En español | Let’s face it: We take our eyes for granted. In fact, when we’re seeing clearly and not feeling any discomfort, we usually don’t give them a second thought.
But there are times when they make their presence known — and your life miserable — particularly if you’ve got a condition known as dry eye. The symptoms, as sufferers can tell you, range from pretty unpleasant to just plain painful: irritation, a gritty or burning feeling, excess watering and blurred vision.
Ideally, our eyes work like a well-oiled machine (literally). Tears are made up of three layers. The layer closest to the cornea is a thin mucus that helps tears adhere to the surface. The middle layer contains the watery portion of the tears. The outer layer is composed of fatty oils. A proper mix helps maintain healthy tears, which coat and lubricate the eyes, nourish cells, wash away dust and other irritants to ward off infection, and keep the surface smooth so you can see clearly.
If any of these layers isn’t functioning properly — and your eyes aren’t getting adequate lubrication — dry eye can occur. “It could be that the lacrimal gland isn’t making enough of the liquid part of the tears, or it could be there’s not a sufficient oil layer to keep tears from evaporating on the surface of the eye — a more common condition known as evaporative dry eye,” says Sarah Dougherty Wood, an optometrist and assistant professor at the Kellogg Eye Center at the University of Michigan.
The prevalence increases with age. “Your likelihood of having dry eye is equal in percentage to your age in years,” says John Hovanesian, M.D., clinical spokesperson for the American Academy of Ophthalmology, an ophthalmologist at Harvard Eye Associates, and a faculty member at the UCLA Jules Stein Eye Institute. “Somebody who is 50 has a 50-50 chance, somebody who is 70 has 70 percent chance. Over time, glands in our eyes produce fewer tears. It’s similar to what happens in our skin. There’s a thinning of tissue and an atrophy of the glands that keep skin moist and healthy.”
Also, as we age, we’re more likely to have medical conditions that can impact our tear function, triggering dry eye — among them, systemic autoimmune diseases (such as rheumatoid arthritis and lupus), as well as diabetes, strokes and thyroid problems. Pharmaceutical use also increases as we age, and some medications can affect tear gland function, contributing to dry eye. They include antihistamines, decongestants, blood pressure medications, antidepressants and anti-anxiety medication, and hormone replacement therapy to relieve symptoms of menopause.
The good news? “In general, dry eye tends to be chronic and doesn’t go away completely. But it’s usually a manageable condition,” says Sarah Nehls, M.D., a Madison, Wisconsin-based ophthalmologist and professor at the University of Wisconsin School of Medicine and Public Health.
1. Take a tech break
“People tend to not blink as much when using a computer, smartphone or other digital devices,” Wood says. “And when you don’t blink, your tears aren’t spreading around the surface of your eye.” Take frequent breaks to give your eyes a rest. Try the 20-20-20 rule: Look away from the screen every 20 minutes, focusing on something 20 feet in the distance for at least 20 seconds. In addition, be sure to blink more often when using these devices — full blinks, gently squeezing your eyelids together to wash your eyes with a fresh layer of tears.
2. Up the moisture
“Increase the humidity in the air in your environment, perhaps by sleeping with a humidifier next to your bed,” Wood says. When outdoors, slip on sunglasses to protect your orbs from the elements (wind, frigid temps and sunlight). According to Nehls, the best choices for people with severe dry eye are ones with “a wrap-around frame, similar to what bikers wear. They have foam padding inside the frame that creates a moisture chamber for the eyes.”
3. Reconsider your contacts
“Even though the materials used to make contact lenses have improved over the years, there can still be a lack of oxygen getting to the ocular surface, and dryness can result,” Nehls says. Give your eyes a break by switching to daily disposable contact lenses for part-time wear, or wear glasses. Soft lenses are also now available in a more breathable silicone hydrogel material.
Those with severe dry eye may opt for scleral lenses. These gas-permeable lenses are custom-made and designed to hold their shape. They move on the eye with each blink, allowing tears to circulate underneath. (Standard soft contact lenses move very little.) Instead of covering only a portion of the cornea (like conventional lenses), these large lenses cover the entire corneal surface and rest on the “white” of the eye. When inserting a scleral lens, you first fill the lens with a saline solution, which provides a kind of cushion between the front surface of the cornea and the back of the lens, and ensures constant hydration.
4. Treat skin conditions
Inflammatory skin conditions, such as rosacea, can also affect the glands in the eyelids, preventing them from producing enough natural oil. (In a survey by the National Rosacea Society, 92 percent of the respondents said that they also suffered from eye problems, including itchiness, grittiness, burning and redness.) In fact, many of the treatments people use to treat rosacea on the face can help with dry eye problems, too. That includes the temporary use of oral antibiotics, such as tetracycline or doxycycline.
5. Use over-the-counter eyedrops
Mild cases of dry eye often can be managed using artificial tear solutions and lubricating eye drops to supplement natural tear production. But with pharmacy shelves crowded with options, finding the right one for you may not be that easy.
Some OTC drops come in multidose bottles and contain preservatives to keep bacteria from growing once the bottle has been opened. These drops can be used several times a day, as needed, to increase tear volume.
