By Dr. Carolyn Shih
Dry Eye: The Silent Irritant and How to Find Relief
Do your eyes often feel scratchy or just plain tired, especially after a long day of screen time? You might be experiencing dry eye disease (DED), a common condition that affects millions of people worldwide.
The Symptoms of Dry Eye
Dry eye symptoms can be surprisingly varied and often worsen throughout the day or in specific environments. You might experience:
- The Scratchy/Gritty Feeling
- Burning or Stinging
- Redness
- Excessive Tearing (Paradoxical Tearing): This happens when the irritation from DED triggers an emergency flush of reflex tears.
- Sensitivity to Light
- Blurred Vision or Eye Fatigue
- Difficulty wearing contact lenses
What Causes Dry Eye?
The root causes of DED generally fall into two categories:
- Evaporative Dry Eye
This is the most common form, accounting for about 86% of all cases.
- Meibomian Gland Dysfunction (MGD): Tiny glands in your eyelids, called meibomian glands, produce the oily layer (lipid) of your tears. This oil is crucial because it slows down the evaporation of the watery layer. If these glands get clogged or inflamed, they produce poor-quality oil or no oil at all. As a result, your tears evaporate too quickly. This is common in patients who have rosacea.
- Environmental Factors: Exposure to wind, smoke, dry climates, high altitudes, or sitting in front of an air conditioner or heater can rapidly increase tear evaporation. Winter is a common time that dryness is worse as the ambient humidity levels are lower.
- Reduced Blink Rate: When focusing intensely—like reading, driving, or using a computer, phone, or tablet—your blink rate can decrease by up to 60%, giving tears more time to evaporate. Some medical problems like Bell’s Palsy or Parkinson’s can be associated with this type of problem
- Aqueous-Deficient Dry Eye (Too Little Water)
In this less common form, the lacrimal glands, which produce the watery part of your tears, don't make enough.
- Aging: Tear production naturally decreases as we get older as we begin to have less hormones
- Certain Medical Conditions: Autoimmune diseases like Sjögren's syndrome, rheumatoid arthritis, and lupus
- Medications: Many common medications can have dry eye as a side effect, including antihistamines, decongestants, antidepressants, and some acne medications.
Treatments: Finding Your Personal Solution
Since dry eye has multiple causes, treatment is highly individualized. A comprehensive eye exam will help your eye doctor determine the optimal treatment for each person.
- Over-the-Counter Relief (First Line)
- Artificial Tears: These are the most common first step. Look for drops labeled "preservative-free" if you use them more than four times a day, as preservatives can sometimes irritate a dry eye.
- Ointments or Gels: Thicker than drops, these are often used at night because they can temporarily blur vision.
- Prescription Medications
Inflammation is both a cause and a result of chronic dry eyes, sometimes creating a vicious cycle.
- Anti-inflammatory Drops: Prescription drops like cyclosporine or lifitegrast help increase tear production and calm the surface inflammation.
- Steroid Eye Drops: Used short-term to quickly reduce severe inflammation.
- In-Office Procedures and Devices
- Punctal Plugs: Tiny, collagen/silicone devices are inserted into the tear ducts to block drainage. This keeps the natural or artificial tears on the eye surface longer.
- Blephex: Specifically for evaporative dry eye (MGD), this procedure focuses on removing excess bacteria, biofilm, and bacterial toxins, which are known to be the primary causes of eyelid plugging and resultant dry eye symptoms
Prevention and Lifestyle Tips
Managing your environment and habits is key to preventing and controlling DED flares.
- The 20-20-20 Rule: When using a screen, every 20 minutes, look away for 20 seconds at something 20 feet away.
- Optimize Your Environment: Use a humidifier while sleeping and when working on the computer. Direct airflow from fans, heaters, or air conditioners away from your face.
- Wear Protective Eyewear: Sunglasses or moisture-chamber glasses (wraparound styles) protect your eyes from wind and dry air when outdoors.
- Dietary Supplements: Omega-3 fatty acids (found in oily fish like salmon, or supplements) can help improve the quality of the oil produced by your meibomian glands.
- Lid Hygiene (Warm Compresses): For MGD, a warm compress (like a heated eye mask) applied for 5 minutes followed by a gentle lid massage can help loosen and express hardened oil, keeping the glands clear.
Don't ignore the discomfort of dry eye. If you suspect you have the condition, see your eye care professional. With the right diagnosis and treatment plan, you can significantly reduce your symptoms and get back to enjoying clear, comfortable vision.
Dr. Carolyn Shih is an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and works at South Shore Eye Care, a member of the Northwell Health Eye Institute.
