Dry Eye

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Dry eye disease—sometimes called dry eye syndrome or just dry eye—occurs when your body doesn’t produce enough quality tears to moisturize your eyes. This condition can cause a variety of troubling symptoms including itchy, red, and irritated eyes that are sensitive to light.

Typically when you blink, your eyes release a layer of tears called the "tear film" over your cornea, or the front part of your eye. Just like windshield wiper fluid for a car, the tear film helps wash away debris or germs that could cause an eye infection and helps keep your vision clear. But if your eyes don't make enough quality tears, you'll feel it—and your vision could worsen as a result.

Dry eye disease is common and affects over 16 million adults in the United States. While dry eye can be uncomfortable, the good news is that it is also typically easy to treat.

Most of the time, you can manage dry eye with eye drops and a few lifestyle changes—including staying hydrated and decreasing the time spent scrolling on your phone. But if left untreated, dry eye can lead to complications like eye infections, scratches on your cornea, and even vision loss.

Types

Your tears are made up of three layers: the oily layer, the aqueous fluid (watery) layer, and the mucus layer. If your tear glands don't have enough oil, water, or mucus, you may be more likely to develop dry eye.

The two types of dry you can have include:

  • Evaporative dry eye: This type of dry eye is the most common type and accounts for more than 85% of all cases. This condition is due to a blockage of the tiny oil glands (called meibomian glands) that line the margin of your eyelashes. When those glands are healthy, they produce a thin layer of clear oil that keeps tears from evaporating too quickly. But if the oil thickens and hardens, your glands can become clogged. As a result, your tears may dry up faster causing dry eye symptoms.
  • Aqueous dry eye: This type is less common than evaporative dry eye and roughly makes up one-tenth of all dry eye cases. Aqueous dry eye happens when another type of gland (called lacrimal glands) in your eye cannot make enough aqueous fluid. If your eye is producing less water, the components that make up your tear film can become imbalanced, making your eyes dryer than usual.

In rare cases, it can be possible to have both types of dry eye simultaneously.

Symptoms

Evaporative dry eye and aqueous dry eye tend to produce similar symptoms. You may experience some of the following symptoms in one or both of your eyes, regardless of which type of dry eye you have:

  • Redness
  • Difficulty blinking
  • Stinging, itching, or burning
  • Scratchy eyes
  • Blurry vision
  • Light sensitivity
  • Eye strain or fatigue
  • Inability to cry
  • Watery eyes
  • Stringy mucus in or around the eye
  • Trouble wearing contact lenses

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Causes

There are two primary reasons dry eye occurs:

  • Your eyes are not producing enough tears
  • Your tears don't have a balanced amount of oil, water, or mucus

Although anyone can experience dry eye, factors that increase your risk of developing the condition include:

  • Sex: Women are more likely to develop dry eye than men. Changes in hormones due to pregnancy, menopause, and using oral contraceptives may increase your risk of developing dry eye.
  • Age: Dry eye is more common in people older than 65.
  • Medications: Certain antihistamines, blood pressure medications, and antidepressants can lower how often your eyes produce tears.
  • Contact lenses: Long-term use of contact lenses or not taking proper care of your contact lenses can make it more likely to develop dry eye.
  • Environment: Smoke, wind, and dry climates can dry your eyes. 
  • Certain medical conditions: Diabetes, lupus, rheumatoid arthritis, or thyroid problems may increase your risk of developing dry eye.

Diagnosis

Many dry eye symptoms tend to overlap with other health conditions, so you will need an eye exam to get an official diagnosis. An eye care specialist, like an optometrist or ophthalmologist, can properly diagnose you.

Your eye care specialist will likely ask you about your symptoms and how long you have had them. They may also want to take a closer look at your tears and may perform exams to test different factors including:

  • Production: Your eye care specialist may use a Schirmer's test by placing a delicate test strip under your eyelid to gauge how many tears your eye can make.
  • Quality: You may be asked to put a special dye into your eye so your eye care specialist can check how lubricated your eyes are and how long it takes your tear film to become dry. Alternatively, they may also conduct a fluorescein dye test which uses orange dye and a blue light to see if there are any scratches on your cornea.
  • Tear Film: Your eyecare specialist can also check the makeup of your tear film. People with dry eye usually have an imbalance of oil, water, or mucus in their tear film.

To rule out other health concerns, your eyecare specialist or healthcare provider can also order additional tests (e.g., blood tests) to ensure that another condition is not causing your dry eye.

Sometimes, you might get tested for dry eye even if you don't have symptoms. For example, if you're scheduled for eye surgery, your healthcare provider will want to know if you have dry eye ahead of time—and treat you for it if you do. For the best surgical results, the surface of your eyes should be in as good condition as possible. Surgery, like LASIK, is also known to dry and irritate your eyes, which can make your symptoms worse.

Treatment

Several different treatments can help lubricate your eyes and help them feel better. Your eye care specialist may suggest treatments like:

  • Artificial tears: This over-the-counter treatment typically includes eye drops, gels, and ointments, can lubricate your eyes.
  • Prescription eye drops: Some particular medications—such as Restasis (cyclosporine) and Xiidra (lifitegrast)—can help your eyes to produce more tears. 
  • At-home care: Some remedies you can do at home to ease symptoms include using a warm compress or giving yourself a gentle eyelid massage.
  • Punctual plugs: These plugs are tiny devices that your provider can put in your tear ducts to keep your tears from drying too quickly.
  • Surgery: Sometimes, having loose eyelids can dry out your tear film. If your eyelids are loose, you may need surgery—however, this treatment is uncommon.

It's essential to seek help for dry eyes—not only because they can make everyday habits like reading or driving uncomfortable. When you ignore your symptoms, you may start to experience redness and swelling, infections, corneal scratches, and—the worst-case scenario—vision loss.

Prevention

A few minor tweaks to your environment, diet, and lifestyle could significantly improve how your eyes feel. Trying some of the following preventative techniques may help:

  • Minimize time spent in air-conditioning: An air-conditioned room can have little humidity, which will dry out your eyes. A portable humidifier can help bring moisture and make your eyes feel more comfortable.
  • Keep air out of your eyes: Wind, hair dryers, fans—all of these can dry out your eyes. Try to keep any gust of air from blowing directly into your eyes.
  • Take breaks from screen time: It can be hard to stay off your phone or computer, especially if you’re required to be on your screens for school or work. Remember to periodically close your eyes for a few minutes or step away from your screen throughout the day to prevent drying out your eyes.
  • Position your screens: Keep your computer, phone, or tablet below eye level. If you have to look up to see the screen, you’ll widen your eyes, which can dry them out faster.
  • Wear sunglasses when you’re outside: Not only will they protect your eyes from the sun, but sunglasses will also shield you from dust and wind.
  • Keep your eyes hydrated: Aim to drink at least eight glasses of water each day and use artificial tears as an added bonus.
  • Prioritize sleep: Here’s another reason to try to get to bed early—there’s some evidence that sleep deprivation could make dry eye symptoms worse.
  • Take it easy on your eyes: Some people find that wearing contact lenses can aggravate dry eye symptoms. On days when your eyes feel extra-sensitive, try to not wear your contact lenses and instead opt to use a pair of eyeglasses.

A Quick Review

Dry eye is a chronic disease in which your body doesn't produce enough quality tears to lubricate your eyes. This condition can be debilitating, causing itchy, red, and irritated eyes that are sensitive to light, making reading, driving, or working difficult. 

Many people have dry eye. While this condition is easy to treat, try to reach out to your eye care specialist to receive a proper diagnosis if you start experiencing symptoms. Early treatment can prevent long-term issues, including eye infections or vision loss.