-humidity conditions.

How Are Tear Ducts Supposed to Work?

The leading causes of dry eye are not enough tears and increased tear evaporation. The lacrimal glands produce tears, which are then secreted. The tears flow over your eye surface and into canals connected to the lacrimal sac. Not enough tear production from those glands can cause dry eye syndrome.

When your tears can not keep your entire cornea and conjunctiva covered by a complete layer, you may develop dry eye symptoms. It can be caused by aging, a condition of your lacrimal gland, collagen vascular diseases, autoimmune diseases, and some medications. Environmental conditions such as dry and windy weather can reduce your tear volume.

Increased evaporation of your tear film can also cause dry eyes. The oily outer layer of tear film is produced by two sets of oil glands in your upper and lower eyelids, known as the meibomian glands. A smooth oil layer is necessary to prevent the evaporation of the water layer. A problem in the meibomian glands can cause increased evaporation.

It can also happen when the glands are clogged due to inflammation, preventing an even oil distribution. When your tears evaporate too fast or do not spread evenly over your cornea, you can develop dry eye symptoms. Other causes include low humidity, aging, certain medications, contact lens wear, and eye injuries.

Risk Factors

Epidemiological studies have found several risk factors for the development of dry eye syndrome. Aging is one of the primary factors, especially with those older than 65.

Not getting enough vitamin A (found in foods like carrots, broccoli, and liver) can contribute to dry eyes.

National Eye Institute

Meibomian gland dysfunction, a significant cause of dry eye, is prevalent in up to 70 percent of the older population. Increasing aging is also associated with reduced tearing.

Women are also more likely to develop dry eye syndrome primarily due to hormonal changes during pregnancy, menopause, and oral contraceptives. Menopausal and postmenopausal women tend to have symptoms of dry eye because of a reduction in tear production.

Research also suggests that reproductive hormones affect meibomian glands, tear production, and ocular surface conditions.

Other factors that increase your likelihood of developing dry eye syndrome include long-term contact-lens wear, certain medications, such as some antidepressants and antihistamines, refractive eye surgeries, as well as some medical conditions including diabetes, blepharitis, rheumatoid arthritis, and thyroid dysfunctions.

When to See a Doctor

Dry eye syndrome can lead to complications that may damage your eyes or affect your quality of life if left untreated. Several signs can indicate that you need to visit your eye doctor. The first is when your symptoms do not get better.

Dry eyes may be a temporary problem because of environmental or behavioral factors, and they may resolve without treatment. However, prolonged symptoms might be a sign of chronic or severe dry eye. If you can’t pinpoint an underlying cause and the symptoms persist, it is advisable to seek medical attention.

Some over-the-counter products and lifestyle adjustments can treat dry eyes for some people. If those fail to alleviate your dry eye symptoms, you should see a doctor. You should also visit an eye doctor if the dry eye symptoms affect your vision, impeding your ability to read, drive, work or complete other daily activities comfortably.

Diagnosis

A comprehensive eye examination can diagnose dry eye syndrome. Your eye doctor will evaluate the quantity and quality of your tears. This involves evaluating your medical history and examination of your external eye, cornea, ocular surface and tear film. Several tests are used to determine tear quantity and quality and classify patients into two categories: aqueous deficient or hyper evaporative.

Your eye doctor will perform a slit lamp examination to diagnose dry eyes and determine the extent of damage. A Schirmer’s test is used to measure the amount of moisture in your eyes. Eye doctors may perform a tear breakup time test to determine how long it takes for your tears to break up in your eyes.

Treatment

The treatment of dry eye syndrome can have many approaches. They include tear supplementation and stimulation, eyelid cleansing, increasing tear retention, treating eye inflammation, and surgery in severe cases. Tear supplementation and stimulation are recommended for mild to moderate dry eye cases.

Applying artificial tears every few hours provides temporary relief for dry eye symptoms. You can use over-the-counter tear solutions to supplement natural tear production as often as necessary.

If the condition is not sufficiently managed with artificial tears, you might use sustained-release eye lubricants.

Esen Karamursel Akpek, M.D.

Your optometrist may also prescribe medical eye drops that increase tear production. Artificial tears are buffered solutions with lubricants, surfactants, electrolytes, preservatives and a viscosity agent.

