What Is Chronically Dry Eyes?
Chronically dry eyes are a relatively common condition, especially in older adults, that can be very uncomfortable and lead to damage of the surface of the eye. They are caused by a decrease in the tear production of the eye or an increase in tear evaporation. Risk factors include age, female gender, use of contacts, Sjogren’s syndrome, diabetes, use of certain medications, and vitamin A deficiency [1,2]. The predominant symptoms are dry and red eyes, irritation of the eye, and a feeling that there is an object in the eye. The primary treatment for dry eyes is to use rewetting drops or artificial tears, which are available over-the-counter.
You can safely treat this condition on your own with artificial tears, which come as eye drops and gels, and are usually great at relieving symptoms. You can purchase these at a pharmacy. You might want to consider consulting your primary care physician (PCP) if over-the-counter remedies don't help.
How common is chronically dry eyes?
Symptoms that always occur with chronically dry eyes:
- Dry eyes
Chronically dry eyes is also known as
- Keratoconjunctivitis sicca
- Dry eye syndrome
- Dysfunctional syndrome
Chronically Dry Eyes Symptoms
The symptoms of dry eyes are generally the result of the increased friction of the eyelid rubbing on the dry eye surface. This can lead to inflammation as a result.
- Eye dryness: The predominant symptom is a feeling that your eyes are “drying out.”
- Eye redness: This is a result of an inflammatory response to the irritated eye surface and is reversible.
- Foreign body sensation: This is the feeling that there is something in the eye or that there is a general “grittiness” or “coarseness” of the eye during blinking.
- Reactive tearing: In response, the eye may produce a large number of tears.
- Stinging/burning eyes
- Inability to wear contact lenses
Symptoms of Sjogren’s Syndrome
If dry eyes are also present with the following symptoms, they can indicate the presence of an immune condition, called Sjogren’s Syndrome.
- Dry mouth
- Difficulty swallowing
- Waking up at night to drink water
- Vaginal dryness
Consequences of dry eyes
If untreated, dry eyes can lead to some serious complications, including:
- Decreased visual sharpness
- Eye infection
- Eye ulceration
Chronically Dry Eyes Causes
There are a wide variety of causes of dry eyes. Many tests are available to diagnose the origin of dry eyes, however, these tests may only tell you that have dry eyes, not why you have dry eyes. Every diagnosis begins with a thorough patient history, which may reveal certain environmental or family risks that may give a clue to the source of the dry eyes. Some of these tests include fluorescein tear breakup time, the Schirmer test, and ocular surface dye staining.
The fluorescein test places a dye in your eye and then observes how long it takes for evaporation of eye tears . The Schirmer test is like a car oil dipstick test: a piece of filter paper is inserted into the eye and the column of tears that forms is measured to see if it is enough . Lastly, the ocular surface dye stain test uses a variety of dyes and a microscope to examine the tear surface of your eye . None of these tests causes pain since numbing drops are used.
The most important risk factor for dry eyes is aging. Aging results in a decline of tear production.
There are a number of exposures that can decrease tear production and/or increase tear evaporation:
- Contact lens use
- Pollution level
- Air dryness and wind level
- Damage to the tear gland from radiation or burns
Disorders of the immune system that cause damage to the tear glands include:
Non-autoimmune conditions can also cause dry eyes:
- Thyroid disorders
- Previous surgery on the eye
- Structural abnormality of the eyelid
- Use of medications: Such as antihistamines (i.e. Benadryl), decongestants (i.e. Sudafed), antidepressants, hormone replacement therapy and birth control, and Parkinson’s disease  Vitamin A deficiency
Treatment Options and Prevention for Chronically Dry Eyes
The mainstay of treatment of dry eyes is eye rewetting drops or “artificial tears.” These tears are designed to mimic human teardrops. They consist of saline (salty water) solution that is not irritating to the eye. Certain “heavier duty” drops exist that contain some oil in them in order to increase how long the drop stays in your eye. These drops are typically milky white in color but do not cloud your vision after a few blinks. Generally, you should put one drop in each eye as needed, but if you use rewetting drops more than six times a day, it is recommended to use a preservative-free formulation. Most of the time, improvement is instantaneous, but it can take a few weeks for the full effect to be reached.
If rewetting drops are insufficient, a doctor may prescribe other medications that are dripped into the eye, such as:
- Cyclosporine: This decreases inflammation of the eye.
- Sodium hyaluronate: This provides a jelly-like gel to the eye.
- Steroids: This decreases inflammation of the eye.
- Pilocarpine: This increases tear production.
In addition, if your dry eyes are caused or worsened by another condition, then it is important to treat the primary condition, such as diabetes, Sjogren’s Syndrome, thyroid disease, Lupus, etc. Obtaining medical management for these conditions may decrease dryness.
Adequate prevention of dry eyes depends on the cause of dry eyes. If the cause is autoimmune (such as Sjogren’s, Lupus, or rosacea), then adequate control of the autoimmune condition may improve eye dryness.
Once you have dry eyes, it is important to treat the condition so as to avoid development of complications of dry eyes. Please see the treatment section above for strategies.
Avoid these activities
The following activities have been linked with worsening dry eyes. Avoiding them may decrease the severity of dry eyes
- Multivitamin use
- Working in conditions that cause air to blow into the eye
- Staring at a screen for long periods of time
Consider these activities
These are some preventative strategies to decrease the development of dry eyes:
- Humidification of the air: Using a humidifier for rooms that are dry may help .
- Eyewear: Eyewear can block excess dry air from entering the eye.
- Take a break from contacts: Every now and then, give your eyes a rest from contacts, and when you do use contacts, use rewetting drops to prevent damage to the eye.
- Caffeine use: Caffeine may be protective against developing dry eyes, but we do not suggest you start using caffeine as a treatment for dry eyes.
When to Seek Further Consultation for Chronically Dry Eyes
If you do not see improvement in your dry eyes with the alteration of your environment (as above) and use of rewetting drops, it is time to seek a doctor. A doctor can help diagnose why you have dry eyes and prescribe medication to decrease your symptoms. Sometimes, your doctor may refer you to an eye specialist, called an ophthalmologist, if he or she cannot diagnose your condition.
Another time to see a doctor is if you notice other conditions besides dry eyes. For example, if you also notice that you have difficulty swallowing, vaginal dryness, and dry mouth in addition to your dry eyes, then it is important to consult a doctor to see if you have a condition called Sjogren’s Syndrome. Dry eyes can also indicate a worsening of another condition, such as diabetes. It is important to tell all your doctors that you have dry eyes as this may be an indication that treatment for another condition requires refinement.
Questions Your Doctor May Ask to Determine Chronically Dry Eyes
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Is there any fluid or discharge coming from your eye(s)?
- Do your eyelids feel sticky?
- How long has your eye been red?
- Is your eye redness getting better or worse?
- Is your eye redness constant or come-and-go?
The above questions are also covered by our A.I. Health Assistant.
- Moss SE, Klein R, Klein BE. Prevalence and Risk Factors for Dry Eye Syndrome. Arch Ophthalmol. 2000;118(9):1264-1268. JAMA Link
- Dry eyes - Symptoms and causes. The Mayo Clinic. Updated Sept. 25, 2018. Mayo Clinic Link
- Vislesel J. Tear breakup time (TBUT). University of Iowa Health Care: EyeRounds.org. Updated June 2, 2015. Eye Rounds Link
- Schirmer’s test. Johns Hopkins Sjogren’s Syndrome Center. Johns Hopkins Sjogren's Link
- Ocular surface staining. Johns Hopkins Sjogren’s Syndrome Center. Johns Hopkins Sjogren’s Link