Dry Eye Syndrome (DES) Symptoms and Treatment

Everyone experiences dry eyes from time to time, whether it’s from allergies, a seasonal cold, or old contact lenses. However, for people with dry eye syndrome, symptoms don't just come and go occasionally—they can be a part of daily life. 

What Is Dry Eye Syndrome?

Dry eye syndrome (DES)—sometimes called dry eye disease—is a chronic condition that occurs when your eyes don't make enough tears or the right kind of tears to keep your eyes properly lubricated. Other medical terms for the condition include keratoconjunctivitis sicca or keratitis sicca. While dry eye symptoms can be frustrating, you are not alone. In fact, nearly 16 million Americans live with this condition. 

man feeling eye pain and rubbing eyes

Oscar Wong / Getty Images

Symptoms

Dry eye symptoms vary from person to person. And, like with many conditions, your chances of developing it increase with age. You might experience a variety of symptoms, either by themselves or in combination with others. 

Redness

Dry eye can cause your eyes to appear red or bloodshot. Typically when you blink, a layer of tears known as “tear film” spreads across your cornea or the outer layer of your eye. The tear film keeps your eyes lubricated and protects you from irritants (e.g., dust, eyelashes, etc.) and infections. 

However, dry eye syndrome makes it hard for your eyes to produce tears. When your eyes don’t have enough lubrication, the act of blinking can cause your eyelids to rub against a dry cornea, which can lead to irritation. As a result, the blood vessels in the sclera, or the white part of the eye, can become swollen and appear red.

In some cases of dry eye, redness may be caused by a condition called meibomian gland dysfunction (MGD). Meibomian glands are small oil glands on your eyelids that produce oil and protect the tear film. If your meibomian glands aren’t making enough oil, it can worsen dry eye and lead to inflammation.

Difficulty Blinking

Dry eye syndrome can prevent you from producing the right amount of tears and oil needed to protect your tear film. Your eyelids need a smooth surface to move across when you blink. 

Think about it this way: you can go down a dry water slide, but it'll be a pretty bumpy ride. Without proper lubrication, dry eyes can create friction that makes it difficult to blink without discomfort. 

Stinging or Burning

Stinging or burning typically occurs when your eyes have difficulty making either oil or tears. 

Blinking is essential for your eyelids to produce the oil that protects your tear film. This oil provides lubrication and without it, your eyes may sting. 

Dry eye syndrome can make it hard to produce tears. When you don’t have enough tears, your cornea can dry out and make you feel a burning sensation. 

Scratchy Eyes

When your tears aren’t lubricating your eye as they should, it can make your eyes feel sandy, scratchy, or gritty—kind of like something is stuck in there and constantly irritating them. This feeling is known as a foreign body sensation. 

Typically, the tear film serves as a layer of protection between the eyelid and the eyeball. With dry eyes, you can develop dry spots on your tear film that can irritate your eyes. Fortunately, these dry spots are not permanent and can heal with treatment that keeps your eyes moisturized.

Dry Eye-caused Blurry Vision

Your vision should appear normal to you when your tear film is lubricated. With dry eye, your tear film can become dry and make your eyes blurry.

A 2020 study published in the International Journal of Molecular Sciences explained that a healthy tear film is necessary for clear vision. The first layer of your eye that sees light is the tear film. Once the tear film becomes dry, your vision can become distorted. 

Blurry vision is a common dry eye symptom that may come and go. Your vision might be clear in the morning because your eyes were closed during sleep. When you wake up, the dryness could quickly set in and cause your vision to blur. 

Your tear film can be repaired with treatments like the regular use of artificial tears (eye drops used to lubricate the eye). When your tear film starts to improve, you may also notice your vision getting better. 

Light Sensitivity

Similar to blurry vision, changes to your tear film can also cause light sensitivity. Light enters your eye through the tear film first. While the tear film is typically lubricated and smooth, dry eye can cause dry spots or unevenness which can make you sensitive to light. 

Some people with dry eye might experience light sensitivity temporarily. Others may have constant sensitivity to natural light in the day or from headlight or street light glares at night. Light sensitivity is also known as photophobia. 

A 2016 study published in Expert Review of Ophthalmology suggested that light-sensitive cells in the retina, the layer of the tissue that lines the back of the eye, may be responsible for the discomfort. Researchers believe that these cells may be connected to the nerves that relay sensory information to the head and face.  

