Dry Eye

Dry eye is a condition in which your eyes don't make enough tears, or the right type of tears needed for optimal eye health. This can make your eyes feel itchy and irritated, among other things.

When you don't make enough quality tears to moisturize your eyes, you have what's called dry eye disease. This common condition can cause symptoms like stinging, burning, or blurred vision. Most of the time, dry eye can be managed with eye drops and a few common-sense changes to your lifestyle. But if left untreated, it can lead to complications like eye infections, corneal scratches, and even vision loss.

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What Is It?

Each time you blink, a film of tears is released over your cornea (the front part of your eye.) It works a lot like windshield wiper fluid for your car windshield: Tear film helps wash away debris or germs that could lead to an eye infection, and it helps keep your vision clear. But if your eyes don't make enough tears, or don't make enough tears that are of good quality, you'll feel it—and your vision could suffer as a result.

Dry eye disease is incredibly common, affecting over 16 million adults in the US alone. While it can be uncomfortable, annoying, and a chronic problem, it's also typically easily to treat.

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Types

Your tears are made up of mucus, fatty oil, and a water component called aqueous fluid. In balanced amounts, the special film they make keeps your eyes moist and clear. If not, your eyes will start to dry out.

There are two different types of dry eye disease.

Evaporative dry eye accounts for nearly 90 percent of all cases. It's due to a blockage of the tiny glands (called meibomian glands) that line your lash margin. When these glands are healthy, they produce a clear oil that keeps aqueous fluid from evaporating too quickly. But if the oil thickens and hardens, your glands can become clogged. As a result, your tears may evaporate up to 16 times faster than normal.

Aqueous dry eye is less common, accounting for only one-tenth of all dry eye disease cases. It happens when another gland in your eye can't make enough aqueous fluid. The ingredients in your tears become imbalanced, so the surface of your eye becomes dryer than it should be.

In severe cases, it's possible to have both these types of dry eye at the same time.

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Symptoms

You could have these symptoms in one, or both, eyes:

  • Redness.
  • Stinging, itching, or burning.
  • Light sensitivity.
  • A feeling that you have something gritty in your eye.
  • Finding it uncomfortable to wear your usual contact lenses.
  • Blurred vision.
  • Stringy mucus around the eye.
  • Watery eyes.
  • Discharge.
  • Trouble driving at night.

Although it sounds odd, another symptom of dry eye is tearing up. When your eyes aren't adequately lubricated, your nervous system is triggered to release more tears. But because they're mostly water, and missing the other ingredients needed to moisturize your eyes, they don't do much good.

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Causes

Evaporative dry eye can be caused by:

  • Dysfunctional oil glands.
  • Not blinking enough (like if you sit at a computer for hours each day or drive long hours).
  • Eyelid issues.
  • Allergies.
  • Exposure to wind, smoke, or heat.
  • Spending long amounts of time in arid weather or air-conditioning.

Aqueous dry eye can be brought on by:

  • Aging.
  • Some medications (like antihistamines, decongestants, antidepressants, and birth control).
  • Long-term contact lens use.
  • Laser eye surgery.

Although anyone can have dry eyes, you're more likely to be affected if you're:

  • A woman.
  • More than 50 years old.
  • A contact lens wearer.
  • Low in vitamin A or omega-3 fatty acids.
  • Living with certain medical conditions (such as diabetes, lupus,  rheumatoid arthritis or thyroid problems).
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Diagnosis

Many symptoms of dry eye disease overlap with other conditions, so you'll need an eye exam to get an official diagnosis. Your eye doctor will ask you questions about your symptoms and when they seem to flare up.

They could also choose to test:

Your tear production. A delicate testing strip under your eyelid can gauge how many tears your eye can make.

Your tear quality. A special dye can be put into your eye so the eye doctor can check how lubricated its surface is and how long it takes your tear film to dry up.

Your tear makeup. Your eye doctor can check the amount of particles and water in your tear film. People with dry eye will have less water in their eyes.

If you're scheduled for any type of eye surgery, your doctor will want to know if you have dry eye disease ahead of time—and treat you for it. For the best surgical results, the surface of your eyes should be in as good condition as possible. (Surgery is also known to dry out and irritate your eyes, so it could make your symptoms worse.)

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Treatment

Several different treatments can help your eyes start to feel better. Your eye doctor could suggest:

Artificial tears. This type of eye drop (which you can buy over-the-counter) can help lubricate and nourish your eyes.

Prescription eye drops. Some special medications can coax your eyes to make more fluid.

At-home care. For instance, warm compresses or gentle eye massages are sometimes recommended to ease symptoms.

It's important to seek help for dry eyes, and not only because they can make everyday habits, like reading, uncomfortable. When you ignore this condition, you leave yourself open for eye redness and swelling, infections, corneal scratches, and—the worst-case scenario—vision loss.

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Prevention

A few small tweaks to your environment, diet, and lifestyle could lead to a big improvement in how your eyes feel. Try to:

Minimize time spent in air-conditioning. An air-conditioned room can have as little as 25 percent humidity, which will dry out your eyes. A portable humidifier can help bring moisture in the air up to at least 40 percent, which can make your eyes more comfortable.

Keep air out of your eyes. Wind, hair dryers, fans…try to keep any gust of air from blowing directly into your eyes.

Take breaks from screen time. Remember to periodically close your eyes for a few minutes or blink several times in a row to help lubricate your eyes.

Position your screens. Keep your computer, phone, or tablet below eye level. If you have to look up to see the screen, you'll widen your eyes, which can dry them out faster.

Wear sunglasses when you're outside. Not only will they protect your eyes from the sun, but shield you from dust.

Use artificial tears. There are plenty of brands to choose from, so ask your eye doctor for a recommendation, as well as how often you should use them.

Stay hydrated. Aim for at least 8 glasses of water or non-caffeinated beverages each day.

Prioritize sleep. Here's another reason to try to get to bed early—there's some evidence that sleep deprivation could make dry eye symptoms worse.

Take it easy on your eyes. Some people find that wearing contact lenses can aggravate their dry eye symptoms. On days when your eyes feel extra-sensitive, take yours out, and make sure you have an updated pair of eyeglasses to wear instead.

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