Eyes that often feel dry, especially when blinking, can be very uncomfortable. Dryness can also eventually damage the eye’s surface. This sometimes happens because your tear ducts are not producing enough tears or because the tears are evaporating. Dry eyes may be a symptom of aging and menopause.
Other causes include contact lenses, air pollution, and dry air. But it can also be from damage to the tear gland from radiation or burns. Certain medications like antihistamines and hormone replacement therapy can also dry eyes out.
Autoimmune disorders, including Sjogren’s syndrome, scleroderma, rheumatoid arthritis, and lupus, can cause dry eyes by damaging the tear glands.
Over-the-counter (OTC) rewetting drops (artificial tears) and adding moisture to the air by using a humidifier, can help. But it’s important to talk to your doctor so they can rule out other underlying conditions.
There are different reasons for dryness, including decreased tear production (making tears), losing tears (eyelids stay open at night), and changes on the eyelid margin that help make the tear film (i.e., blepharitis). —Dr. Steven Yeh
1. Sjögren’s Syndrome
- Dry eyes
- Dry mouth
- Joint pain
- Dysfunction of organs such as the kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas, and the central nervous system
Sjögren’s syndrome is a systemic autoimmune disease, which happens when the body's immune system attacks its own cells, tissues, and organs. There is no single way it progresses, which makes it difficult for both patients and doctors. Some people feel only mild discomfort, while others have severe symptoms that impact how their body functions.
Roughly half the time Sjögren’s occurs on its own. For the other instances, people have other autoimmune diseases like rheumatoid arthritis, lupus, or scleroderma.
Treatment depends on your specific symptoms and the progression of the disease. But a combination of behavioral strategies such as eyelid scrubs and OTC and prescription drugs will usually improve the quality of your tears.
- Gritty or burning sensation in the eyes
- Excessive tearing
- Red and swollen eyelids
- Dry eyes or crusting of the eyelids, like dandruff
- Eyelid discharge and recurrent styes
Blepharitis is when the eyelids become inflamed. It is a common eye disorder, caused by bacteria or a skin condition like dandruff or rosacea.
Treatment varies depending on the type of blepharitis. It usually focuses on keeping the lids clean and free of crust by:
- Applying warm compresses
- Practicing eyelid hygiene (gently scrubbing the eyelids with special products such as OcuSoft lid scrubs)
- Using OTC artificial tears to keep your eye moist.
- Mix a drop of baby shampoo with water to clean the eyelid
- Dry eyes
- Itching, stinging, or burning
Dry eyes are a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes. In addition, some medications that older people are more likely to take, like blood pressure medications, can worsen the problem.
And older women are more likely to develop it because of the hormonal changes that occur with menopause.
You can use over-the-counter artificial tear solutions to help keep your eyes moist. These can be used as often as needed.
- Flushing and redness in the center of the face
- Visible broken blood vessels (spider veins)
- Swollen, sensitive skin
- Stinging and burning skin
- Dry, rough, or scaling skin
- Frequent flushing or blushing
Rosacea is a very common skin disease where your face becomes red over time, usually along the nose, cheeks, forehead, and chin. Sometimes the ears, chest, and back are red all the time. Eyelids can become inflamed, red, or irritated.
Treatment doesn’t cure rosacea but avoiding triggers and using sun protection (sunglasses, wide-brimmed hat) can lessen symptoms. Taking care of the eyelids with warm compresses, eyelid hygiene, and OTC soaks and scrubs can also help.
- Unintended weight loss
- Palpitations (rapid or irregular heartbeat)
- Irritability or mood swings
- Heat intolerance: excessive sweating and uncomfortable warmth in relatively mild temperatures.
- Skin irritation, including clammy or itchy skin
Hyperthyroidism is when the thyroid gland releases too much thyroid hormone. This causes the body's metabolism to speed up, which leads to symptoms like tremors, sweating, and a faster heartbeat.
The most common cause of hyperthyroidism is the autoimmune condition known as Graves disease. In Graves disease, the eyes may seem to protrude and become dry from exposure of the white part of the eye.
Treatment includes anti-thyroid medications, radioactive iodine, and sometimes surgery. If the thyroid eye disease is severe, you may need anti-inflammatory medications, including oral steroids, to better control symptoms.
You can treat dry eyes with artificial tear drops and find ways to decrease exposure of the eye to the environment if the protrusion is severe.
- Cold intolerance
- Dry, cool skin, clammy hands
- Weight gain
- Facial swelling and lower leg swelling
- Decreased appetite
- Brittle hair and nails
Hypothyroidism is when the thyroid gland is underactive, so it doesn't produce enough thyroid hormone. This slows your metabolism and heart rate. Dry eyes are more common with hyperthyroidism, but it can occur with hypothyroidism.
Treatment usually centers around replacement hormones for low thyroid levels.
- Joint pain, stiffness, and swelling
- A butterfly-shaped rash on the face that covers the cheeks and bridge of the nose
- Rashes elsewhere on the body
- Skin lesions that worsen with sun exposure
- White or blue fingers and toes when exposed to cold or during stressful periods (Raynaud's phenomenon)
- Shortness of breath
- Chest pain
- Dry eyes
- Mouth ulcers
- Hair loss
- Headaches, confusion, and memory loss
Lupus is an autoimmune disease that can affect multiple body systems and organs, including the heart, lungs, joints, and eyes. Symptoms are different for every person, depending on which organs or systems are under attack.
