Updated on 

April 8, 2022

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Dry Eye: Causes, Symptoms & Treatment

What Is Dry Eye?

Dry eye means that your eyes don't have enough lubrication. Other terms for dry eye include dry eye syndrome, dry eye disease, and keratoconjunctivitis sicca.

For many people, it is a chronic condition. For others, it is a temporary symptom of contact use, eye surgery, certain medications, or environment.

Dry eyes can be the result of:

  • A lack of tear production
  • Poor quality of tears

Studies estimate that approximately 7 to 33% of people have dry eye symptoms. 

11 Common Causes of Dry Eye

Several factors can influence your risk for dry eyes. Generally, women and people over 50 are more likely to develop dry eye syndrome.

The most common causes of dry eye include:

1. Older age

Your tear production declines with age.

In women, hormonal changes that occur with menopause negatively affect tear secretion. In men, a decline in androgen levels with age can cause a decrease in tear production.

2. Female gender

Menopausal and post-menopausal women have a higher risk of dry eyes.

3. Environment and climate

Sunny or windy conditions can trigger dry eyes. Pollution, pollen, dust, and other environmental irritants can also aggravate symptoms.

People living in dry climates are more prone to dry eye than those living in humid climates.

4. Contact lenses

Many people who wear contact lenses also suffer from dry eye.

Contact lenses:

  • Affect the quality of your tear film
  • Restrict oxygen and tear flow
  • Can trap allergens and irritants in your eye

All of these factors can aggravate dry eyes.

5. Digital devices

Blinking helps your eyes distribute fresh tears.

However, most people who stare at a tablet, phone, or computer screen often do not blink frequently enough while using their device. This causes your eyes to dry out faster.

6. Medications

There are several classes of drugs that can cause dry eyes.

These include:

  • Blood pressure medication
  • Allergy (antihistamine) medication
  • Antidepressants
  • Antipsychotics
  • Decongestants
  • Hormonal therapies
  • Diuretics
  • Sedatives
  • Retinoids (such as Accutane).
7. Eye surgery

Laser eye surgery (such as LASIK) and cataract surgery can disrupt the tear film. Post-surgical dry eye is common. Most cases are temporary; others are long-lasting.

8. Systemic conditions

Sjogren's Syndrome is an autoimmune disease that causes dry eyes and dry mouth.

Other conditions frequently associated with dry eye syndrome include:

  • Rheumatoid arthritis
  • Lupus
  • Diabetes
  • Thyroid problems
9. Blepharitis

Blepharitis is when your eyelids are swollen or red. It is usually caused by clogged oil glands.

10. Entropion

Entropion is a condition where your eyelid is turned inward. This causes your eyelashes to rub against your eyeball.

11. Ectropion

Ectropion is a condition where your eyelid turns outward. This leaves your eyes exposed and prone to irritation.

Why Are Tears Important?

A healthy tear film is important because your tears:

  • Flush out irritants
  • Prevent eye infections
  • Help you see clearly
  • Lubricate your eyes

Your tear film consists of three layers:

Mucin (mucous) layer

The first layer of your tear film (closest to your eye) is the mucous coating. It helps spread tears across your eye each time you blink. Goblet cells in your conjunctiva produce the mucin layer.

Aqueous (water) layer

The aqueous layer is the second and biggest layer of your tear film. This water layer helps moisturize your eyes and maintains clear vision.

The lacrimal glands, which sit behind the outer part of your eyebrow, produce the aqueous layer.

Lipid (oil) layer

The lipid is the outer layer of your tears. An oil layer is essential because it keeps the aqueous layer from evaporating quickly. The meibomian glands along your eyelid margins produce the oil.

tear film eye scaled e1587582183284

Each time you blink, your eyelids help distribute a fresh layer of tears across your eye. If there is a deficiency in any of these tear film layers, you can have dry eyes.

Types and Symptoms of Dry Eye

Dry eye is categorized based on the affected tear film layer: 

Aqueous deficient dry eye

This is when your lacrimal glands do not produce enough of the aqueous layer of tears. It's less common and usually affects people with underlying systemic conditions.

Evaporative dry eye

This occurs when you do not have a sufficient lipid layer in your tear film, causing the aqueous layer to evaporate. It's the most common type of dry eye and occurs when the meibomian (oil) glands are clogged.

People with rosacea are prone to evaporative dry eye.

Dry Eye Symptoms

Dry eye syndrome (chronic dry eye) affects a large percentage of the population. These percentages are likely to increase due to increased digital screen exposure. This can aggravate dry eyes.

Physical symptoms of dry eye syndrome include:

  • Burning sensation
  • Itching
  • Heavy or sore eyes
  • Foreign body sensation (feels like an eyelash is in your eye)
  • Discharge
  • Redness
  • Tearing
  • Eye pain

Visual symptoms of dry eye syndrome include:

How to Treat Dry Eye

There are a variety of treatments for dry eye, depending on the severity of the disease.

Some at-home therapies include:

Lubricating eye drops

Lubricating drops, also known as artificial tears, provide extra moisture for your eyes.

There are many over-the-counter options to choose from. Your eye doctor can recommend a specific type depending on the severity and type of dry eye you have.

Heat compresses

Heat compresses are helpful for clogged Meibomian glands. Clogged glands can lead to a deficiency in the lipid layer of your tear film. The heat, along with a gentle eyelid massage, encourages the oil glands to open up.

Your eye doctor can examine your eyes to check for clogged Meibomian glands.

