Our eyes work hard every day. We move them about three times a second for a total of over 100,000 times a day. We blink about 15-20 times every minute. We roll our eyes, we have staring contests, we wink. So, when your eyes feel scratchy or dry, you want quick, lasting relief.
But what if uncomfortable, dry eyes are happening to you more often? What if your eyes aren’t just dry, but red, watery or sensitive to light?
You may be experiencing symptoms of dry eye disease – something that millions of Americans suffer from each year. But few people are aware of its causes or the best ways to treat it.
It may seem silly to bring up dry eye with your doctor or eye care specialist, but it’s not – dry eye can interfere with your quality of life and threaten the overall health of your eyes. Here’s what you need to know about dry eyes.
Your eyes at a glance
The eye is one of the most complex and hardest working organs in the human body, but most people don’t think about their eyes until they notice discomfort.
This inch-long sphere detects light and converts it into electrical impulses, which are then sent to the brain so it can interpret what you’re looking at. Think of it like a visual game of telephone or the process of taking a photo.
The front of your eye (comprised of the iris, cornea, lens and pupil) filters in light and focuses an image onto the membrane at the back of the eye, called the retina. This membrane sends electrical signals to the optic nerve, which then funnels them to the brain so you can understand what you’re seeing.
Because it’s made of several different layers, your eye needs to stay lubricated to function at its best.
What is dry eye?
Dry eye disease (also known as keratoconjunctivitis sicca) is a condition that occurs when your eyes don’t get enough moisture. Without proper lubrication, they can feel itchy and painful, often with an accompanying burning sensation or vision issues.
Dry eye can be triggered by several factors (more on that later), but it’s typically the result of decreased tear production or increased tear evaporation. This means that your eyes aren’t making enough tears or that the overall quality of your tears has decreased.
Tears keep our eyes from getting too dry
Tears are a nourishing liquid made of water, oil, proteins and mucus. In fact, researchers have discovered about 2,000 different molecules (so far) that make up our tears. Tears help your eyes function by lubricating the eye’s surface, which eliminates possible irritants and decreases the risk of infection. They’re also important in nourishing the tissues on the surface of the eye. But where do tears come from?
Tears are produced by two glands called the lacrimal glands. There is one above each eye, and they send tears to the surface of the eye through small openings inside the upper eyelid. Each time you blink, tears are spread evenly across your eye.
Tears are not just water. A series of glands called the meibomian glands surround the edges of your eyes and secrete oil. This oil prevents the water in your eye from evaporating too quickly and keeps it from spilling over the edge of your eyelid. Mucus is made by your conjunctiva, or the clear membrane that covers the whites of your eyes. This mucus helps tears distribute evenly across your eye and stick to the eye’s surface.
Each eye has two tiny holes located in the inner corner near the nose, one on the top eyelid and one on the bottom. These four holes are called puncta, and they act like drains, funneling tears out of the eyes with every blink. From the puncta, tears travel through the tear ducts and into vertical tubes called nasolacrimal ducts that run along either side of the nose. These tubes empty into the nasal cavity. Usually there is such a small amount of tears that we don’t notice it. But this connection is why we tend to blow our noses when we cry.
Sometimes the balance of tears in your eyes can be disrupted. “Inadequate” tears are tears made without the right mixture of oil, water and mucus, due to a variety of reasons. When there isn’t enough water, or water isn’t held in the eye by a layer of mucus on one side and oil on the other, then your eyes can’t be adequately lubricated and nourished.
If you think you might be experiencing dry eyes, some of these symptoms may sound familiar to you:
- A stinging, burning or itching sensation in your eyes
- Feeling that something is stuck in your eye
- Clear, stringy mucus in or around your eyes
- Eye redness
- Increased light sensitivity
- Difficulty driving at night
- Blurred or impaired vision, especially while reading
- Watery eyes
It may come as a surprise that watery eyes are in fact a side effect of dry eye. Sometimes the body’s response to eye irritation is to go into overdrive with tear production. However, in many cases these tears are made in such high quantities that their quality suffers.
What causes dry eye?
Typically, dry eye issues come down to functionality – maybe your glands aren’t making enough tears, or the kind of tears being produced aren’t adequately lubricating your eye. But what’s behind these malfunctions?
Factors that can contribute to dry eye include:
Although anyone can develop dry eye, people over 65 are more likely to experience it as part of the aging process. As we get older, our lacrimal glands slow down, producing less tears than they used to.
Another part of aging is a gradual loss of the muscle tension that keeps your eyelids in place. This laxity most commonly affects the lower eyelids and results in the eyelid either folding inward against the eye (entropion) or drooping outward away from the eye (ectropion).
With entropion, the lashes of the lower eyelid rub against the eye and cause chronic irritation and damage to the cornea. Ectropion, on the other hand, exposes more of the eyeball and the delicate tissue of the inner eyelid. Both conditions may need to be repaired with surgery.
Women are 2-3 times more likely to have dry eye than men, at any age. Research suggests that women are more susceptible to dry eye due to the hormonal changes they experience during pregnancy and menopause. Certain forms of birth control can also contribute to dry eye. Women are also more likely to wear makeup and use makeup remover, both of which contain ingredients that can irritate eyes.
Pre-existing health conditions
Your overall health is connected to the health of your eyes, and certain health conditions can have a big impact. Autoimmune disorders (like rheumatoid arthritis), thyroid dysfunction, diabetes, Sjogren’s syndrome, sleep apnea and seasonal allergies are all linked to dry eyes. Other illnesses like the common cold and COVID-19 can dry out your eyes too.
