Dry Eye

Diagram shows structures in the eye involved in tear productionWhat is dry eye?

Dry eye results when there are not enough tears to properly lubricate the eyes, or the quality of the tears is not sufficient. It is one of the most common eye conditions, affecting millions of adults in the United States. Other names for dry eye are:

  • Dry eye syndrome
  • Keratoconjunctivitis sicca (KCS)
  • Dysfunctional tear syndrome
  • Lacrimal keratoconjunctivitis
  • Evaporative tear deficiency
  • Aqueous tear deficiency
  • LASIK-induced neurotrophic epitheliopathy (LNE)

What causes dry eye?

The following factors raise the risk of dry eye:

  • Getting older. Dry eye is more common in people age 50 and older.
  • Women are more likely than men to experience dry eye, particularly during pregnancy and menopause. They are also more likely to develop autoimmune disorders.
  • Medications, such as antihistamines, decongestants, birth control pills, hormone replacement therapy for menopause, antidepressants, and anti-anxiety medications. Certain medicines for high blood pressure and Parkinson’s disease can also cause dry eye.
  • Exposure to wind, smoke, and dry environments.
  • Seasonal allergies.
  • Looking at a screen too long and not blinking enough.
  • Autoimmune disorders such as lupus, rheumatoid arthritis, Sjögrens syndrome, and scleroderma can cause dry eye. So can diabetes, thyroid disorders, and vitamin A deficiency.
  • Laser eye surgery (LASIK) can temporarily cause dry eye.

What are the symptoms of dry eye?

Usually, lubricating tears called “basal tears” bathe your eyes and keep them moist and comfortable. Your tears normally contain more than 1,500 different proteins and contain an outer oily layer, a middle watery layer, and an inner mucus layer to keep the eyes wet. Every time you blink, basal tears flow across the surface of your eye (cornea), providing nourishment and protection. Dry eye may develop when your eyes don’t make enough basal tears or when the composition of your tears changes. You may experience:

  • A scratchy sensation
  • The feeling that something is in your eye
  • Stinging or burning
  • Discharge
  • Pain
  • Excessive tearing followed by periods of dryness
  • Redness
  • Heavy eyelids
  • Blurred vision, since tears play an important role in focusing light coming into your eyes

How is dry eye treated?

If you have persistent dry eye symptoms, see an eye care professional to determine the cause and the best treatment for you. Options include:

  • A change in medications. If your doctor believes a medication is causing your dry eye, a change to another drug may result in relief.
  • Eyedrops. Over-the-counter eyedrops (such as artificial tears), gels, and ointments may be all that is needed to relieve mild cases of dry eye. More serious cases may benefit from prescription eye medications such as lifitegrast or cyclosporine, which can decrease eye inflammation.
  • Changing your lifestyle or environment. Stopping smoking, limiting exposure to secondhand smoke, reducing your screen time, and taking breaks to close your eyes and blink repeatedly to replenish tears can help to curb dry eye symptoms. If you are regularly exposed to wind and dry air, wearing sunglasses that wrap around your face and have shields on the sides can reduce your exposure to wind and dry air.
  • Special devices. Certain devices have been approved by the U.S. Food and Drug Administration to temporarily relieve dry eye by stimulating the nerves and glands responsible for making tears.
  • Surgery. When nonsurgical approaches fail to relieve dry eye symptoms, surgery may help. An eye care professional inserts a silicone or collagen plug in the tear ducts at the inner corners of the eye to prevent tears from draining from the eye. In the most severe situations, the surgeon uses a technique called “thermal punctal cautery” to close the drainage ducts permanently.