People with photophobia may squint or shut their eyes when exposed to light. The amount of discomfort can vary, too. Some people might experience extreme pain when light comes into contact with the nerve endings in the eye. Others may complain about the light being too bright or feel the need to close their eyes.

Eye Strain and Fatigue 

Eye fatigue can occur from staring at phones or computer screens for extended periods of time. These habits can change how often you blink. Anyone can experience eye fatigue; however, people with dry eye may be more vulnerable to strained or tired eyes. On average, people blink about 22 times per minute. When people spend too much time on digital devices, they tend to blink at more than one-half of the normal rate. 

Blinking is important because it lubricates your eyes and keeps your tear film healthy. Dry eye can damage the tear film and eye strain can worsen it. You might blink less whenever you perform any activity that requires intense focus, such as reading or driving. 

To avoid eye fatigue, follow the 20/20/20 rule of thumb from the American Academy of Ophthalmology: take a break every 20 minutes by looking at something 20 feet away for 20 seconds.

Inability to Cry

You could have dry eye if your tears won’t fall when you’re feeling emotional. It can be a frustrating feeling to not get the emotional release of crying when you feel like you need to cry. 

Some people with dry eye might think they’re unable to cry because they’re having trouble expressing their emotions. What is actually happening is that your eyes aren’t able to produce enough tears. 

However, a lack of tears can also be a result of other factors such as a side effect of medication or living in a dry or windy environment. It's also one of the hallmarks of Sjogren's syndrome, an autoimmune disorder that reduces the production of tears and saliva in your body. If you notice your dry eye is accompanied by dry mouth, talk to your healthcare provider about getting tested for Sjogren's syndrome.

Watery Eyes

While some people may experience the inability to cry, others might produce too many tears. This may sound counterintuitive, but watery eyes can also be a dry eye symptom. 

Researchers suggest this symptom occurs because of a subtype of dry eye called evaporative dry eye syndrome. As the most common type of dry eye syndrome, evaporative dry eye happens when you don’t produce the right kind of tears.

Tears need to contain a balanced amount of water, oil, and mucus to protect your eyes. If your meibomian glands (the glands that produce oil) don’t function properly, you may not have enough oil in your eyes to coat the tear film. The oil from the meibomian glands helps keep the tears in your eyes. Too little oil can make your tears easily evaporate, or water too much. 

Stringy Mucus in the Eye

This symptom is more common in people with moderate to severe dry eye and may occur in combination with other conditions, like an infection or allergy.

People with dry eye who don’t produce enough tears or oil to protect the tear film can experience friction or strain when they blink. When this happens, the tear film tries to make mucus in order to make up for the lack of moisture in your eyes. 

The mucus usually looks like a stringy discharge coming out of your eyes. If you begin to see mucus coming out of your eyes, try to remove it gently with a clean tissue instead of rubbing your eyes. Too much rubbing can cause inflammation in your eyes and worsen your condition. 

Wearing Contacts With Dry Eye Syndrome

A 2017 study published in Contact Lens and Anterior Eye found that nearly half of contact lens wearers report dryness when wearing contacts too long. Long-term use of contact lenses can lead to dryness because your eyes can’t produce as many tears. 

This doesn’t necessarily mean you have dry eye syndrome. However, if your contact lenses suddenly become uncomfortable to wear and you experience additional dry eye symptoms, you may want to get tested.

When to See a Healthcare Provider

Dry eye syndrome can have several different symptoms. If you have a mild case of dry eye, you may be able to manage your condition with lifestyle changes such as taking more computer breaks and using over-the-counter eye drops.

 If you begin to notice further discomfort or additional symptoms, don’t wait too long before seeing your healthcare provider. Dry eye can be very manageable. However, if left untreated, you may develop more serious conditions that can lead to vision loss.

 If you begin to notice common dry eye symptoms, speak to your eye care specialist (e.g., optometrist or ophthalmologist) about getting tested. They can help determine what is causing your symptoms and give you a proper diagnosis.

A Quick Review

Dry eye occurs when your eyes have trouble producing enough tears or the right kind of tears. People with dry eye syndrome can have a variety of uncomfortable symptoms, such as redness, blurry vision, light sensitivity, or difficulty blinking, driving, and reading. 

The good news is that there are many treatments for dry eye syndrome. Getting tested early can help your healthcare provider find the best treatment option for you. In the end, this may help keep your condition from progressing and, ultimately, preserve your vision.

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Sources
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