Medications meant to dry other parts of your body can inadvertently dry your eyes. These include antihistamines, decongestants and isotretinoin. Other culprits of dry eye are blood pressure medications (beta-blockers and diuretics), antidepressants, birth control pills, hormone replacement therapy, Parkinson’s medication and NSAID pain relievers.
Your eyes are always exposed to your surroundings, whether you’re in the desert, at the sauna or next to a cozy bonfire. Environments with very dry, hot air affect our eyes, as do polluted areas and smokey, windy, dusty or ultra-sunny conditions. Even regularly using a hairdryer can dry out our eyes.
Eye-related infection or inflammation
When it comes to our eyes, it can be hard to tell the difference between infection, inflammation and allergies. Sometimes your eye issues may be attributed to a mixture of all three. If you’re not sure what’s causing your problem, an eye doctor can help you determine the source.
Common eye conditions that are related to dry eye are blepharitis (eyelid inflammation), conjunctivitis (inflammation of the conjunctiva, commonly known as pink eye) and styes (a blocked oil gland on the eyelid).
Surgeries to correct certain eye issues can lead to temporary dry eye. In rare cases, this dry eye is permanent. Laser eye surgery and cataract surgery can result in minor dry eye symptoms that last from a few weeks to a year at most.
Those who frequently wear contacts, and who’ve worn them long-term, are also more likely to experience dry eye.
We spend a lot of time looking at digital screens, which has a big impact on our eyes and vision. Studies have shown people blink 66% less when looking at screens. If you work on a computer or other device, you’ll blink significantly less throughout the day as part of a condition called computer vision syndrome.
Can dry eye cause blurry vision?
Yes, dry eye can cause blurry vision. It’s a relatively common symptom and is often accompanied by some of the others listed above. However, blurry vision may be an indicator of something more serious. If your blurry vision lasts throughout the day or you experience other symptoms like floating spots, dizziness or double vision, contact an eye doctor right away.
Is chronic dry eye dangerous?
In some cases, it can be. Tears protect your eyes from bacterial buildup, and without that protective layer of tears, your risk of infection increases. Excessive tear evaporation and dryness can also lead to scratching or scarring on the corneal surface as well as an eye ulcer.
Does that mean dry eye can cause blindness? It may be possible, but it’s not likely. While there are many ways this condition can affect your vision, it’s incredibly rare for dry eye to cause total blindness.
At-home treatments for dry eyes
Depending on your symptoms, dry eye may respond to over-the-counter medicines and home remedies.
Try blinking exercises
We don’t think about our blinking, and for some dry eye sufferers, that’s exactly the problem. Try to be more conscious of and intentional about your blinking. First, make sure that each time you blink, your eyelids touch. Partial blinking causes and exacerbates dry eye symptoms.
Try gently closing your eyes and keeping them closed for two seconds before opening them again. Repeat this exercise five times. To build upon this exercise, perform the same motion, but after two seconds gently squeeze your eyelids together before opening them.
For more eyelid exercises, talk with your eye doctor.
Use lubricating eye drops
When looking at lubricating eye drops, also called artificial tears, you’ll find that you can purchase a range of over-the-counter options. They fall into two categories – standard and preservative-free. Standard eye drops contain preservatives that prevent bacterial growth after the eye drop bottle has been opened. You may find that these preservatives irritate your eyes further. In this case, preservative-free artificial tears may be a good choice – especially if you use eye drops frequently.
Protect your eyes from dry conditions
For many people, dry eye comes down to environmental factors. Is the air conditioning in your home making the air too dry? Are you consistently exposed to heat or smoke? If you can, remove yourself from those situations as soon as possible. You could also invest in a small humidifier to add moisture to the air in your home and wear wrap-around sunglasses when out and about on sunny, windy days.
Take occasional breaks from screens
We know screen time is necessary these days. But too much time spent staring at a computer or phone screen means significantly less time blinking, which can really strain your eyes.
If you must be plugged in for long periods, remember the 20-20-20 rule: Every 20 minutes, take 20 seconds to look at something at least 20 feet away. Or invest in a pair of blue light glasses, which protect your eyes from some of the high-frequency light emitted from electronic screens. Both strategies can help your eyes relax, and don’t forget to blink! Blue-light-blocking glasses come with claims to help reduce eye strain without taking screen breaks, but recent research hasn’t found much proof that they work effectively. Taking regular, quick screen breaks have a much more proven, positive and less expensive effect.
Who treats dry eye?
For more severe, complex or stubborn cases of dry eye, you may need to be treated by an optometrist. Optometrists are eye doctors who can diagnose and treat most eye-related health problems. They can also perform minor procedures, but if you need surgery for your dry eye, you will likely be referred to an ophthalmologist. Ophthalmologists are doctors who can perform eye surgeries.
When to talk to an eye doctor
Managing dry eye isn’t always simple, and sometimes you need a little help. If you’ve tried a few at-home solutions and things don’t seem to be improving, it might be time to visit an optometrist – especially if you’re experiencing more intense symptoms, like increased amounts of mucus that is no longer clear, excessive eye drainage, prolonged dizziness or other issues.
Your eye doctor can examine you to explore what may be causing your dry eyes and recommend a host of different treatment options depending on your needs. These can include anti-inflammatory medications, artificial tear eye inserts, medicated eye drops, customized lenses and procedures to correct eyelid, gland and tear system issues.
Looking for more information on dry eye disease?
Dry eye is usually no cause for alarm, but if it’s impacting your quality of life, it can feel like a big deal (and rightfully so).
To get help with additional questions, concerns and treatment recommendations for dry eye, make an appointment with an eye doctor. If needed, your eye doctor can also refer you to a dry eye specialist.