It's easy to take tears for granted—until they stop doing their job. Not only do they lubricate your eyes and keep them comfortable, tears also deliver oxygen to the cornea, flush away debris, contain antibacterial agents, maintain vision clarity, and promote healing. And tears are more complicated than they seem. A system of glands and ducts produces a three-layer film—an oily outer layer, a watery middle layer (containing proteins, sodium, and other substances), and a mucus coating over the cornea—that spreads evenly over the eyes and limits evaporation.
Everyone experiences dry eyes at least occasionally. But if your eyes constantly burn, sting, feel scratchy and gritty, and even hurt, you may have what’s commonly called dry eye syndrome (or disease). The symptoms may also include blurry vision and increased light sensitivity. Paradoxically, you may also experience excessive tearing and watering intermittently, which is a response to microscopic corneal scratches caused by the dryness. In addition to having dry eye syndrome, some people suffer from allergies that affect their eyes, leading to even worse symptoms and complicating treatment. If dry eye syndrome is severe and left untreated, it can eventually scar the cornea and possibly cause permanent vision problems.
How dry I am
Dry eye syndrome is common, especially after age 40, and can interfere with reading, work, driving, and life in general. Women are more susceptible than men, particularly around menopause, suggesting that hormonal changes play a role.
The syndrome can be the result of decreased tear production, altered tear composition, and/or rapid evaporation or drainage of tears. It has many different causes and contributing factors. For example, Sjögren's syndrome and certain other autoimmune diseases can reduce tear production or alter tear composition, as can blepharitis (a common condition of the eyelids that affects the oily layer of the tear film). Parkinson’s disease and Bell's palsy can reduce blinking and thus cause dryness. Chronic dry eye is a side effect of many drugs, notably beta blockers (for hypertension and cardiac arrhythmias), diuretics, and certain antidepressants and antihistamines. Contact lenses and LASIK eye surgery can also contribute to or cause dry eyes. One relatively new theory is that chronic inflammation of tear glands often plays a major role in the syndrome.
The symptoms may worsen in windy, dry, or hot conditions and when air pollution levels rise. Activities such as computer use can cause dry eyes, largely because blinking tends to slow, leading to greater tear evaporation.
Relief and prevention
If your eyes often feel dry and burn, try the following:
- When working at a computer screen or reading a book or newspaper, remember to blink regularly and take frequent breaks.
- Avoid tobacco smoke, hair dryers, overheated rooms, fans blowing on your face, and riding in a car with the windows open. Wear wraparound sunglasses outdoors.
- If you wear contact lenses, consider switching to glasses or changing your replacement schedule.
- Over-the-counter "artificial tears," preferably preservative-free brands, can lubricate and moisturize dry eyes. They come in different formulas and viscosities. Thinner drops provide fast—but short-term—relief. More viscous products (which may also come as gels) provide greater moisturizing ability, but because they cause temporary blurring they are best used at bedtime and should not be used before driving. Avoid drops that claim to "get the red out," which usually contain a decongestant (such as phenylephrine or naphazoline) and can worsen dry eyes.
- Lubricating ointments (such as DuoLube, Refresh PM, or Lacri-Lube), used at bedtime, help treat dry eyes overnight, allowing you to start the day with moist eyes.
- Warm compresses on the lids can help melt semi-solid secretions blocking the tear glands and increase the production of some tear components. You can use a warm washcloth, but there are also eye masks (usually microwavable) designed for this purpose.
- Eat more fish. There’s some evidence that people with low dietary intakes of omega-3 fats from fish are at increased risk for dry eye.
- Be skeptical about dietary supplements containing vitamins, minerals, and herbs that are promoted as treatments for dry eye syndrome. There’s little or no clinical research to support the claims. Some eye care professionals recommend fish oil supplements, though the evidence about them has been inconsistent.
- If you don't close your eyes completely when blinking, simple exercises may help.
Treatments, old and new
If the steps above don’t help enough, consult your doctor to find out if there is an underlying cause that can be mitigated. You may be referred to an ophthalmologist or optometrist. If necessary, you may also be referred to a dry eye clinic (specialists in dry eye, some located at universities), where you can get a fuller workup, including tests to analyze your tears and assess gland function.
A variety of prescription medications are used to treat dry eye syndrome. These include cyclosporine A (Restasis), which reduces inflammation and restores tear production in many patients; corticosteroid drops; nonsteroidal anti-inflammatory drops; eye lubricants, including Lacrisert, a cellulose-containing artificial tear insert that dissolves under your lower eyelid; and antibiotic ophthalmic ointments.
There’s also a rapidly growing array of in-office therapies for dry eye syndrome, depending on its cause and severity. Punctal occlusion is an established procedure in which tiny collagen or silicone plugs are inserted in the openings (puncta) in each eyelid through which tears normally drain, thus creating more of a reservoir of tears. A newer treatment for dry eye caused by excessive evaporation is LipiFlow, which uses controlled heat and pressure to help clear blocked oil glands in the eyelids. Another option is intense pulsed light therapy, which uses bursts of light for a similar effect on tear glands.
Bottom Line: Self-care steps help many people with milder forms of dry eye syndrome. But for persistent or severe cases, it’s essential to consult an eye care professional to diagnose your specific problem and tailor treatment to it.
See also Diet for Healthy Eyes.