By Korin Miller
Dry eye symptoms can force you to wage war with your instincts. When something on your body itches, you’re going to get the urge to scratch it. Unfortunately, you can’t scratch your eyes without potentially doing some serious damage, even though dry eye symptoms can make it tempting.
Dry eye is a common enough condition that some specialists deal with it all the time. “We see patients for dry eye every day in our practice,” James Khodabakhsh, M.D., chief of ophthalmology at Cedars Sinai Medical Center and medical director of the Beverly Hills Institute of Ophthalmology in Beverly Hills, California, tells SELF.
You’ve probably heard of dry eye at some point, or may have even struggled with dry eye symptoms yourself, but still might be hazy on the details. Here’s the rundown.
What is dry eye, exactly?
Dry eye is a condition that happens when your eyes can’t lubricate themselves adequately, according to the National Eye Institute. In general, dry eye happens when either your amount or quality of tears can’t keep your eyes moist enough.
Sure, tears come out of your eyes when you cry, but you actually have a tear film covering your eyes at all times to keep them wet. When you blink, this film spreads across your eyes, making sure they’re nice and lubricated, before draining away, Phillip Yuhas, O.D., an optometrist and faculty member at The Ohio State University College of Optometry, tells SELF. (Your eyelids have four openings known as puncta that help drain your tears.)
Your tears keep the surface of your eyes smooth and protect them from the environment, things that can irritate them, and germs that could cause infection. They’re also kind of complicated. “Most people think they’re just made up of water, but there’s more to tears than that,” Mina Massaro-Giordano, M.D., co-director of the Penn Dry Eye & Ocular Surface Center and a professor of clinical ophthalmology at the University of Pennsylvania, tells SELF. Three different layers make up your tears:
- First up, there’s a lower mucus-based layer that binds with water in your tears to make sure your eyes stay wet.
- There’s also a middle layer of water and water-soluble proteins. It’s made by the lacrimal glands located under your eyebrows. This layer nourishes your corneas, i.e., the clear, dome-shaped surfaces of your eyes, and conjunctiva, the mucus membranes that cover the front of your eyes.
- Then there’s the oily outer layer, which keeps your tears from evaporating too quickly. Your Meibomian glands, which are located under your eyelids, produce this tear film component.
Got it. So, if something goes wrong with my tears, what kinds of dry eye symptoms might I experience?
Dry eye can be irritating at best and painful at worst, and it can present with a range of signs. Here are the ones you should keep in mind:
- Watery eyes (surprisingly, sometimes your eyes get excessively watery in response to dry eyes)
- A sense that something is in your eyes when nothing actually is
- Stringy eye discharge that seems like mucus
- Sensitivity to light
- Discomfort when wearing contact lenses
- Difficulty driving at night
- Blurred vision
- Eye fatigue
Yikes, so dry eye symptoms are no joke. What causes them, anyway?
You can’t do anything about certain factors that contribute to dry eye symptoms, like being a woman—hormonal changes from things like pregnancy), birth control pills, and menopause can result in a lack of tears—or getting older, since tear production decreases as you age. But the following factors can cause dry eye symptoms, too.
You have a health condition that dries out your eyes. There are several health-related reasons why you might not make enough tears, Dr. Massaro-Giordano says. One is having the autoimmune condition Sjogren’s syndrome, which affects the mucus membranes and moisture-secreting glands of your eyes and mouth, according to the Mayo Clinic. Sjogren’s often comes along with other immune system conditions, like rheumatoid arthritis and lupus, so you might experience dry eye symptoms with those health issues as well.
If your doctor thinks you’re not making enough tears because of a health condition, they’ll likely investigate and figure out treatment for the root cause from there, Dr. Yuhas says.
You have poor tear quality. Remember: Several things have to come together to make great tears. If one element isn’t working as well as the others, you could end up with less-than-optimal tear quality.
Blepharitis is one of the most common reasons this happens, Dr. Massaro-Giordano says. It’s an inflammation of your eyelids that can plug up your Meibomian glands, which make up the oily part of your tears, according to the Mayo Clinic. “If you don’t have enough oil from the eyelids, your tears don’t make that protective coat and evaporate too quickly,” Dr. Massaro-Giordano explains.
Luckily, you may be able to fix this pretty easily by creating a warm compress with a washcloth and holding it over your eyelids for a few minutes each day. This is a really simple way to take better care of your eyes, whether or not you’re dealing with dry eye symptoms.
You’re taking medications that dry you out. Various drugs can cause you to make less tears, including antihistamines, decongestants, antidepressants, hormone replacement therapy to relieve symptoms of menopause, and medications for anxiety, Parkinson’s disease, and high blood pressure, according to the NEI.
This is by no means a guaranteed side effect; you might be able to take these meds without issue. But if you have dry eye symptoms and are on any sort of medication, be sure to tell your doctor about all the drugs you’re taking, even if you think they’re not relevant. Your doctor may want to tweak your medication to see if your dry eye symptoms improve, Dr. Yuhas says.