“Sometimes people have to use a lot of teardrops, and the preservatives can start to irritate their eyes, which is counterproductive,” Wood says. Preservative-free drops — which come in little vials that are tossed after a single use — contain fewer additives, so they’re less likely to irritate the eyes. If you use artificial tears more than, say, four times a day, this may be the smarter choice.
Artificial tears with low viscosity are light and watery and often provide fast relief. But because that soothing effect is short-lived, you’ll probably use them frequently. Artificial tears with a high viscosity have a more gel-like consistency. They stick around on the surface of the eye longer and provide longer-lasting lubrication. A caveat: “Typically, these drops cause blurring of the vision temporarily after you apply them,” Nehls says. “For this reason, they are recommended for bedtime use, to moisturize your eyes while you sleep.”
6. Keep clean
It’s important to keep your eyelids healthy and clean — particularly if you wear eye makeup. “People often avoid the area around their eyelids when washing their face,” says Steven L. Maskin, M.D., a Tampa, Florida-based ophthalmologist and the author of Reversing Dry Eye Syndrome: Practical Ways to Improve Your Comfort, Vision, and Appearance. “They think they can splash water on their face and call it a day. But it doesn’t work that way.”
The entire eye area (lids included) should be clear of toxins, allergens, irritants, debris, dead cells and crusting, which can lead to inflammation on the surface of the eye as well as clog the openings of the oil glands. Twice a day, gently scrub lids and lashes with a mild cleanser — diluted baby shampoo or an eyelid scrub such as Ocusoft will work.
Demodex folliculorum (more commonly known as mites) can also cause inflammation of the eyelids, known as blepharitis. The miscroscopic mites “live on the eyelids of nearly all of us who reach retirement age, and there’s increasing evidence that they contribute to dry eye,” says Hovanesian. “It’s been an inconvenient problem for patients because there has not been a tolerable treatment available.” One common fix, tea tree oil, Hovanesian notes, is irritating (not to mention smelly). A drug that shows promise is a prescription eye drop from Tarsus Pharmaceuticals. Clinical studies show that it dramatically reduces or eliminates populations of mites. “I suspect that patients will use it as a kind of maintenance to keep mites at bay,” says Hovanesian. “Kind of like using toothpaste to eradicate decay.”
7. Soften your oil glands
Your eyelids’ meibomian glands secrete oils onto the surface of the eyes in order to keep tears from evaporating too quickly. “The glands are supposed to be like an olive oil consistency coming out, but some patients will get inflammation, which causes the oil to thicken to a toothpaste consistency, so it doesn’t want to come out on its own,” Wood says. “This results in a deficient oil layer.”
If you want to try to soften the oil yourself, warm a wet washcloth or compress in the microwave, then place it over your eyelids for about five minutes. EverTears from ThermaMEDx, launched earlier this year, is an over-the-counter option for those with mild dry eye symptoms. These convenient self-heating, premoistened, disposable compresses let you add warm moisture to the surface of the eye to get relief.
If that doesn’t do the trick, your eye doctor may discuss different in-office procedures that squeeze, massage or otherwise treat the glands in order to release the moisture you need. LipiFlow and iLux, for instance, are devices placed over the eyelids that combine heat and pressure to soften and push out oil trapped within the meibomian glands, so the glands are able to secrete their natural oil into the tear film.
Other medical treatments
- Prescription eye drops. If you’re suffering from chronic dry eye, your doctor may prescribe twice-a-day prescription eye drops, such as Restasis or Xiidra, that can be used instead of (or in addition to) OTC artificial tears to treat chronic dry eye, decreasing inflammation and increasing tear production. Both have been shown to work well, though Xiidra may deliver faster results (it can kick in within two weeks, compared with Restasis, which can take up to three months).
- Punctal plugs. Another tactic is to insert tiny punctal plugs into the tear ducts (puncta) in the inner corners of the eyes to keep natural tears on the surface of the eyes longer.
- Corticosteroids. These can also be used, short term, to do away with signs and symptoms of dry eye. For the drug to be truly effective, it has to get to the target organ. But, notes Hovanesian, the mucin in tear film can prevent eye drops from getting where they need to go. “You can use a higher concentration of drug to get past a barrier of mucus, but there’s a risk of side effects,” says Hovanesian. “Or, you can find a way to get a lower concentration through the barrier.” That’s the approach taken with Eysuvis, an ocular corticosteroid approved by the Food and Drug Administration in 2020 for the short-term treatment of dry eye disease. It’s designed to penetrate the mucin barrier. And since it’s a low-dose steroid, it’s less likely than other steroids to cause glaucoma problems. It’s designed to take as needed for dry eye flare-ups.
- Lacrisert. These are “little pellets filled with a lubricating agent [that] are placed into the lower pockets of the eye,” Nehls says. “They slowly dissolve over the course of the day, releasing moisture throughout the day onto the eye surface.”
- Intense pulsed light therapy. IPL uses gentle pulses of intense light, delivered to the skin around the eyes, to melt the thick secretions on the edges of the lids. This treatment isn’t for everyone: It can cause hyperpigmentation or hypopigmentation (darkened or lightened patches) on those with darker skin.
Barbara Stepko is a longtime health and lifestyle writer, and former editor at Women’s Health and InStyle. Her work has appeared in The Wall Street Journal, Parade, and other national magazines.