Author: Dr Amit Pasan, Clinical Lead at Teladoc Health UK
Understanding Dry Eye Disease: Causes, Symptoms and Treatments
Dry Eye Disease happens when the eyes don’t making enough tears or tears evaporate too quickly. It causes irritation, blurred vision and discomfort. Treatments include lifestyle changes, lubricating drops and sometimes specialist care.
What is Dry Eye Disease?
Tears are essential for keeping the surface of the eyes moist, nourished and protected from foreign particles. When tear production or retention is disrupted, it can impact eye health.
Dry Eye Disease (DED), also known as keratoconjunctivitis sicca (KCS), is a common condition affecting millions of people worldwide.
It occurs when the eyes do not produce enough tears, or the tears evaporate too quickly, leading to discomfort and irritation. Although dry eyes do not usually cause long-term problems with sight, left untreated, DED can significantly impact daily activities and quality of life.
What Causes Dry Eye Disease?
Several factors can contribute to the development of dry eyes, including:
Aging: As we age, tear production naturally declines, making dry eyes more common after the age of 50. While both men and women can be affected, it’s more frequently seen in women, particularly after menopause.
Environmental factors: Wind, dry air, smoke, air conditioning and central heating can all increase tear evaporation. Additionally, prolonged screen time on devices like computers and phones can contribute to dry eyes, as it reduces the frequency of blinking.
Medications: Certain medications, including antihistamines, antidepressants and blood pressure medications can reduce tear production.
Health conditions: Autoimmune diseases such as rheumatoid arthritis, lupus and Sjögren’s syndrome can reduce tear production. Other conditions like diabetes, thyroid disorders or allergic eye conditions (e.g. due to pollen, dust or pet dander).
Blepharitis: This is a common eyelid condition causing inflammation and irritation, often caused by bacteria or blocked oil glands.
Contact lens use: Wearing contact lenses for extended periods can disrupt the natural tear film, leading to dryness and discomfort.
Surgery: Laser eye surgery can temporarily affect tear production, leading to dry eyes.
What Are the Symptoms of Dry Eye Disease?
The symptoms can vary from mild to severe. Common signs include:
A sandy or gritty feeling in the eyes
Burning or stinging sensation
Itchiness or irritation
Redness in the eyes
Temporary blurred vision, especially when reading or using screens
Excessive tearing, happens as the eyes produce extra tears to make up for dryness
Foreign body sensation
Are Dry Eyes Dangerous?
Complications of dry eyes are very rare and usually occur in people with an underlying medical condition who are exposed to a dry environment. If the eyes in such patients become too dry, the clear part at the front of the eye (cornea) can become damaged by forming ulcers and scars which can permanently affect vision. Thankfully this is very rare and can be prevented by early interventions.
How is Dry Eye Disease Diagnosed?
To diagnose dry eye disease, a clinician will conduct a comprehensive eye assessment. This may include:
Patient history: Asking about symptoms, lifestyle habits and any underlying medical conditions or medications.
Examination: This is necessary to assess the surface of the eye for signs of eye disease or complications like inflammation, or in rare cases, the presence of ulcers or scarring.
Blood tests: These may be done to investigate some of the causes of dry eye disease like thyroid disorders, diabetes or auto-immune conditions.
More specialised tests: Sometimes further tests are required, often conducted by community Optometrists or Ophthalmologists. These may include some or all the following:
Schirmer’s test: This test uses small strips of paper placed in the lower eyelid to measure tear production.
Eye surface staining: Special dyes may be used to check for damage to the surface of the eye caused by dryness.
Tear breakup time: This test involves placing a special dye in your eyes and measuring how quickly the tear film breaks up.
What Are the Best Treatments for Dry Eye Disease?
The treatment for dry eye disease depends on the underlying cause and the severity of the symptoms. Fortunately, a combination of lifestyle and environmental changes can help most people prevent dry eyes. For those who are still having symptoms despite these changes, tear substitute treatments and/or prescription treatments within primary care can effectively manage dry eye symptoms.
