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Dry eyesBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/dry-eyes/DS00463
Dry eyes occur when your tears aren't able to provide adequate moisture for your eyes. Tears can be inadequate for many reasons. For example, dry eyes may occur if you don't produce enough tears or if you produce poor-quality tears.
Dry eyes feel uncomfortable. If you have dry eyes, your eyes may sting or burn. You may experience dry eyes in certain situations, such as on an airplane, in an air-conditioned room, while riding a bike, or after looking at a computer screen for a few hours.
Treatments for dry eyes may make you more comfortable. These treatments can include lifestyle changes and eyedrops. For more-serious cases of dry eyes, surgery may be an option.
Signs and symptoms, which usually affect both eyes, may include:
- A stinging, burning or scratchy sensation in your eyes
- Stringy mucus in or around your eyes
- Increased eye irritation from smoke or wind
- Eye fatigue
- Sensitivity to light
- Eye redness
- A sensation of having something in your eyes
- Difficulty wearing contact lenses
- Periods of excessive tearing
- Blurred vision, often worsening at the end of the day or after focusing for a prolonged period
When to see a doctor
See your doctor if you've had prolonged signs and symptoms of dry eyes, including red, irritated, tired or painful eyes. Your doctor can take steps to determine what's bothering your eyes or refer you to a specialist.
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|Tear glands and tear ducts|
Dry eyes are caused by a lack of adequate tears. Your tears are a complex mixture of water, fatty oils, and mucus. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eyes from infection.
For some people, the cause of dry eyes is an imbalance in the composition of their tears. Other people don't produce enough tears to keep their eyes comfortably lubricated. Eyelid problems, medications and other causes, such as environmental factors, also can lead to dry eyes.
Poor tear quality
The tear film has three basic layers: oil, water and mucus. Problems with any of these layers can cause dry eyes symptoms.
- Oil. The outer layer of the tear film, produced by small glands on the edge of your eyelids (meibomian glands), contains fatty oils called lipids. These smooth the tear surface and slow evaporation of the middle watery layer. If your oil glands don't produce enough oil, the watery layer evaporates too quickly, causing dry eyes. Dry eyes are common in people whose meibomian glands are clogged. Meibomian dysfunction is more common in people with inflammation along the edge of their eyelids (blepharitis), rosacea and other skin disorders.
- Water. The middle layer is mostly water with a little bit of salt. This layer, produced by the tear glands (lacrimal glands), cleanses your eyes and washes away foreign particles or irritants. If your eye produces inadequate amounts of water, the oil and mucous layers can touch and cause a stringy discharge.
- Mucus. The inner layer of mucus helps spread tears evenly over the surface of your eyes. If you don't have enough mucus to cover your eyes, dry spots can form on the front surface of the eye (cornea).
Decreased tear production
Dry eyes can occur when you're unable to produce enough tears. The medical term for this condition is keratoconjunctivitis sicca (ker-uh-toe-kun-junk-tih-VIE-tis SIK-uh).
You may not produce enough tears if you:
- Are older than 50. Tear production tends to diminish as you get older. Dry eyes are common in people older than 50.
- Are a postmenopausal woman. A lack of tears is more common among women, especially after menopause. This may be due in part to hormonal changes.
- Have a medical condition that reduces your tear production. Dry eyes are also associated with some medical conditions such as diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren's syndrome, thyroid disorders and vitamin A deficiency.
- Have had laser eye surgery. Refractive eye surgeries such as laser-assisted in-situ keratomileusis (LASIK) may cause decreased tear production and dry eyes. Symptoms of dry eyes related to these procedures are usually temporary.
- Have tear gland damage. Damage to the tear glands from inflammation or radiation can hamper tear production.
Blinking spreads a continuous thin film of tears across the surface of your eyes. If you have an eyelid problem that makes it difficult to blink, tears may not be spread across your eye adequately or your tears may evaporate too quickly, causing dry eyes. Eyelid problems can include an out-turning of the lids (ectropion) or an in-turning of the lids (entropion).
Medications that cause dry eyes
Medications that can cause dry eyes include:
- Some drugs used to treat high blood pressure
- Antihistamines and decongestants
- Hormone replacement therapy
- Certain antidepressants
- Isotretinoin-type drugs for treatment of acne
Other causes of dry eyes include:
- Dry air
- Tasks that require enough concentration that you blink less often, such as working at a computer, driving or reading
Factors that make it more likely that you'll experience dry eyes include:
- Increasing age
- Being a woman
- Taking medications that can cause dry eyes
- Having laser eye surgery
- Undergoing radiation therapy, such as is used to treat cancer, aimed at the eyes
- Eating a diet that is low in vitamin A, which is found in liver, carrots and broccoli, or low in omega-3 fatty acids, which are found in fish, walnuts and vegetable oils
Generally, dry eyes don't cause serious problems. However, possible complications include:
- More-frequent eye infections. Your tears protect the surface of your eyes from infection. Without adequate tears, you may have an increased risk of eye infection.