Omega-3 fatty acid supplements

Omega-3 supplements such as fish oil or flaxseed oil have anti-inflammatory properties.

Since dry eye syndrome is considered an inflammatory condition, some research suggests taking omega-3 supplements may improve symptoms.

Humidifier

You can buy a humidifier (especially during winter) to help relieve dry eye symptoms.

Prescription medications or in-office treatments can also treat dry eye:

Meibomian gland expression

Your eye doctor can perform this procedure to unclog your oil glands if the heat compresses do not help.

Punctal plugs

Your eye doctor can place plugs into your puncta, the small holes in your eyelids that drain tears out of your eyes. The plug will slow down tear drainage, allowing more tears to stay on the surface of your eyes.

Temporary punctal plugs are made of collagen and dissolve after a few months. Semi-permanent plugs made of silicone are also available.

Corticosteroid eye drops

Corticosteroid eye drops are prescription anti-inflammatory drops that can improve dry eye symptoms.

Corticosteroids can increase your risk of cataracts and glaucoma. That's why most doctors only use this as a short-term treatment.

Immunomodulatory drugs

These medications change your body’s immune response.

Cyclosporine (brand name Restasis) and lifitegrast (brand name Xiidra) are two eye drop medications in this class of drugs. They work by reducing inflammation associated with dry eyes and stimulating your eyes to produce more tears.

Severe cases of dry eye may have to be treated with:

Autologous serum eye drops

These eye drops are made with your blood. The components of this serum are naturally found in your tears and promote healing.

Autologous serums are usually reserved for severe dry eye disease where the eye's surface is damaged.

Amniotic membranes

Amniotic membranes are made from the placental tissue of female donors after they give birth.

In a simple in-office procedure, your eye doctor places the membrane onto your cornea. The amniotic membrane serves as a biological bandage that promotes corneal healing and reduces inflammation.

Can Dry Eyes Cause Blindness, Headaches, or Floaters?

Dry eye rarely causes blindness. However, severe cases can cause significant pain and blurry vision. 

Your cornea, the clear covering over your eye, is a delicate tissue filled with nerves. Good corneal health is essential for clear vision.

Severe dry eye syndrome can damage the cornea, which is why you have symptoms of pain and blurry vision. If left untreated, permanent scarring of the cornea and vision loss can occur.

Can Dry Eyes Cause Headaches?

The connection between dry eyes and migraines is unclear. However, people who get frequent migraines appear to develop dry eyes more often.

Can Dry Eyes Cause Floaters?

Dry eye is typically not a risk factor for floaters. Eye floaters are spots you see in your field of vision. They are common and usually harmless. 

Some spots can move around, while other floaters appear stationary. Other people may see flashes of light instead of spots, which can look like someone is turning the light switch on and off. 

9 Cited Research Articles
  1. Ambroziak, Anna M., et al. “Immunomodulation on the Ocular Surface: a Review.” Central European Journal of Immunology, vol. 41, no. 2, 15 July 2016, pp. 195–208., doi:10.5114/ceji.2016.60995.
  2. “Amniotic Membrane in Ocular Surface Disease.” Optometry Times, 20 Dec. 2013, www.optometrytimes.com/articles/amniotic-membrane-ocular-surface-disease. Accessed 11 Mar. 2020.
  3. Donnenfeld, Eric D., et al. “Safety of Lifitegrast Ophthalmic Solution 5.0% in Patients With Dry Eye Disease.” Cornea, vol. 35, no. 6, 2016, pp. 741–748., doi:10.1097/ico.0000000000000803.
  4. Farrand, Kimberly F., et al. “Prevalence of Diagnosed Dry Eye Disease in the United States Among Adults Aged 18 Years and Older.American Journal of Ophthalmology, vol. 182, Oct. 2017, pp. 90–98., doi:10.1016/j.ajo.2017.06.033.
  5. Fraunfelder, Frederick T., et al. “The Role of Medications in Causing Dry Eye.Journal of Ophthalmology, vol. 2012, 2012, pp. 1–8., doi:10.1155/2012/285851.
  6. Gayton, Johnny. “Etiology, Prevalence, and Treatment of Dry Eye Disease.” Clinical Ophthalmology, vol. 3, 14 July 2009, pp. 405–412., doi:10.2147/opth.s5555.
  7. Javadi, Mohammad-Ali, and Sepehr Feizi. “Dry Eye Syndrome.” J Ophthalmic Vis Res, vol. 6, no. 3, July 2011, pp. 192–198., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306104/. Accessed 11 Mar. 2020.
  8. Ozdemir, M, and H Temizdemir. “Age- and Gender-Related Tear Function Changes in Normal Population.” Eye, vol. 24, no. 1, 20 Feb. 2009, pp. 79–83., doi:10.1038/eye.2009.21.
  9. Sindt, Christine W., and Reid A. Longmuir. “Contact Lens Strategies for the Patient with Dry Eye.The Ocular Surface, vol. 5, no. 4, Oct. 2007, pp. 294–307., doi:10.1016/s1542-012470095-2.
Melody Huang is an optometrist and freelance health writer. Through her writing, Dr. Huang enjoys educating patients on how to lead healthier and happier lives. She also has an interest in Eastern medicine practices and learning about integrative medicine. When she’s not working, Dr. Huang loves reviewing new skin care products, trying interesting food recipes, or hanging with her adopted cats.
https://www.visioncenter.org/author/melody/
Author: Dr. Melody Huang, O.D.  | UPDATED April 8, 2022
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