Dry eye, also known as dry eye syndrome or keratoconjunctivitis sicca, is a common condition that occurs when your eyes either do not produce enough tears or produce tears that are poor in quality. The result is insufficient lubrication and moisture on the surface of your eyes, leading to discomfort, visual disturbances, and sometimes damage to the eye surface.

It’s estimated that more than 16 million adults in the United States live with dry eye, but the actual number may be much higher due to underdiagnosis. While it’s rarely dangerous, untreated dry eye can interfere with daily tasks such as reading, driving, and using digital devices, and may lead to more serious eye health complications.

Types of Dry Eye

Dry eye is classified into two main types, depending on the underlying problem with tear production.

Evaporative Dry Eye This is the most common form, accounting for around 85% of all dry eye cases. It occurs when the meibomian glands, located along the edges of your eyelids, fail to produce enough oil to prevent the tear film from evaporating too quickly. Without this protective oil layer, tears dry out faster, resulting in dry eye symptoms.

Contributing factors may include:

  • Meibomian gland dysfunction (MGD)
  • Inflammation of the eyelid margins (blepharitis)
  • Poor blinking habits (e.g., during screen use)
  • Environmental irritants like wind or smoke

Aqueous Deficient Dry Eye This type happens when the lacrimal glands don’t produce enough of the watery component of your tears. It’s less common but can lead to more severe symptoms. Aqueous tear deficiency is often associated with autoimmune disorders, such as Sjögren’s syndrome.

Some individuals may have a combination of both types, making symptoms more challenging to treat.

Symptoms of Dry Eye

Dry eye can range in severity and presentation. Most people experience symptoms in both eyes, but it may affect one eye more than the other. Common signs include:

  • Blurred or fluctuating vision
  • A burning, stinging, or scratchy sensation
  • Redness and irritation
  • Light sensitivity (photophobia)
  • The sensation of having something in your eye
  • Difficulty wearing contact lenses
  • Stringy mucus in or around the eyes
  • Eye fatigue, especially after reading or screen use
  • Watery eyes (a reflex to dryness, not actual lubrication)

Chronic dry eye may also lead to complications such as inflammation, corneal ulcers, or even vision loss if left untreated.

What Causes Dry Eye?

Tears are composed of three essential layers: the oil layer (lipid), the aqueous layer (water), and the mucin layer (mucus). An imbalance or dysfunction in any of these layers can result in dry eye. Common causes include:

  • Reduced tear production: Aging, autoimmune diseases, or damage to the lacrimal glands
  • Increased tear evaporation: Meibomian gland dysfunction, reduced blinking, eyelid problems
  • Environmental factors: Exposure to dry climates, air conditioning, or wind
  • Screen time: Decreased blinking while using digital devices
  • Medication use: Antihistamines, antidepressants, decongestants, blood pressure medications
  • Contact lenses: Long-term use may disturb tear film stability
  • Hormonal changes: Particularly during pregnancy, menopause, or use of oral contraceptives

Risk Factors

Several factors increase the likelihood of developing dry eye:

  • Age over 50
  • Female sex (especially postmenopausal)
  • Use of contact lenses
  • Long hours of screen exposure
  • Underlying systemic diseases (e.g., diabetes, lupus, thyroid disease)
  • Previous eye surgeries (e.g., LASIK)
  • Environmental exposure (wind, smoke, low humidity)
  • Vitamin A deficiency

How Dry Eye Is Diagnosed

To diagnose dry eye, an optometrist or ophthalmologist will evaluate your symptoms, medical history, and perform several specialized tests:

  • Schirmer’s test: Measures how much tear fluid your eyes produce using a small strip of paper placed under the eyelid.
  • Tear breakup time (TBUT): Examines how quickly your tears evaporate after blinking using fluorescent dye.
  • Meibography: Images the meibomian glands to check for blockages.
  • Ocular surface staining: Special dyes highlight areas of damage on the eye's surface.
  • Tear osmolarity test: Measures the saltiness of your tears, which may be elevated in dry eye.

These tests help determine the severity, type, and underlying cause of your dry eye to guide proper treatment.

Treatment Options for Dry Eye

The goal of treatment is to restore or maintain the normal amount of tears in the eye and reduce symptoms. Depending on severity, options range from simple self-care to advanced procedures.

Artificial Tears and Lubricants

  • Over-the-counter drops and gels provide temporary relief by mimicking natural tears.
  • Preservative-free options are recommended for frequent use or sensitive eyes.

Prescription Eye Drops

  • Restasis® (cyclosporine): Increases tear production by reducing inflammation.
  • Xiidra® (lifitegrast): Targets inflammation associated with dry eye disease.
  • Tyrvaya® (varenicline nasal spray): Stimulates natural tear production via nasal nerve pathways.

Punctal Plugs Small biocompatible devices inserted into tear ducts to block drainage and retain tears longer on the eye surface.

Eyelid Hygiene and Warm Compresses

  • Clean eyelid margins daily to treat blepharitis and meibomian gland dysfunction.
  • Use warm compresses to soften oil in blocked glands.

Nutritional Support

  • Omega-3 fatty acid supplements (from fish oil or flaxseed) may help reduce eye inflammation.

Surgical Options In rare cases, surgery may be necessary to correct eyelid structure or permanently block tear drainage.

Prevention Strategies

Incorporating the following habits into your routine can help reduce dry eye flare-ups:

  • Avoid direct airflow from fans, heaters, or hair dryers.
  • Use humidifiers in dry environments.
  • Blink regularly, especially during computer use.
  • Position screens below eye level.
  • Wear wraparound sunglasses outdoors.
  • Stay hydrated by drinking adequate water.
  • Limit screen time or take frequent breaks (20-20-20 rule).
  • Choose eye-friendly cosmetics and avoid applying eyeliner to the inner eyelid margin.

Living With Dry Eye

Although dry eye is typically a chronic condition, most people manage it successfully with consistent care. Working with an eye specialist is key to finding the right treatment combination and making necessary lifestyle adjustments.

Tips for living with dry eye:

  • Stick to your treatment routine even if symptoms improve.
  • Monitor your symptoms with a journal to identify triggers.
  • Keep lubricating drops with you for use during travel or dry environments.
  • Prioritize eye rest during and after visually demanding tasks.
  • Seek support from eye health communities or forums if symptoms affect your quality of life.

Left untreated, dry eye can lead to complications like corneal damage, infection, and persistent vision issues. Timely care improves comfort and prevents long-term consequences.