Lifestyle and Environmental Changes
Increase blink rate: When using digital devices, people tend to blink less, which can contribute to dry eyes. Try to take breaks using the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds.
Humidify the air: Use a humidifier to add moisture to the air, especially in dry or air-conditioned environments.
Avoid wind and smoke: Protect your eyes from wind and smoke by wearing sunglasses or a wrap-around style of glasses when outdoors
Stay hydrated: Drink plenty of water throughout the day to maintain adequate hydration levels, which can affect tear production.
Diet: Incorporate omega-3 fatty acids, which are found in fish and flaxseeds, into your diet, as they have been shown to improve tear quality.
Computers: Lower computer screen positions to below eye level which decreases the gap between upper and lower eyelids, helping to retain moisture.
Contact lens wearers: Wear lenses for shorter periods and remove them if dry eye symptoms are occurring. Changing the lens type or solution may help – speak to your optometrist.
What Tear Substitutes Help With Dry Eyes?
These are the mainstay of treatment for most people where lifestyle and environmental changes are not enough to prevent dry eye symptoms and aim to supplement and replace your natural tears to make the eyes more comfortable. Many of these tear substitutes can be purchased over the counter but some may require a prescription.
Artificial tears: These are lubricating eye drops that can help soothe the dryness and irritation associated with the condition. The recommendations are to use low viscosity drops frequently during the daytime as these reduce the risk of blurring vision, eyelid debris or eye stinging.
Gels: These are more viscous and so provide longer-lasting relief of symptoms. They cling to the surface of the eye and therefore need less frequent applications than drops.
Ointments: During sleep, the eyes may not fully close, which can let tears evaporate and leave the eyes very dry upon waking. Using eye ointments overnight helps keep the eyes moist and comfortable in the morning. They are best applied at night since they can temporarily blur vision and should not be used with contact lenses.
Preservative-free eye drops: These may be suggested if:
Artificial tears containing preservatives are causing eye irritation
Artificial tears are needed more than four times a day
You wear contact lenses
What Are The Treatment Options For Severe or Advanced Dry Eyes?
For more advanced dry eye conditions where diet, lifestyle and tear substitutes have not been successful in managing symptoms, a referral to an eye specialist may be required for further assessments and prescription medications to be considered depending on the underlying cause.
Specialist options include methods to retain or increase eye moisture, such as:
Eye drops or certain antibiotics that reduce inflammation in the eyelids and tear glands, which can be a major cause of dry eyes
Special eye drops that help the eyes make more natural tears
Small devices placed in the eye that can either slowly release moisture or stop tears from draining away too quickly
Minor procedures to close the tear ducts or improve the oil flow from eyelid glands
Can Dry Eyes Be Prevented?
While it may not always be possible to prevent dry eyes, there are steps you can take to reduce the risk:
Clean your eyelids every day
Protect your eyes from environmental irritants
Take frequent breaks from screens
Stay hydrated and eat a balanced diet
Wear protective eyewear in harsh weather conditions or when using screens for extended periods
Use lubricating eye drops regularly if you have a tendency toward dry eyes
When Should You See an Eye Care Professional?
If you experience persistent dry eye symptoms that interfere with your daily life, it’s important to consult an eye care professional. Getting treatment early can help stop problems like eye infections, damage to the surface of the eye (cornea) or long-term eye problems.
You should seek medical attention if you experience any of the following:
Persistent eye irritation or discomfort
Decreased vision or blurry vision that doesn’t improve with blinking
Eye redness or increased sensitivity to light
Difficulty wearing contact lenses
Discomfort that doesn’t respond to over-the-counter treatments
Conclusion
Dry Eye Disease can be managed with lifestyle changes, over the counter or prescription treatments, and sometimes specialist care. Understanding its causes and symptoms helps guide effective relief, so if you experience dry eyes, consult an eye care professional before discomfort worsens.
