When to see a specialist
See your doctor if you’ve had prolonged signs and symptoms of dry eyes, including red, irritated, tired or painful eyes. Your doctor can take steps to determine what’s bothering your eyes or refer you to a specialist.
Dry eyes are caused by a lack of adequate tears. Your tears are a complex mixture of water, fatty oils and mucus. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eyes from infection.
For some people, the cause of dry eyes is decreased tear production. For others it’s increased tear evaporation and an imbalance in the makeup of your tears.
Decreased tear production
Dry eyes can occur when you’re unable to produce enough tears. The medical term for this condition is keratoconjunctivitis sicca. Common causes of decreased tear production include:
- Certain medical conditions, including diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren’s syndrome, thyroid disorders and vitamin A deficiency
- Certain medications, including antihistamines, decongestants, hormone replacement therapy, antidepressants, and drugs for high blood pressure, acne, birth control and Parkinson’s disease
- Laser eye surgery, though symptoms of dry eyes related to this procedure are usually temporary
- Tear gland damage from inflammation or radiation
Increased tear evaporation
Common causes of increased tear evaporation include:
- Wind, smoke or dry air
- Blinking less often, which tends to occur when you’re concentrating, for example, while reading, driving or working at a computer
- Eyelid problems, such as out-turning of the lids (ectropion) and in-turning of the lids (entropion)
Imbalance in tear composition
The tear film has three basic layers: oil, water and mucus. Problems with any of these layers can cause dry eyes. For example, the oil film produced by small glands on the edge of your eyelids (meibomian glands) might become clogged. Blocked meibomian glands are more common in people with inflammation along the edge of their eyelids (blepharitis), rosacea or other skin disorders.
Factors that make it more likely that you’ll experience dry eyes include:
- Being older than 50. Tear production tends to diminish as you get older. Dry eyes are common in people over 50
- Being a woman. A lack of tears is more common in women, especially if they experience hormonal changes due to pregnancy, using birth control pills or menopause
- Eating a diet that is low in vitamin A, which is found in liver, carrots and broccoli, or low in omega-3 fatty acids, which are found in fish, walnuts and vegetable oils
- Wearing contact lenses
People who have dry eyes may experience these complications:
- Eye infections. Your tears protect the surface of your eyes from infection. Without adequate tears, you may have an increased risk of eye infection
- Damage to the surface of your eyes. If left untreated, severe dry eyes may lead to eye inflammation, abrasion of the corneal surface, corneal ulcer and vision problems
- Decreased quality of life. Dry eyes can make it difficult to perform everyday activities, such as reading
Tests and diagnosis
Tests and procedures that may be used to determine the cause of your dry eyes include:
- A comprehensive eye exam. An eye exam that includes a complete history of your overall health and your eye health can help your doctor diagnose the cause of your dry eyes
- Measuring the volume of your tears. Your doctor may measure your tear production using the Schirmer test. In this test, blotting strips of paper are placed under your lower eyelids. After five minutes your doctor measures the amount of strip soaked by your tears
- Determining the quality of your tears. Other tests use special dyes in eyedrops to determine the surface condition of your eyes. Your doctor looks for staining patterns on the corneas and measures how long it takes before your tears evaporate
Treatments and drugs
For most people with occasional or mild dry eye symptoms, it’s enough to regularly use over-the-counter eye drops (artificial tears). If your symptoms are persistent and more serious, you have other options. What you do depends on what’s causing your dry eyes.
Some treatments focus on reversing or managing a condition or factor that’s causing your dry eyes. Other treatments can improve your tear quality or stop your tears from quickly draining away from your eyes.
Treating the underlying cause of dry eyes
In some cases, treating an underlying health issue can help clear up the signs and symptoms of dry eyes. For instance, if a medication is causing your dry eyes, your doctor may recommend a different medication that doesn’t cause that side effect. If you have an eyelid condition, such as out-turning lids (ectropion), your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids (oculoplastic surgeon). Or if you have rheumatoid arthritis, your doctor may refer you to a rheumatologist.
Prescription medications used to treat dry eyes include:
- Drugs to reduce eyelid inflammation. Inflammation along the edge of your eyelids can keep oil glands from secreting oil into your tears. Your doctor may recommend antibiotics to reduce inflammation. Antibiotics for dry eyes are usually taken by mouth, though some are used as eye drops or ointments
- Eye drops to control cornea inflammation. Inflammation on the surface of your eyes (cornea) may be controlled with prescription eye drops that contain the immune-suppressing medication cyclosporine or corticosteroids. Corticosteroids are not ideal for long-term use due to possible side effects
Other procedures that may be used to treat dry eyes include:
- Closing your tear ducts to reduce tear loss. Your doctor may suggest this treatment to keep your tears from leaving your eye too quickly. This can be done by partially or completely closing your tear ducts, which normally serve to drain tears away
Tear ducts can be plugged with tiny silicone plugs (punctal plugs). These are removable. Or tear ducts can be plugged with a procedure that uses heat. This is a more permanent solution called thermal cautery.
- Using light therapy and eyelid massage. A technique called intense-pulsed light therapy followed by massage of the eyelids helps people with severe dry eyes. In one study, the therapy was given monthly to 78 people, and 68 of them experienced reduced symptoms