Author: Medical reviewer:
October 09, 2024
Contributing writer
Contributing writer
Kirsten Nunez is a health and lifestyle journalist based in Beacon, New York. She has a Master of Science in Nutrition from Texas Woman’s University and Bachelor of Science in Dietetics from SUNY Oneonta.
Medical review by
Scott Nass, M.D., MPA, FAAFP, AAHIVS
Board-certified Family Physician
Scott Nass, M.D., MPA, FAAFP, AAHIVS is a family physician and HIV specialist in California. He takes a holistic approach to healthcare, incorporating principles of functional medicine and using food as medicine when working with patients.
Image by Denis Komarov / iStock
October 09, 2024
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There’s nothing like itchy, irritated eyes to throw your day off course. Maybe you’re dealing with seasonal allergies, or you have something stuck in your eye. Or maybe you stayed up way too late reading and your eyes are just plain tired (we’re guilty of that too). Truthfully, it’s normal to experience the occasional eye dryness—but if your eyes constantly feel like parchment, you might have dry eye disease.
Also known as dry eye syndrome, dry eye disease can trigger a variety of irritating symptoms. It’s also super common, affecting about 16 million people in the US. Here, learn everything you need to know about dry eye, plus the best treatment options available.
What is Dry Eye Disease?
“Dry eye disease is a condition where there are not enough quality tears to lubricate, moisturize, and nourish the eyes,” explains Rosalyn Perez, OD, FAAO, optometrist at Manhattan Eye, Ear, Nose Throat Hospital. This can happen because your eyes don’t make enough tears, your tears evaporate too quickly, or both, according to the National Institutes of Health1. The result? Dry eyes in a blink of an eye—no pun intended.
Since your tears are meant to hydrate and protect the cornea (the clear part that covers the eye), this lack of tears can cause inflammation and irritation. Over time, if left untreated, it may even damage the eye’s surface.
Causes
There are many possible causes of dry eye disease. Here’s a brief rundown:
As we get older, tear production naturally declines2, causing our tear glands to make less tears. Aging also reduces skin elasticity, making the eyelids sag, says Perez. This can prevent the eyelid from closing properly, which is key for spreading tears across the eye’s surface. Plus, aging increases the need for medication, potentially prompting side effects that further worsen dry eye, notes Perez.
2.
Meibomian gland dysfunction
The meibomian glands are found along the edge of your eyelids, right along the eyelashes. They release meibum, a type of oil, that prevents tears from evaporating too quickly. Meibomian gland dysfunction3 (MGD) happens when there’s something wrong with these glands, causing tears to dry up too fast.
Menopause causes a natural drop in androgens, male sex hormones that women naturally have. This can lead to dry eye, as androgens support the function4 of meibomian glands. Even the menstrual cycle can contribute to dry eye, as tear production tends to drop during the follicular phase5. This phase is marked by low levels of estrogen and progesterone, two hormones that affect tear production.
In an autoimmune disease, the dysfunctional immune response can cause inflammation in the eye6, triggering dry eye disease. Examples of autoimmune conditions linked to dry eye include Sjögren’s syndrome, rheumatoid arthritis, systemic sclerosis, and lupus.
Dry eye disease is a side effect of many medications, including antihistamines, diuretics, beta-blockers, decongestants, oral contraceptives, oral isotretinoin, antidepressants, and anti-anxiety drugs. Depending on the medication, it can cause dry eye by reducing the function7 of the tear gland or meibomian gland (or both).
Living in a dry or windy area can make your tears evaporate quickly. You might also be more prone to dry eyes if you spend a lot of time in air-conditioned rooms, have pollen allergies, or are frequently exposed to secondhand smoke.
Some habits, like prolonged reading, driving, and looking at screens, can dry out your eyes. Regularly wearing contact lenses can also worsen your symptoms.
Chronic conditions like Bell’s palsy, diabetes, and hepatitis C are associated with dry eye. The risk is especially high with Parkinson disease, as the condition reduces how often you blink.
