Most people don’t spend much time thinking about their eyes until there’s a problem — and then it’s hard to think of anything else. Dry eye disease is one of those issues that’s hard to ignore, leading to uncomfortable symptoms like eye dryness, scratchiness, and blurry vision.
“Dry eye is a multifactorial disease process,” says Mina Massaro-Giordano, MD, a codirector of the Penn Dry Eye and Ocular Surface Center and a professor of clinical ophthalmology at the University of Pennsylvania. “It can be very uncomfortable for patients.” Here, we cover what you need to know about dry eye disease, including its major symptoms, causes, and how to get relief.
Experts Featured in This Article:
Mina Massara-Giordano, MD, is a codirector of the Penn Dry Eye and Ocular Surface Center.
Mohammad Dastjerdi, MD, is a cornea and external diseases specialist at Rutgers Health.
Danielle Orr, OD, is the chief of the Advanced Ocular Care clinic at The Ohio State University College of Optometry.
Vivian Shibayama, OD, is an optometrist at UCLA Health.
What Is Dry Eye Disease?
Dry eye disease is a condition that happens when your eyes don’t make enough tears or when your tears don’t work correctly, according to the National Eye Institute. “Additionally, certain conditions can cause tears to evaporate from the surface of the eye more quickly than normal,” says Mohammad Dastjerdi, MD, a cornea and external diseases specialist at Rutgers Health. “Tears are essential for eye health as they keep the eyes moist, clear, and comfortable.”
Dry eye disease can cause a host of uncomfortable symptoms and can even make it difficult to see properly. Unfortunately, nearly 16 million Americans struggle with the condition.
Dry Eye Disease Signs and Symptoms
Dry eye disease is more than dry eyes, though. The following symptoms are also very common, per Dr. Massaro-Giordano:
That said, everyone experiences the condition differently. “Some patients state that their eyes feel dry, while others complain that their eyes water excessively,” says Danielle Orr, OD, the chief of the Advanced Ocular Care clinic at The Ohio State University College of Optometry. While extra tears seem like they would be helpful, Dr. Orr says that they’re “often not of high quality, so the eyes remain dry, and it creates a vicious cycle.”
What Causes Dry Eye Disease?
At its core, dry eye disease is an issue with tears. “Tears are not as simple as one might think,” Dr. Orr says. “There are different layers to the tears, produced by glands and structures on our eye surface and eyelids. Dry eye results from inadequate tear production, altered composition of the tear components, or both.”
But there are several underlying causes that can lead to dry eye disease. Dr. Dastjerdi breaks them down:
- Age. Tear production usually decreases with age, making older adults more prone to dry eye.
- Environmental factors. Wind, smoke, dry climates, or prolonged screen time can cause tears to evaporate.
- Meibomian gland dysfunction. Blockage or malfunction of the oil glands in the eyelids (called the meibomian glands) can lead to poor tear film quality.
- Medications. Some medications, like antihistamines, antidepressants, blood pressure drugs, and decongestants, can reduce tear production.
- Autoimmune conditions. Diseases like Sjögren’s syndrome, rheumatoid arthritis, and lupus can reduce tear production.
- Contact lenses. Wearing contact lenses over long periods can disrupt the tear film, leading to dryness.
- Hormonal changes. Changes during pregnancy, menopause, or while using birth control pills can impact tear production.
- Eye surgeries. Procedures like LASIK can sometimes impact tear production and cause temporary or long-term dry eye.
How Is Dry Eye Disease Diagnosed?
Dry eye disease is diagnosed during a comprehensive dilated eye exam. “Through a microscope, we can measure the tear volume and tear evaporation rate,” says Vivian Shibayama, OD, an optometrist at UCLA Health. “There is also a test called Schirmer’s where we use a paper strip to measure your tear production.”
How Is Dry Eye Disease Treated?
Treatment can vary based on patient needs. “In my experience, the most effective dry eye treatment often depends on the underlying cause and the severity of the condition,” Dr. Dastjerdi says. Treatment usually takes a “stepwise approach,” Dr. Orr says.
That means starting with lubricating artificial tears and good eyelid hygiene. “Environmental modifications can help, such as not sleeping with a fan blowing directly in your face, or taking breaks when on the computer,” she says.
Some people need prescription eye drops like cyclosporine (Restasis, Cequa) or lifitegrast (Xiidra), per Dr. Orr. “There is also a nasal spray, varenicline (Tyrvaya), that can stimulate tear production.”
Punctal plugs, which are small devices inserted into the tear ducts, can be placed in the tear drainage system to keep tears on the eyes for longer, Dr. Orr says. “In severe cases, autologous serum drops can be created from a patient’s own blood to provide added nutrients and growth factors,” she tells PS.
If someone is dealing with meibomian gland dysfunction, warm compresses, in-office procedures to express oil from the glands, and lubricants that contain oil can be helpful, Dr. Shibayama says. Specialty contact lenses can also be used to “bathe” the eye’s surface in a solution, Dr. Orr says.
“It is important to know that none of these treatments cure dry eye,” Dr. Orr says. “Treatments are often undergone for a long period of time, and in combination, with the goal of managing symptoms for this chronic condition.”
If you’re struggling with symptoms of dry eye disease, doctors say it’s important to get checked out. “You need to have somebody look at your eyes,” Dr. Massaro-Giordano says. “Many times, people come in thinking their eyes are dry and it’s just an allergy.”
Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women’s Health, Self, Health, Forbes, and more.
