Dry Eyes: Why Your Eyes Feel Dry and What Helps

What dry eyes feel like

• grittiness, as if there is sand or an eyelash in the eye
• burning, stinging or scratchiness
• redness
• tired or heavy eyes, especially late in the day
• blurred vision that clears with blinking
• stringy mucus in or around the eye
• light sensitivity
• discomfort with contact lenses
• watery eyes: irritation triggers reflex tears, which are watery and do not lubricate well, so a dry eye can overflow

Symptoms are often worse in wind, air conditioning, heated rooms, on planes and during long periods of reading or screen use.

How tears work

The tear film has three layers:

1. Oil (lipid) layer: made by the meibomian glands along the eyelid edges. It slows evaporation.
2. Water (aqueous) layer: made by the lacrimal glands. It moistens and nourishes the eye.
3. Mucus layer: helps tears stick to the eye surface.

A problem with any layer causes dryness.

Two main types

Many people have a mix of both.

Common causes of dry eyes

Everyday factors

• Screens and reading: people blink up to 60% less while concentrating on screens, and many blinks are incomplete.
• Environment: dry, windy or smoky air, air conditioning, heating and airplane cabins.
• Contact lenses, especially when worn for long hours.
• Aging: tear production falls with age. Dry eye is very common after 50.

Eyelid problems

• Meibomian gland dysfunction: blocked oil glands, the single most common cause.
• Blepharitis: inflamed, crusty eyelid margins.
• Incomplete eyelid closure: from facial nerve weakness, eyelid surgery or bulging eyes in thyroid eye disease.

Hormones

Dry eyes are more common in women, especially during menopause, pregnancy and while using some hormonal contraception.

Medicines

• antihistamines and decongestants
• antidepressants and anti-anxiety medicines
• blood pressure medicines, including diuretics and beta-blockers
• acne medicine isotretinoin
• some medicines for bladder control, Parkinson's disease and acid reflux
• eye drops containing preservatives, used often

Medical conditions

• Sjogren's syndrome: an autoimmune disease that attacks tear and saliva glands, causing dry eyes and dry mouth.
• Rheumatoid arthritis, lupus and scleroderma.
• Thyroid disease, diabetes and vitamin A deficiency.
• Rosacea, which often affects the eyelids.
• After LASIK or cataract surgery, usually temporary.

For the full medical overview of dry eye disease, its grading and prescription treatments, see dry eye.

How dry eyes are diagnosed

An eye doctor (optometrist or ophthalmologist) will ask about symptoms, screen habits, medicines and general health, then examine your eyes with a slit lamp microscope. Common tests:

• Fluorescein dye: shows dry patches on the cornea and measures how fast the tear film breaks up (tear break-up time).
• Schirmer test: small paper strips under the lower lids measure tear production over 5 minutes.
• Meibomian gland expression: checks the quality of the oil.
• Tear osmolarity and inflammation tests in some clinics.
• Blood tests for Sjogren's syndrome if suspected.

Dry eye relief: what works

At home

• Artificial tears: use them 4 times a day or more. If you use them more than 4 to 6 times a day, choose preservative-free single-use vials. Thicker gels or ointments at night help morning dryness but blur vision.
• The 20-20-20 rule: every 20 minutes, look at something 20 feet (6 meters) away for 20 seconds, and blink fully.
• Warm compresses: a warm cloth or heated eye mask on closed lids for 5 to 10 minutes, then gentle massage of the lid edges, melts blocked oil.
• Lid hygiene: clean the lid margins daily with a diluted baby shampoo or a lid wipe if you have blepharitis.
• Humidify dry rooms, and point car and fan vents away from your face.
• Position screens slightly below eye level so the eyes are less wide open.
• Wear wraparound glasses outdoors in wind.
• Stay hydrated, and avoid smoke.
• Omega-3 supplements: evidence is mixed. A large trial found no clear benefit over placebo.

Avoid "get the red out" drops for regular use, because they constrict blood vessels and can cause rebound redness.

Medical treatments

• Anti-inflammatory drops: cyclosporine or lifitegrast, used twice daily for several months.
• Short courses of steroid drops for flare-ups, with eye pressure monitoring.
• Punctal plugs: tiny plugs in the tear drainage ducts to keep tears on the eye.
• Treatment of eyelid disease: in-office thermal pulsation, intense pulsed light, or oral doxycycline or azithromycin for meibomian gland dysfunction and rosacea.
• Newer drops that reduce evaporation or stimulate tear production.
• Changing medicines that worsen dryness, where possible.

Frequently asked questions

Why are my eyes so dry?

The most common reasons are screen use (which reduces blinking), dry or air-conditioned environments, aging, blocked oil glands in the eyelids, contact lenses, hormonal changes such as menopause, and medicines such as antihistamines and antidepressants. Autoimmune conditions like Sjogren's syndrome are less common causes.

Why do my dry eyes water?

When the eye surface becomes dry and irritated, it sends a signal to the tear glands to make reflex tears. These are mostly water and lack the oil needed to stay on the eye, so they spill over without fixing the dryness. Treating the dryness often stops the watering.

Why are my eyes dry when I wake up?

Some people sleep with their eyelids slightly open, and ceiling fans, heating or dry bedroom air speed evaporation overnight. A lubricating gel or ointment at bedtime, a humidifier and avoiding fans blowing on the face usually help. Eyelid problems can also cause morning symptoms.

Can dry eyes damage your vision?

Mild dry eye does not cause permanent vision loss. Severe, untreated dry eye can damage the corneal surface, causing scarring, infection or ulcers, especially in conditions such as Sjogren's syndrome. Blurred vision that clears with blinking is common and not a sign of damage.

What is the best eye drop for dry eyes?

For most people, a preservative-free artificial tear used regularly works best. Thicker gels suit nighttime use. Drops with lipids help evaporative dry eye. If artificial tears are not enough after a few weeks, an eye doctor can prescribe anti-inflammatory drops.