Symptoms
The most common symptoms of dry eye disease include:
- Eye dryness
- Eye fatigue
- Scratchy sensation in the eye
- Stinging or burning in the eye
- Red eyes
- Blurry vision
- Difficulty driving at night
- Sensitivity to light (photophobia)
- Feeling like something is stuck in your eyes
- Difficulty wearing contact lenses
- Difficulty driving, reading, or using a computer
Diagnosis
An optometrist or ophthalmologist can diagnose dry eye disease. At your appointment, they can evaluate the quantity and quality of your tears and rule out possible diseases.
Typically, your eye doctor will perform a comprehensive eye exam, which might include the following tests:
- Slit lamp test: Special drops will be added to your eyes to make your tears more visible. Next, your eye doctor will examine your eyes using a bright light and microscope called a slit lamp.
- Schirmer test: Your eye doctor will insert “little strips of paper at the edge of your eyelid, which measure how much tears are being produced,” says Perez.
- Tear break up time test: This test measures how quickly your tears evaporate, notes Perez. It involves putting dye in your eyes, which spreads over your entire eye as you blink. Your eye doctor can determine if you have dry eye disease depending on how long the dye lasts.
Treatment Options for Dry Eye Disease
Eye drops
- Over-the-counter drops: According to Perez, the first line of treatment for dry eye is over-the-counter (OTC) artificial tears. These are available without a prescription, so you can stroll into your local drugstore and buy them right off the shelf. OTC tears are designed to “maintain the moisture you do have [in your eyes] and prevent your symptoms from getting worse,” says Perez. They’re also considered a short-term treatment, as they’re meant to relieve mild symptoms in the moment.
- Prescription drops: Whereas OTC drops add artificial moisture to the eyes, prescription drops target the underlying cause—i.e., poor tear production, inflammation, or even tear evaporation, says Perez. This is a long-term treatment that can provide relief for folks who deal with it chronically.
Lifestyle and environmental changes
- Humidifiers: Use a humidifier at home. This will add moisture to the air, preventing tears from evaporating too quickly. Just be sure to clean it on the reg!
- Protective eyewear: Protect your peepers from wind, dust, and pollen by wearing protective eyewear. This is particularly helpful if you live in a windy area or spend a lot of time outdoors.
- Hydration and diet: “Staying hydrated will support the body’s ability to [properly] produce tears,” says Perez. A well-balanced diet is also key for overall eye health, though it doesn’t hurt to focus on vitamin A and omega-3 fatty acids for vision and anti-inflammatory support, respectively.
- Lid hygiene: If you have MGD, your doctor might recommend cleaning your eyelids regularly. This might involve warm compresses, mild cleansers, and gentle massages to help the meibomian glands release oil.
Advanced therapies
- Prescription medications: As mentioned, your doctor can prescribe medicated eye drops, like those that target tear evaporation or tear production. Another option is medicated nasal spray, which improves tear and oil production. And ICYW, there are no oral prescription medications for dry eye disease, says Perez.
- Therapeutic contact lens: Special contact lens can protect the cornea and keep the eye hydrated, potentially improving dry eye symptoms.
- Intense pulsed light: Intense pulse light8 (IPL) therapy uses light to unblock meibomian glands. This helps the tear film stay on your eye a bit longer. Usually, IPL is used for folks with both MGD and rosacea9.
- Meibomian gland expression: For severe MGD10, your healthcare provider can clear blocked meibomian glands using heat or a probing device. This can improve the production and quality of your tears.
- Punctal plugs: Tiny plugs are inserted into the tear ducts, helping reduce tear drainage so the eyes stay moist. The plugs can be temporary or semi-permanent, according to the American Academy of Ophthalmology.
- Tarsorrhaphy: In severe cases, dry eye might be related to poor eyelid closure or blinking. This might warrant a tarsorrhaphy11, which involves sewing part or all of the eyelids together to shield the cornea and reduce tear evaporation. A tarsorrhaphy can be temporary or permanent.
The takeaway
If you think you have a dry eye disease, chat with an eye doctor. They can determine the cause of your symptoms, along with a personalized management plan. After all, there are a lot of treatment options, so following your doc’s recommendations is the best way to find relief. And as always, talk to your healthcare provider before trying a new treatment for dry eye disease. Your eyes will thank you!