Lupus can also cause dry eyes and other eye problems that may lead to blurred vision.
Treatment is focused on reducing symptoms, mostly with a range of medications, depending on the organs that are affected.
8. Parkinson’s disease
- Pill-rolling tremor, mainly at rest (looks like you’re trying to roll a pill between your thumb and index finger), though other tremor types are possible
- Bradykinesia (slowness of movement)
- Limb rigidity
- Gait and balance problems
- Reduced blink rate
Parkinson's disease is a progressive disorder that erodes specific neurons, or brain cells, in certain parts of your brain. Symptoms progress differently from person to person. Doctors don't know what causes the condition.
Because it reduces the rate of blinking, it makes eyes dry.
There is no cure, but medications and surgery can help manage symptoms. OTC lubricants (i.e., artificial tears, lubricating ointment) at bedtime can help with symptoms.
9. Vitamin A deficiency
- Vision loss, particularly side vision
- Reduced vision, especially at night
If you don't get enough vitamin A from your diet, you can develop a deficiency. Foods high in vitamin A include leafy green vegetables, orange vegetables, eggs, and cantaloupe. While uncommon, people who have had surgery on their stomach (i.e., for weight loss) and small intestine are at higher risk for vitamin A deficiency.
A deficiency causes your eye to stop producing the pigments that allow you to see a full spectrum of light. This creates night blindness. Vitamin A is also crucial for nourishing other parts of your eye, such as the cornea. If you are deficient in the vitamin, your eyes can't produce enough moisture to stay well lubricated.
Treatment is with vitamin A supplements. Never take unless your doctor tells you to. Because there is a risk of toxicity from too much vitamin A, your doctor will monitor vitamin A levels in your blood.
Other possible causes
A number of conditions may also cause dry eyes:
- Stevens Johnson syndrome
- Graft-versus-host disease
An important question to ask your doctor is: What type of dry eye do I have? For example, inflammatory, tears are evaporating, tears aren’t being produced? —Dr. Yeh
When to call the doctor
Call your primary care physician if you have any of the following signs:
- Persistent eye redness that does not get better with artificial tears
- Vision loss
- Dry eye symptoms accompanied by new symptoms that affect other parts of the body (i.e., dry mouth, tremors, arthritis)
Should I go to the ER?
You should go to the emergency department if you have any of these signs of a more serious problem:
- Any vision loss that does not return to normal quickly. It may be a symptom of something more severe than dry eyes.
- Moderate to severe pain that does not get better with artificial tears
- Severe eye redness when associated with pain or vision decline
- Use rewetting drops.
- Try to blink regularly when reading or staring at a computer screen.
- Warm compresses and eyelid hygiene (gently scrubbing the eyelids with special products such as OcuSoft lid scrubs)
- Avoid smoking and working in conditions that cause air to blow into the eye, or jobs that require you to stare at a screen for long periods of time. When you have to stare at a screen for a long time, try to take a break approximately every 15 minutes.
- Use a humidifier in rooms that are particularly dry.
- Get specialized eyewear that acts as a moisture chamber. These have side shields to block excess dry air and wind from entering the eye and increase the humidity for your eyes.
- Wear contact lenses as prescribed by the eye doctor. They usually recommend that you occasionally give your eyes a rest from contacts. When you wear contacts, be sure to use rewetting drops to prevent eye damage.
I once took care of an 87-year-old patient who developed dry eyes from prior scarring and had many dry spots on his cornea (front of the eye). After lubrication with artificial tears, consistent warm compresses, and monitoring, his dry eye and vision impairment completely improved. —Dr. Yeh
Other treatment options
Your doctor may prescribe:
- Cyclosporine to decrease eye inflammation
- Lifitegrast (Xiidra) eye drops
- Low-dose steroids to decrease eye inflammation
- Pilocarpine to increase tear production
Steven Yeh, MD, is a board-certified ophthalmologist at Emory University School of Medicine's Emory Eye Center, where he also holds the M. Louise Simpson Endowed Professorship in Ophthalmology and directs the Uveitis and Vasculitis Service. A vitreoretinal physician and surgeon, Dr. Yeh's areas of expertise include advanced diagnostics for the care of adult and pediatric uveitis, age-related macular degeneration, diabetic retinopathy, ocular trauma, retinal vascular disease, retinal detachment surgery, and autoimmune conditions that can affect the eyes. He has worked with the NIH and World Health Organization to serve on the front lines of the Ebola crisis in the U.S. and Africa, pursue clinical research interests, and ultimately build a program around infectious diseases of the eye. Internationally recognized for his clinical expertise, teaching, and research, Dr. Yeh has published more than 200 peer-reviewed publications and abstracts, many of which have been presented at premier ophthalmology conferences and meetings around the world. Dedicated to improving access to and the delivery of care, Dr. Yeh has partnered with colleagues, trainees, and industry to inform the development of diagnostic procedures, drug treatment, and surgical innovations in ophthalmology Dr. Yeh is a member of several professional societies and committees — including the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee and the American Uveitis Society Executive Committee. He has received awards through the American Society of Retina Specialists, Macula Society and the Association for Research in Vision and Ophthalmology.