- Scarring on the surface of your eyes. If left untreated, severe dry eyes may lead to eye inflammation, scarring on the surface of your corneas and vision problems.
- Decreased quality of life. Dry eyes can make it difficult to perform everyday activities.
Preparing for your appointment
Start by seeing your family doctor or a general practitioner if you have any eye problems that worry you. Your doctor may then refer you to an eye specialist (ophthalmologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready and know what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Write down questions to ask your doctor.
Preparing a list of questions can help you make the most of your time with your doctor. For dry eyes, some basic questions to ask your doctor include:
- What's the most likely cause of my dry eyes?
- Do I need any tests?
- Can dry eyes get better on their own?
- What are my treatment options?
- What are the potential side effects of each treatment?
- Are there alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage these conditions together?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
- Do I need to plan for a follow-up visit?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions that may occur to you during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover points you want to address. Your doctor may ask:
- Can you describe your symptoms?
- Do you recall when you first began experiencing symptoms?
- Have your symptoms been continuous or occasional?
- Do other members of your family have dry eyes?
- Have you tried over-the-counter eyedrops? Did they provide relief?
- Are your symptoms worse in the morning or late in the day?
- What medications do you take?
What you can do in the meantime
To relieve your signs and symptoms while you wait for your appointment, try over-the-counter eyedrops. Look for lubricating eyedrops and avoid those that reduce redness in the eyes. Eyedrops that reduce eye redness can cause additional eye irritation.
Tests and diagnosis
Tests and procedures used to determine the cause of your dry eyes may include:
- A comprehensive eye exam. An eye exam that includes a complete history of your overall health and your eye health can help your doctor diagnose the cause of your dry eyes.
- Measuring the volume of your tears. Your doctor may measure your tear production using the Schirmer test. In this test, blotting strips of paper are placed under your lower eyelids. After five minutes your doctor measures the amount of strip soaked by your tears.
- Determining the quality of your tears. Other tests use special dyes in eyedrops to determine the surface condition of your eyes. Your doctor looks for staining patterns on the corneas and measures how long it takes before your tears evaporate.
Treatments and drugs
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For most people with occasional or mild dry eyes symptoms, treatment involves over-the-counter eyedrops, such as artificial tears, and other home remedies. It's best to avoid eyedrops that reduce redness, however. If your dry eyes symptoms are persistent and more serious, your treatment options will depend on what's causing your dry eyes. Some conditions that cause dry eyes can be reversed or managed. Other treatments can improve your tear quality or stop your tears from quickly draining away from your eyes.
Treating the underlying cause of dry eyes
In some cases, treating an underlying health issue can help reverse dry eyes. For instance, if a medication is causing your dry eyes, your doctor may recommend a different medication that doesn't cause that side effect.
If you have an eyelid condition, such as an anatomic abnormality or a condition that makes it difficult to close your eye completely when you blink, your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids (oculoplastic surgeon).
If your signs and symptoms suggest an autoimmune condition, such as rheumatoid arthritis or Sjogren's syndrome, your doctor may refer you to a rheumatologist for evaluation.
Prescriptions used to treat dry eyes include:
- Antibiotics to reduce eyelid inflammation. If inflammation along the edge of your eyelids keeps the oil glands from secreting oil into your tears, your doctor may recommend antibiotics to reduce inflammation. Antibiotics can be administered as eyedrops or ointment, or they can be taken in pill form.
- Prescription eyedrops to control cornea inflammation. Inflammation on the surface of your eyes may be controlled with prescription eyedrops that contain the immune-suppressing medication cyclosporine (Restasis) or that contain corticosteroids to control inflammation.
- Prescription eye inserts that work like artificial tears. For people with moderate to severe dry eyes symptoms who can't use artificial tears, one option may be a tiny eye insert that looks like a clear grain of rice. Once a day, you place the hydroxypropyl cellulose (Lacrisert) insert between your lower eyelid and your eyeball. The insert dissolves slowly, releasing a substance that's used in eyedrops to lubricate your eye.
Treatments that may be used include:
- Closing your tear ducts to reduce tear loss. Your doctor may suggest treatment to keep your tears from leaving your eye too quickly. This can be done by partially or completely closing your tear ducts, which normally serve to drain tears away. Tear ducts can be plugged with tiny silicone plugs (punctal plugs) that conserve both your own tears and artificial tears you may add. Silicone plugs can be removed or left in. Or, tear ducts can be plugged with a procedure that uses heat. In a more permanent procedure called thermal cautery, your doctor numbs the area with an anesthetic and then applies a hot wire that shrinks the tissues of the drainage area and causes scarring, which closes the tear duct.
- Covering your eyes with a special contact lens. People with severe dry eyes may opt for special contact lenses. These contact lenses help protect or shield the surface of your eyes, trapping moisture close to your eyes in order to relieve your dry eyes symptoms. Ask your eye doctor whether these special lenses, called bandage lenses or corneal shields, are an option for you.
