Dry eyes: understanding the symptoms and causes and finding relief

“No more tears” may be something to strive for, but an actual lack of tears can cause an uncomfortable condition known as dry eye. “Normally, eyes constantly make tears to stay moist,” says Natasha Herz, MD, clinical spokesperson for the American Academy of Ophthalmology. When they don’t, we end up with dry, scratchy, stinging eyes.

Dry eye is common, with more than 16 million Americans suffering from the condition. As we age, the risk increases, and women of all ages are about twice as likely to experience dry eye as men.

If your eyes get this painful, gritty sensation, a number of options await — including over-the-counter eye drops and lifestyle shifts. Here’s what you need to know about dry eyes and how to get some relief support. With any luck, there shouldn’t be a dry eye in the house.

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Dry eye symptoms

While the official term is keratoconjunctivitis sicca, the common name for this condition explains just how it feels. The primary symptom of dry eye is just that: a sensation of dryness in and around the eyeballs. You might also experience these eye-related symptoms:

• Blurry vision
• Burning, pressure or stinging
• Eyelid twitching
• Excessive blinking
• Inability to produce tears
• Redness
• Sensitivity to light
• Stringy mucus around the eye
• Tired eyes
• Watery eyes

What causes dry eyes

Tears are a big part of how eyes are supposed to work. “Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter and keep the surface of the eyes smooth and clear,” says Ronald L. Benner, OD, president of the American Optometric Association.

When our eyes are healthy, tears spread across the eye’s surface with every blink. But that gets interrupted when we don’t produce enough tears, or when the tear film — a protective layer of water, oil and mucus — gets damaged, making tears evaporate too quickly.

Some people with dry eyes, oddly, can experience watery eyes. A lack of normal tears makes the lacrimal gland (an area responsible for sad and happy tears) go into overdrive. “Excess tears in the eyes flow into small drainage ducts in the inner corners of the eyelids, which drain into the back of the nose,” says Dr. Benner.

Risk factors for dry eyes

This condition can crop up for a number of reasons. It’s important to understand with your health care provider why you’re experiencing dry eye, since this will determine the best way forward. Reasons might include any of the following:

• Age: As we get older, the ability to produce tears gets weaker. After the age of 65, most people will experience some dry eye symptoms.
• Allergies: Pollen and other substances can cause allergic red eye, making the eyes itchy and watery. The use of antihistamines to fight them can also cause dry eye.
• Contact lenses: Over time, contact lens wear can alter your tear film, a major driver of dry eye syndrome.
• Environment: Being in windy or dry climates can cause tear production to decrease or tears to evaporate too quickly. Air conditioning, eye makeup, fans and heating can also contribute to dry eye.
• Eye surgery: Corrective surgery, including LASIK, can contribute to dry eyes.
• Hormone shifts: Hormonal shifts can lead to tear imbalances, and this is especially true for women. “Dry eye is more common in women going through menopause,” says Dr. Herz. Menstrual cycle variations, oral birth control and conditions like polycystic ovarian syndrome can also lead to dry eye.
• Medical conditions: Diabetes, lupus, rheumatoid arthritis, thyroid disease and other diseases can increase the risk.
• Medication: Certain antidepressants, antihistamines, decongestants and opioids are among the medications that have dry eyes as a side effect.
• Screen time: Long hours at the computer — or scrolling on the phone — can be a contributing factor.

As always, it’s best to get a professional opinion before trying to address persistent symptoms. “The only way to know for sure if you've got chronic dry eye syndrome is to have your doctor of optometry perform several dry eye tests during an eye exam,” says Dr. Benner.

Eye drops for dry eyes

The most common treatment for dry eye is available without a prescription. Over-the-counter lubricating eye drops, aptly called artificial tears, act like natural tears to help the tear film work more effectively. “There are many over-the-counter brands to choose from, but keep in mind that no single brand works best for all types of dry eye,” says Dr. Herz. She recommends trying a few different options until you find a solution that works best for you.

“If you use artificial tears more than four times a day or are allergic to preservatives, you should use preservative-free tears,” says Dr. Herz. 

Other ways to help soothe dry eyes

Lifestyle changes can make a difference in dry eye discomfort. Dr. Herz recommends avoiding cigarette smoke and reminding yourself to blink and take breaks while working at a computer. Dr. Benner adds that wearing a sleep mask at night may help.

Using a humidifier in the home adds moisture to dry air. An air purifier may help in areas with a lot of air pollutants.

If at-home solutions aren’t working, more intensive treatments are available. Your doctor may recommend prescription medication, pulsed light treatment, surgery or duct plugs to conserve tears.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements, and prior to beginning or changing any health care practices.