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What to Do About Dry Eye

There are a range of treatments for this common age-related problem

Avoid dry eyes by using eye drops when needed.

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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.

Simply put, dry eye syndrome happens when your eyes aren’t making adequate tears. “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. Sometimes you can have both problems.

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 usage 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 a chronic and doesn’t go away completely. But it’s usually a manageable condition,” says Sarah Nehls, a Madison, Wisc.-based ophthalmologist and associate professor at the University of Wisconsin School of Medicine and Public Health.

A few ways to treat dry eye

Mature woman rubs her irritated eyes after prolonged use of her computer

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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 some 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.

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 done 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 their 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 can often 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 can be tossed after each 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 that have 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, Fla.-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 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.

Middle-aged man washing his face while his image is reflected in the mirror

How Your Doctor Can Help

If you’re suffering from chronic dry eye, your doctor can offer a wide range of treatments to help keep your eyes healthy and comfortable. 

  • They include prescription drops such as Restasis or Xiidra (which can be used instead of OTC artificial tears or gels and ointments, or in addition to them) and tiny punctal plugs that are inserted into the tear duct (puncta) in the inner corners of the eyes to keep natural tears on the surface of the eyes longer.
  • Another physician-assisted option for people with moderate to severe symptoms is Lacrisert, in which “little pellets filled with a lubricating agent 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.”
  • Or your doctor might suggest softening your meibomian glands — tiny glands located in the eyelids that secrete oils onto the surface of the eyes in order to keep the 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 glands yourself, warm a wet washcloth or compress in the microwave, then place it over your eyelids for about five minutes. 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.

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