- Unblocking blocked oil glands. A new treatment called LipiFlo thermal pulsation helps clear blocked oil glands. During the treatment, a device that looks like an eyecup is placed over your eye. The device then delivers a gentle, warm massage to the lower eyelid. The procedure takes less than 15 minutes, and you can go home right afterward. Results usually begin within a few days. Because this is a new treatment, it may not yet be available everywhere.
Lifestyle and home remedies
If you experience mild or occasional dry eyes symptoms, you may be able to manage your condition with over-the-counter eyedrops and frequent eyelid washing.
Adding tears with over-the-counter eyedrops
Mild cases of dry eyes may be relieved by over-the-counter artificial tears. A variety of artificial tears are available, so ask your doctor or eye doctor which drops might be best for you. Some ideas to help you select eyedrops include:
- Preservative vs. nonpreservative drops. Preservatives are added to some eyedrops to prolong shelf life. You can use eyedrops with preservatives up to four times a day. But using the preservative drops more often can cause eye irritation. Nonpreservative eyedrops come in packages that contain multiple single-use vials. After you use a vial, you must throw it away. If you rely on eyedrops more than four times a day, nonpreservative drops are safe.
- Drops vs. ointments. Lubricating eye ointments coat your eyes, providing longer lasting relief from dry eyes. But ointments are thick and can cloud your vision. For this reason, ointments are best used just before bedtime. Eyedrops can be used at any time and won't interfere with your vision.
How often you need to put eyedrops in your eyes will depend on your symptoms. Some people need to put drops in every hour, and some need eyedrops only once a day.
Washing your eyelids to control inflammation
For people with blepharitis and other conditions that cause eyelid inflammation that blocks the flow of oil to the eye, frequent eyelid washing may help. To wash your eyelids:
- Apply a warm washcloth to your eyes. Wet a clean cloth with warm water. Hold the cloth over your eyes for five minutes. Re-wet the cloth with warm water when it cools. Gently rub the washcloth over your eyelids to loosen any debris.
- Use a mild soap on your eyelids. Use baby shampoo or another type of soap recommended by your doctor. Put the soap on your clean fingertips and gently massage your closed eyes near the base of your eyelashes. Rinse the soap completely away.
Your doctor may recommend that you do this daily, even when you don't have dry eyes symptoms. Stopping this daily routine may cause your dry eyes to return.
Omega-3 and omega-6 fatty acids may help relieve dry eyes symptoms. These fatty acids, found in fish and vegetable oils, are thought to reduce inflammation in the body. In theory, increasing the amount of omega-3 fatty acids in your diet could reduce eye inflammation. More study is needed to prove this theory. But if you're interested in trying omega-3 fatty acids, discuss the benefits and risks with your doctor.
Omega-3 fatty acids are available in foods and in supplements. Some omega-3 fatty acid supplements can cause a fishy aftertaste and upset stomach. If this is a problem for you, look for pills that are odorless. Or, try adding foods that contain omega-3 fatty acids to your diet, such as:
- Palm oil
- Soybean oil
- Flaxseed oil
- Ground flaxseed
- Eggs from chickens fed with feed rich in omega-3 fatty acids
A recent study found that tear volume increased within hours after the use of caffeine. There's no specific research yet on caffeine and dry eyes, so it's not clear what effect, if any, caffeine might have on dry eyes symptoms.
If you experience dry eyes, pay attention to the situations that are most likely to cause your symptoms. Then find ways to avoid those situations in order to prevent your dry eyes symptoms. For instance:
- Avoid air blowing in your eyes. Don't direct hair dryers, car heaters, air conditioners or fans toward your eyes.
- Add moisture to the air. In winter, a humidifier can add moisture to dry indoor air.
- Consider wearing wraparound glasses or eyeglass shields to protect your eyes. Safety shields can be added to the tops and sides of eyeglasses to block wind and dry air from getting to your eyes. Ask about shields where you buy your eyeglasses. Swim goggles may create the same effect.
- Take eye breaks during long tasks. If you're reading or doing another task that requires visual concentration, take periodic eye breaks. Close your eyes for a few minutes. Or blink repeatedly for a few seconds to help spread your tears evenly over your eyes.
- Be aware of your environment. Ambient air at high altitudes, desert areas, and in airplanes can be extremely dry. When spending time in such an environment, especially when flying over long distances, it may be helpful to frequently close your eyes for a few minutes at a time to minimize evaporation of your tears.
- Position your computer screen below eye level. If your computer screen is above eye level, you'll open your eyes wider to view the screen. Position your computer screen below eye level so that you won't open your eyes as wide. This may help slow the evaporation of your tears between eye blinks.
- Stop smoking and avoid smoke. If you smoke, stop. Ask your doctor for help devising a quit-smoking strategy that's most likely to work for you. If you don't smoke, stay away from people who do. Smoke can worsen dry eyes symptoms.
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