Anyone who's ever dealt with dry eye knows the irritating symptoms: from scratchy, stingy, red and itchy eyes to an irksome sensation like something's in your peeper 24/7 or discomfort wearing contact lenses.
While the signs of dry eye are often easy to spot, the underlying reasons for this eye condition — which happens when your eyes don't produce enough tears or make healthy ones — can vary greatly.
Here, Arvind Saini, MD, clinical spokesperson for the American Academy of Ophthalmology (AAO) and ophthalmologist at Integrity Eye Associates, breaks down the most common causes of dry eye and offers tips on decreasing dryness and maintaining much-needed moisture in your eyes.
1. You Need a Break From Screens
Your digital devices aren't doing you any favors in the dry eye department. Whether you're scrolling through social media on your phone or sitting at a laptop all day, a lot of people experience this digital strain issue, Dr. Saini says.
Here's why: You're supposed to blink very frequently (approximately every five to seven seconds), but when you concentrate and stare at something, you don't blink as often, Dr. Saini says.
"Blinking is very important to refresh the tear film because every time you blink, it's like a windshield wiper — you're freshening that tear layer and you're bringing a new layer of moisture across the surface of the eye," he explains.
Simply put, if your blink rate decreases, the surface of your eye dries out.
Fix it: Practice the 20-20-20 rule. This is the idea that you should take a break every 20 minutes when you’re looking at a screen and look at an object about 20 feet away for about 20 seconds, Dr. Saini says.
To further reduce eye strain when using your digital devices, the AAO suggests doing the following:
- Adjust your screen brightness (it should be equal in brightness to the light around you)
- Increase the screen contrast
- Use a matte screen filter to reduce the glare
- Position your computer, tablet or phone so your gaze is slightly downward
2. You Have Poor Tear Quality
"Broadly speaking, dry eye occurs because you don't make enough tears or there's excessive loss of tears, and part of that is also poor quality of your tears," Dr. Saini says.
When it comes to poor tear quality (or unstable tears), by far the most common cause is blepharitis, he says. Blepharitis is an inflammation of the eyelid that can be caused by bacteria or problems in the oil glands in the eyelid.
Oil is a very important part of your tear layer because it sits on the tear surface (like an oil slick floating on water) and provides a barrier to evaporation, Dr. Saini explains. "So, when people have blepharitis, the oily layer is not uniform and not healthy and breaks up too soon, which allows for an excessive evaporation of tears," he says.
What's more, people with blepharitis also tend to have increased inflammatory chemicals in their tears, which can also cause irritation on the surface of the eye, Dr. Saini adds.
With blepharitis, your eyelid may also be red and itchy and look crusty or greasy.
Fix it: “The first line of treatment for people who have dry eye is over-the-counter artificial tears, which have lubricant properties and, depending on the brand/formulation, different degrees of viscosity,” Dr. Saini says.
But to resolve blepharitis, which is often the underlying cause of dry eye symptoms, warm compresses and eyelid scrubs are also particularly helpful. The National Eye Institute recommends these steps for cleaning your eyelids when you have blepharitis:
- Wash your hands with soap and water.
- Mix warm water with a gentle cleanser, like baby shampoo.
- Dip a clean, soft cloth in the water-soap mixture and press it against your closed eye to loosen crusts.
- Gently rub the cloth on the area where your eyelashes meet your eyelids.
- Rinse your eye with clean water, then repeat these steps on your other eye using a new cloth.
In addition, omega-3 oils, which may help reduce inflammation and enhance the function of the meibomian glands that produce the oily layer of tears, could also possibly improve dry eye symptoms for some people, according to the AAO. Talk to your eye doctor to decide if omega-3 supplements are a good treatment option for you.
3. Your Environment Is Too Dry, Windy or Smoky
The drier the environment, the drier the surface of your eye will be, Dr. Saini says.
Indeed, an April 2014 study in Ophthalmology found that people who live in higher-altitude climates with drier air are 13 percent more likely to suffer with dry eye than their lower-altitude counterparts.
In addition to a dry climate, things like wind and smoke can suck the moisture from your eyes too.
Wind — which wicks away tears — can be particularly tricky for people with blepharitis whose tears evaporate quickly, Dr. Saini says. This often leads to tiny scratches on the surface of the eye, causing even more irritation and reflex tearing.
"This is one reason why, paradoxically, people who have dry eye many times have a lot of tearing especially if they're in windy conditions," he says.
Similarly, smoke can also exacerbate — or even increase your risk of developing — dry eye symptoms, according to the AAO.
Fix it: “One way to treat this is to take eye drops uniformly throughout the day — in the morning, midday and at night — to keep your eye hydrated and to protect the surface of the eye,” Dr. Saini says. In other words, use artificial tears as a preventive measure rather than waiting until you have severe symptoms (when it’s often too late).
Wearing wrap-around glasses when it’s windy and using a humidifier to add moisture to the air are also simple-yet-effective strategies to combat dry conditions, per the AAO.
4. You Have a Certain Health Condition
Some medical conditions can lead to a decreased production of tears, Dr. Saini says. The most common culprits are Sjogren's syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, graft vs. host disease, sarcoidosis, thyroid disorders and vitamin A deficiency, according to the Mayo Clinic.
Fix it: Again, the mainstay treatment for most people is using artificial tears, which you can take up to four times a day. But if you’re using eye drops more than four to six times daily, talk to your doctor — you probably need preservative-free artificial tears, says Dr. Saini, explaining that some people experience irritation from the preservatives found in bottled drops.
5. It's Your Medication
Likewise, certain medications can deter you from producing enough tears too. These include diuretics, beta-blockers, allergy and cold medicines like antihistamines, sleeping pills, anxiety and antidepressant medicines and heartburn medicines, according to the AAO.
Medicines used to treat Parkinson's disease and acne as well as hormone replacement therapy and birth control may also inhibit tear production, per the Mayo Clinic.
Fix it: “If artificial tears don’t provide sufficient relief, try a hybrid gel drop or an ointment, which really lubricates (and sticks to) the surface of the eye,” Dr. Saini says. But keep in mind these thicker products can cause blurry vision, so it’s best to use them at night before bedtime.
In more severe cases, your ophthalmologist may also suggest taking prescription eyedrop medication or inserting small silicone or gel plugs in your tear ducts to prevent your natural tears from leaving your eyes too quickly, per the AAO.
Is This an Emergency?
- American Academy of Ophthalmology: “The Benefits of Fish Oil for Dry Eye”
- National Eye Institute: “Blepharitis”
- American Academy of Ophthalmology: “Remedies to Reduce Dry Eye Symptoms”
- Ophthalmology: “Environmental factors affect the risk of dry eye syndrome in a United States veteran population”
- American Academy of Ophthalmology: “What Is Dry Eye?”
- Mayo Clinic: “Dry eyes”
- American Academy of Ophthalmology: “Computers, Digital Devices and Eye Strain”