Causes and Risk Factors
A healthy tear film has watery, oily, and mucus layers; trouble with any layer causes symptoms. Common contributors include:- Aging and hormonal change: Tear production declines with age, and women are affected more often, particularly after menopause.
- Oil gland dysfunction: Blocked meibomian glands along the eyelids let tears evaporate too fast — the single most common cause.
- Screen time and reading: Concentrating on screens cuts the blink rate roughly in half, drying the eye surface.
- Medications: Antihistamines taken for hay fever, decongestants, some antidepressants, and diuretics all reduce tear production, and some drops used for glaucoma can irritate the eye surface.
- Medical conditions: Autoimmune diseases — including Sjogren's syndrome and forms of inflammatory arthritis — as well as thyroid disorders and eyelid problems can drive persistent dryness.
- Environment: Air conditioning, ceiling fans, wind, and low humidity speed tear evaporation.
- Contact lenses and eye surgery: Years of lens wear, and procedures such as LASIK or cataract surgery, can reduce corneal sensation and tear production for months afterward.
Symptoms
Dry eye produces a characteristic cluster of complaints, usually in both eyes:- Burning, stinging, or a gritty, sandy feeling: As though something is in the eye.
- Redness and irritation: Often worse late in the day, after screen use, or in air-conditioned rooms.
- Paradoxical watering: Irritation triggers reflex tears that overflow but do not lubricate, so watery eyes can actually signal dryness.
- Fluctuating blurry vision: Vision that clears briefly with blinking points to an unstable tear film.
- Stringy mucus or morning crusting: Discharge along the lash line and in the corners of the eye, usually worst on waking.
- Contact lens intolerance: Lenses that were once comfortable become unwearable by mid-afternoon.
Diagnosis
Diagnosis rests on your symptom history, a review of medications and medical conditions, and an eye examination. An eye specialist may measure tear production, check how quickly the tear film breaks up, and use harmless dyes to highlight dry patches on the eye's surface. Part of the evaluation is separating dry eye from conditions that feel similar — eyelid inflammation, allergic eye disease, and infection all cause redness and irritation but call for different treatment. When dryness is severe or comes with dry mouth or joint symptoms, blood tests for thyroid and autoimmune disease are reasonable.Treatment
Most people improve with a stepwise approach:- Artificial tears: Preservative-free lubricating drops used regularly — not just when symptoms peak — are the foundation; gels or ointments help overnight.
- Eyelid care: Warm compresses and gentle lid cleansing unclog oil glands and improve tear quality.
- Habit and environment changes: Follow the 20-20-20 rule (every 20 minutes, look 20 feet away for 20 seconds), lower screens below eye level, use a humidifier, and redirect fans and vents.
- Prescription therapy: Anti-inflammatory drops such as cyclosporine or lifitegrast boost natural tear production; tiny punctal plugs can keep tears on the eye longer.
- A medication review: Where good alternatives exist, adjusting a drying antihistamine, decongestant, or other contributing prescription can help more than any drop.