Tear retention allows your natural tears to stay in your eye longer to reduce dry eye symptoms. This happens through punctal plugs, which are small silicone or gel-like medical devices that you place near your tear ducts to prevent tear drainage. There are also surgical procedures to close the tear ducts permanently.

Doctors prescribe therapeutic contact lenses for severe dry eye cases to retain tear film and promote the healing of your eye surface. Your optometrist will closely monitor the use of these contact lenses.

Silicone hydrogel contact lenses are recommended for dry eye patients. These lenses allow more oxygen into your eyes and have low water content making the lenses less likely to dehydrate.

Treating the contributing ocular surface or eyelid inflammation also reduces dry eye symptoms. Your optometrist may prescribe eye drops or ointments. If you have a severe case of dry eyes, there is the option of tarsorrhaphy, a surgical procedure where your eyelids are partially sewn together, reducing eyelid separation and tear evaporation.

Home Remedies and Lifestyle Changes

Avoiding exacerbating factors is a significant component of treating or preventing dry eye at home. You should avoid dry, drafty, smoky, and dusty environments as they can promote dry eyes. So, you should avoid direct exposure to heaters, dryers, fans, and air conditioners. You can add moisture to dry indoor air, especially during winter, by using a humidifier.

You can also minimize eye discomfort by excessively blinking, especially during prolonged reading or computer use. You should avoid rubbing your eyes as it can further irritate them. If you have eye inflammation, eyelid cleaners, warm compresses, and eyelid massages it can also help reduce the inflammation around your eye surface.

Nutritional supplements with essential fatty acids may be effective in reducing dry eye symptoms for some people.

Complications

In untreated cases of dry eye syndrome, cornea scarring, corneal infection, corneal thinning, and eye inflammation can occur. When insufficient tears do not provide enough oxygen and nutrients, your cornea may become infected or develop abnormal blood vessels that affect your vision.

Severe dry eye can lead to complications that may damage the eyes, leading to impaired vision, blurry vision, or vision loss in very rare cases. The loss of tear film affects your cornea’s ability to focus light properly. Long-term problems due to dry eye seldom develop if properly treated.

Prevention

The prevention of dry eye syndrome involves steps such as implementing proper eye hygiene, limiting computer screen use, avoiding dry, smoky, windy, and dusty conditions, reducing or quitting smoking, avoiding refractive surgery, using lubricating drops or ointments, wearing protective eyewear outdoors, drinking plenty of water to prevent dehydration and blinking regularly.

FAQs

How do dry eyes feel?

If you have dry eyes, you will experience an uncomfortable sandy-gritty eye irritation sensation like something is stuck in your eye. You also experience a stinging, itching, or pulling sensation in your eye with sensitivity to bright lights.

Is dry eye serious?

Dry eye is almost always a serious problem since it can interfere with your vision and the quality of your life. Although complications seldom develop, if left untreated or not treated properly, the condition can lead to impaired vision or even vision loss in extreme cases.

References

1. Dry Eye. (December 2020). National Eye Institute.

2. Dry eye: diagnosis and current treatment strategies. (July 2004). National Center for Biotechnology Information.

3. Etiology, prevalence, and treatment of dry eye disease. (July 2009). Clinical Ophthalmology.

4. Dry Eye Disease (Keratoconjunctivitis Sicca. (January 2022). Medscape.

5. Dealing with Dry Eye. (June 2005). Food and Drug Administration Consumer Magazine.

6. Keratoconjunctivitis Sicca. (May 2020). Merck Manual Professional Version.

7. Aging and dry eye disease. (April 2012). Experimental Gerontology.

8. The influence of gender on the ocular surface. (March 1999). National Center for Biotechnology Information.

9. Discordant Dry Eye Disease (An American Ophthalmological Society Thesis). (August 2016). Transactions of the American Ophthalmological Society.

10. What is Dry Eye? Symptoms, Causes, and Treatment. (September 2021). American Academy of Ophthalmology.

11. The Pathophysiology, Diagnosis, and Treatment of Dry Eye Disease. (January 2015). Deutsches Arzteblatt International.

12. Management of Dry Eye. (April 2008). American Journal of Managed Care.

13. Punctal occlusion for dry eye syndrome. (June 2017). The Cochrane Database of Systematic Reviews.