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

Just about everyone has experienced a feeling of dryness in their eyes at some point. In fact, acute irritations are common, with many lifestyle choices and environmental factors — like staring at your phone or being in a low-humidity environment — triggering symptoms, says Whitney Hauser, MD, an optometrist 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)

Dry eye may cause various problems with the eyes. Common dry eye symptoms include: (1,2,3)

• Stinging, burning, or itchiness
• Pain or redness
• Sandy or gritty feeling (as if something is in the eye)
• Stringy discharge (mucus)
• Periods of watery eyes followed by dry eyes
• Inability to cry
• Temporary blurred vision or eye fatigue
• Sensitivity to light
• Heavy eyelids
• Difficulty wearing contact lenses
• Eyestrain from reading or computer use

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
• Allergies
• 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.

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

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)

Acute dry eye caused by environmental factors, health problems, or medication may go away or improve once you identify the cause of dryness and make the necessary adjustments — such as treating an underlying health problem or switching medicines.(5)

Unfortunately, severe cases of dry eye can’t be fully cured, but all hope isn’t lost, says Arian Fartash, OD, a California-based optometrist.

“The best way to identify the cause of dry eye is to see your eye doctor,” Dr. Fartash says. “With the right tools and consistency, it can be managed.”

The right dry eye treatment often depends on the cause of your condition.

Over-the-Counter Options

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)

Prescription Options

While artificial tears are often the first line of defense for dry eye, more severe symptoms require a prescription from your ophthalmologist or optometrist.

But prescription products don’t necessarily rehydrate the eyes, so you may be advised to use both OTC artificial tears and one of the products listed below.

• The immune-suppressing drug cyclosporine ophthalmic (Restasis) relieves dry eyes by stopping inflammation that interferes with tear production. (8)
• Similarly, the prescription drug lifitegrast ophthalmic (Xiidra), a nonsteroid drug that can reduce inflammation, can also adequately manage the condition, says Hauser. (3)
• Corticosteroid eye drops may be used temporarily to reduce inflammation. (8)
• Antibiotic eye drops can also reduce eyelid inflammation, helping with the secretion of oil into your tears. (5)
• A tear-stimulating drug — cevimeline (Evoxac) or pilocarpine (Salagen) — 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)
• The nasal spray varenicline (Tyrvaya) also stimulates an increase in tear volume, but offers a novel delivery method: It is sprayed into each nostril, twice a day, rather than being administered as an eye drop, like most dry eye treatments.
• The drug perfluorohexyloctane ophthalmic (Miebo) is the first prescription dry eye treatment to relieve dry eyes by reducing tear evaporation on the surface of the eye. According to BioSpace, the eye drop forms a layer over the natural tear film, limiting its evaporation.

Surgery Options

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, although 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 washcloth 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)

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.

“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 quality of life.

Dry eye can occur at any age, but it’s most common in elderly people. (3)

Nearly five million Americans age 50 and older are affected by dry eye syndrome. (12)

Interestingly, the condition affects more women than men. (1,4)

Although dry eye can affect anyone, research finds that people of Asian descent may have a predisposition to dry eyes. A 2019 study investigated the difference in eye dryness, tear film quality, and ocular surface of 103 Asian participants and 103 white participants. The researchers 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)

Although dry eyes can occur as a result of environmental and lifestyle factors, some conditions also increase the likelihood of poor tear quality.

Dry eyes has been linked to the following: (14)

• Diabetes mellitus
• Thyroid disease, such as hyperthyroidism and hypothyroidism
• Rheumatoid arthritis
• Lupus
• Neurotrophic deficiency
• Eye surgery
• Side effects of medication, including diuretics, antihistamines, antidepressants, psychotropics, cholesterol lowering agents, beta-blockers, and oral contraceptives

According to a review published in 2017, perimenopausal and post-menopausal women are also prone to dry eyes. This is possibly due to a decrease in the hormones estrogen and androgen, which can affect tear film production. (15)