Dry Eye Syndrome

Dry eye syndrome (also called dry eye disease or keratoconjunctivitis sicca) occurs when your eyes don't make enough tears or your tears evaporate too quickly. It's one of the most common eye conditions, affecting millions of people and significantly impacting quality of life.

Types of Dry Eye

Aqueous Deficient Dry Eye

• Lacrimal glands don't produce enough watery component of tears
• Associated with:
  • Aging
  • Sjögren syndrome
  • Other autoimmune conditions
  • Certain medications

Evaporative Dry Eye

• Most common type (85% of cases)
• Tears evaporate too quickly
• Usually due to meibomian gland dysfunction (MGD)
• Oil layer of tear film is inadequate

Mixed Dry Eye

• Combination of both types
• Very common in practice

Symptoms

• Burning or stinging sensation
• Gritty or sandy feeling
• Redness
• Light sensitivity
• Blurred vision that clears with blinking
• Eye fatigue, especially with screens
• Difficulty wearing contact lenses
• Watery eyes (reflex tearing in response to dryness)
• Stringy mucus in or around eyes
• Discomfort in windy or dry conditions

Causes and Risk Factors

Environmental Factors

• Dry, windy, or air-conditioned environments
• High altitude
• Prolonged screen use (reduced blinking)
• Smoke exposure

Medical Conditions

• Meibomian gland dysfunction (MGD)
• Blepharitis (eyelid inflammation)
• Sjögren syndrome
• Rheumatoid arthritis, lupus
• Diabetes
• Thyroid disorders
• Rosacea
• Vitamin A deficiency

Medications

• Antihistamines
• Decongestants
• Antidepressants
• Blood pressure medications
• Hormone replacement therapy
• Isotretinoin (Accutane)

Other Factors

• Age—dry eye increases with age
• Female sex—hormonal changes, especially menopause
• Contact lens wear
• Previous eye surgery (LASIK, cataract surgery)
• Incomplete eyelid closure

How Dry Eye Is Diagnosed

Clinical Examination

• Symptom questionnaire (OSDI, DEQ-5)
• Slit-lamp examination of:
  • Tear film
  • Cornea (staining for damage)
  • Eyelid margins
  • Meibomian glands

Testing

• Tear break-up time (TBUT)—how quickly tears evaporate
• Schirmer test—measures tear production
• Tear osmolarity—concentration of tears
• MMP-9 testing (InflammaDry)—detects inflammation
• Meibography—images meibomian glands

Treatment Options

Lifestyle and Environmental Modifications

• Take breaks from screens (20-20-20 rule: every 20 minutes, look 20 feet away for 20 seconds)
• Use a humidifier
• Avoid direct airflow from fans, heaters, AC
• Blink consciously during screen use
• Stay hydrated
• Omega-3 supplements (fish oil or flaxseed)
• Avoid smoking

Artificial Tears

• First-line treatment
• Many formulations available
• Preservative-free recommended for frequent use (>4 times daily)
• Thicker gels/ointments for nighttime use
• Lipid-containing drops for evaporative dry eye

Lid Hygiene

For blepharitis and MGD:

• Warm compresses (10 minutes daily)
• Lid scrubs or wipes
• Lid massage after warm compresses

Prescription Medications

Anti-inflammatory drops:

• Cyclosporine (Restasis)—increases tear production
• Lifitegrast (Xiidra)—reduces inflammation
• Cyclosporine 0.09% (Cequa)—higher concentration cyclosporine

Short-term steroids:

• Loteprednol (Eysuvis)—for dry eye flares
• Used briefly to reduce inflammation

Secretagogues:

• Varenicline nasal spray (Tyrvaya)—stimulates natural tear production

For MGD:

• Perfluorohexyloctane (Miebo)—evaporation-preventing drop

Procedures

Punctal Plugs

• Tiny plugs inserted in tear drainage ducts
• Keep tears on eye longer
• Temporary (dissolvable) or semi-permanent

Meibomian Gland Expression

• Manual or device-assisted expression of gland contents
• LipiFlow, iLux, TearCare systems
• Clears blocked glands

Intense Pulsed Light (IPL)

• For MGD and rosacea-related dry eye
• Reduces inflammation and improves gland function

Amniotic Membrane

• For severe cases
• Promotes healing of damaged ocular surface

Severe Dry Eye

• Autologous serum tears (made from your blood)
• Scleral contact lenses (hold moisture)
• Tarsorrhaphy (partially closing eyelids)—rare

Living with Dry Eye

Daily Management

• Use artificial tears regularly, not just when symptomatic
• Maintain consistent lid hygiene if recommended
• Adjust environment (humidity, airflow)
• Take screen breaks
• Follow up regularly with your eye doctor

Tips for Contact Lens Wearers

• Use rewetting drops frequently
• Consider daily disposable lenses
• Limit wearing time
• Consider glasses for screen-heavy days
• Discuss options with your eye doctor

Frequently Asked Questions

Why do my eyes water if I have dry eye?

Reflex tearing is a response to eye surface irritation from dryness. These emergency tears are watery and don't have the proper composition to lubricate effectively, so they don't relieve the underlying dryness.

Can dry eye be cured?

For most people, dry eye is a chronic condition requiring ongoing management rather than a cure. However, symptoms can usually be well-controlled with appropriate treatment.

Are artificial tears safe to use long-term?

Yes, especially preservative-free formulations. They're safe for long-term use and don't cause dependency. Your eyes don't "forget" how to make tears.

Do I need prescription drops if artificial tears help?

If artificial tears adequately control your symptoms, prescription drops may not be necessary. Prescription medications are typically added when over-the-counter options aren't sufficient.

Can LASIK cause permanent dry eye?

LASIK temporarily worsens dry eye for 3-6 months in most patients. Permanent dry eye is uncommon but possible. Pre-existing dry eye should be treated before considering LASIK.

Does screen use cause dry eye?

Extended screen use reduces blink rate by up to 60%, leading to increased tear evaporation. This contributes to dry eye symptoms but can be managed with conscious blinking and regular breaks.

References