You’re regularly exposed to wind, smoke, or dry air. If you step outside on a windy day, it’s unlikely that alone will give you dry eye. But if you’re regularly in dry, windy conditions without eye protection, it could lead to the condition, Dr. Khodabakhsh says. “Wind and dry air cause evaporation of the tear film,” he says. The best thing you can do is wear sunglasses when you go outside, ideally ones that wrap around and protect your eyes from all angles (or are at least big enough to offer your eyes a ton of protection).
Smoke is slightly different, Dr. Yuhas says: It irritates your eyes and introduces chemicals and foreign substances to your tear film that can mess with your tear quality. If you’re a smoker, here are some tips on how to quit. (You can also ask a qualified medical professional for help.)
If the issue is that you often encounter smoke or other eye irritants at work, look into safety glasses or other eyewear that can help you protect your vision.
You’re basically always on the computer. It’s not the computer itself that’s the problem—it’s how often you blink when you’re on it. The American Optometric Association points out that people just don’t blink as often when they’re using the computer or similar technological devices. When you don’t blink frequently enough, you’re not spreading tear film across your eyes as regularly as you should. The (incredibly bothersome) result: dry eye symptoms.
If you’re spending an extended period of time on the computer or playing with your phone, it’s a good idea to take “blinking breaks” every 30 minutes to pause, blink a bunch, then go back to what you were doing, Caroline A. Blackie, O.D., Ph.D., Medical Director, Dry Eye, at Johnson & Johnson Vision, tells SELF. If you know you’re going to forget, try setting an alarm until it feels like a habit, or go with the 20-20-20 rule if it’s easier to remember: Every 20 minutes, set your gaze on something 20 feet away for at least 20 seconds.
You just wrapped up laser eye surgery. Dry eye can be a side effect of laser eye surgery, the Mayo Clinic notes, though it usually abates as your eyes adjust to their new normal.
You’re not taking care of your contacts well. At the end of the day, your contacts are foreign objects on your eyes, so it’s no surprise they can interfere with your tear film, Dr. Yuhas says. Contacts can do this in a couple of ways.
First of all, the fit of your contacts matters, Dr. Massaro-Giordano says. Remember how your doctor examined your eyes thoroughly before prescribing contact lenses? That’s because if your contacts are too tight, they won’t allow for tears to get in below them; if they’re too loose, they’ll move around too much and may allow for evaporation. If you switch to a new kind of contact lens and are suddenly dealing with dry eye symptoms, this could be the cause.
Then there’s sleeping in your contacts. Doing so can block enough oxygen from getting to your eyes, which can cause or worsen dry eye symptoms, Dr. Yuhas says. (It can also set you up for an eye infection, so seriously, better to just not.)
If you think your contact lenses are contributing to your dry eye symptoms, talk to your eye doctor. They may have you try out some different lenses to see how you handle them before committing.
How can I treat dry eye symptoms?
Treatment ultimately depends on the cause of your dry eye. In general, your doctor will usually recommend eye drops to start, Dr. Yuhas says. That may be enough to quash mild to moderate dry eye. It’s important to choose one without preservatives, as they can further irritate your eyes. Also, eye drops that promise to reduce redness are vasoconstrictors, so they narrow the blood vessels in your eyes, thus reducing redness. But they can actually cause a rebound effect where you wind up with even redder eyes, so keep that in mind while shopping.
If your dry eye symptoms are a little more severe, there are two prescription medications—cyclosporine and lifitegrast—that are approved by the Food and Drug Administration for treating the condition, the NEI says. Your doctor may prescribe corticosteroid eye drops for a short period of time to tamp down on inflammation.
In some cases, your doctor may recommend something called a punctal plug. Your doctor can insert this device, which is made of silicone or collagen, into your tear ducts to partially or completely plug them up and keep tears from draining from your eyes, the NEI says. If your dry eye symptoms are more severe, your doctor may suggest surgically closing the drainage ducts in your eyes.
Is there anything I can do to prevent dry eye symptoms from happening in the first place?
There’s only so much you can do to lower your risk of developing dry eye. But if you do things like regularly take antihistamines, shun sunglasses, or work in front of the computer all the time, you can take little steps to lower the odds you’ll experience dry eye symptoms. And, no matter your situation, you can keep a humidifier in your bedroom or where you work to help get more moisture into the air, Dr. Massaro-Giordano says.
You should also be sure to see your eye doctor often. The American Optometric Association recommends adults aged 18 to 60 get an eye exam at least every two years, but your eye doctor may have you come in more frequently if you have persistent eye issues.
Whatever you do, if you have dry eye symptoms, don’t just ignore them and hope they’ll go away.
“You can get into a vicious cycle,” Dr. Massaro-Giordano says. Your dry eye symptoms can cause inflammation that, if left untreated, can damage your eye. Dry eye symptoms can also predispose you to an infection. Either outcome could lead to damaged vision if left untreated. “It’s important to address this,” Dr. Massaro-Giordano says. “It could impact your quality of life.”