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What Causes Dry Eyes?

Dry eye is a common eye problem suffered by many people, and is typically characterized by redness, pain, or an itching/ burning sensation in the eyes.

What Causes Dry Eyes? Optometrist
Specialty Vision

Understanding Dry Eye: Importance of Early Diagnosis and Treatment

There are a wide range of conditions which can cause symptoms of dry eye. For this reason, it’s extremely important to schedule a visit with our eye care professional if you're experiencing dry eye symptoms. A Specialty Vision listed optometrist can help determine the underlying causes of dry eye in your specific case, allowing you to start the correct treatment.

Some causes of dry eye are easier to treat than others, and some treatments will only work for dry eye caused by specific issues. For this reason, it is crucial to contact your optometrist for a proper diagnosis.

In most cases, dry eye is a result of your tears evaporating too quickly, leaving your eyes improperly moisturized.

So, What Causes Dry Eye?

So, What Causes Dry Eye?

Some common factors include:

  • Blepharitis (demodex mites): Tiny mites which can live in hair follicles on the face and eyes can carry bacteria and other waste which can clog the oil-producing glands in the area and inflame the eyelids. Learn more about blepharitis.
  • MGD (Meibomian Gland Dysfunction): Meibomian gland dysfunction is an umbrella term for conditions which lead to clogged meibomian glands, which secrete oil which is a vital part of the tears. WIthout this oil film, they will evaporate too quickly and leave your eyes dry. Learn more about meibomian gland dysfunction.
  • Hormonal Changes: Changes in the body’s hormone levels can affect the tears, and thus lead to dry eye. In particular, as much as 80 percent of post-menopausal women suffer from dry eye due to hormonal changes.
  • Medication: Certain medications, such as plaquinil (a heart medication), and hydroxychloroquine (a drug made a household name due to COVID-19), have been shown to cause dry eye.

 

Other causes of dry eye include:

Other causes of dry eye include:

  • Makeup: Certain types of makeup, eye makeup in particular, can lead to reactions in some that causes dry eye.
  • Climate: People who live in drier climates, and who spend a lot of time outdoors in windy areas are more likely to experience dry eye due to the lack of moisture in the air, or exposure to more dust and other particles which can irritate the eyes.
  • Excessive Computer Use: People who spend a great deal of time staring at computer (or other) screens are likely to experience dry eye, due either to not blinking enough, or not fully blinking. Blinking replenishes the tears and keeps the eyes moist, so even if there are no other underlying problems, simply staring at screens all day can lead to dry eye symptoms. Learn more about it here.
  • Contact Lenses: People who are more susceptible to dry eye are more likely to experience symptoms while wearing contact lenses, especially those contacts which are less breathable, as this can make the eyes drier. Additionally, products linked to contact lenses, such as contact lens solution, can irritate the eyes and cause symptoms. Learn more about it here.
  • Eye Surgery: It is very common for people to suffer from dry eye following eye surgeries such as cataract or lasik surgery.

 

Common Questions

Some symptoms of dry eyes are that your eyes may feel gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or you may experience light sensitivity. Other symptoms may include blurry vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up, after going in and out of focus, due to an unstable ocular surface.
Yes, when we perform tasks that require high visual concentration, such as staring at a computer screen, reading, or writing for a prolonged period of time, this results in us blinking less, causing dry eyes. Additionally, some other everyday activities that can cause dry eyes are using a hair dryer, not drinking enough water, sitting in front of the office air-conditioner or fan, wearing eye makeup, working in extreme temperatures, wind blowing in your face, or being surrounded by cigarette smoke.
Dry eyes can be detected by your eye doctor first reviewing your symptoms and the severity. Some symptoms of dry eyes include burning, itching, excessive tearing, gritty/foreign body sensation, eye discomfort, inflammation, or blurry vision. Then a thorough dry eye evaluation will be conducted. Your doctor will look at your eyes under a microscope where they will assess your meibomian glands on your upper and lower lid margin. To get a better image of the inside of your meibomian/oil glands your doctor may also take an image of them using a Lipiscan/Meibography. If any of your oil glands are capped, truncated or atrophied this may indicate you have dry eyes. Also your tear layer will be assessed, typically a sodium fluorescein dye would be used. Here we can examine your tear break up time (TBUT), tear meniscus height, and blink rate. Various other tests can be used to detect dry eyes such as Lissamine green and Rose Bengal dye, Schirmer test 1 and 2, and Phenol red test. For the Schirmer Test your eye doctor will place a strip of medical paper inside of your lower eyelids, and the paper will then absorb your tears, which will show us the amount of tears you have. For the phenol red test it’s the same concept as the Schirmer test but instead a thin red thread string is placed inside your lower eyelids to determine the volume of your tears. If any of these values are below normal this can also help us detect dry eyes.
Yes, especially winter weather. In the winter due to cold weather outdoors and heated air indoors we have less moisture and low humidity, which may result in our eyes feeling dry. Also if it’s windy and cold this can cause excessive tearing as well. Snowfall can also cause your eyes to be sensitive to light/painful because snowfall creates many reflective surfaces that increase the amount of light. If there is a lot of pollution outside or if it’s during the spring time and there is a lot of pollen in the air this can also make your eyes feel itchy and gritty.
Depends on the severity of the meibomian gland dysfunction (MGD). We have meibomian glands on our upper and lower lid margin that help to produce oil, which contributes to the outermost oil layer of our tears and prevents our tears from evaporating. MGD is when the glands don’t work properly. If these glands are blocked, they do not secrete the oils necessary to maintain a healthy tear film, and can eventually die off resulting in various symptoms such as dry eyes, burning, itching, irritation, tearing, foreign body sensation etc. If the glands have already atrophied then there is no way of getting the glands back. However, if the glands are still present but just truncated or tortuous, then there is still a chance to allow the glands to start working properly again with various MGD treatment options.
When you have dry eyes this sends out a signal to your lacrimal gland to produce more tears, but then this results in an overproduction of tears causing tearing/watery eyes. The overproduction of tears is called reflex tearing. Your body is trying to counteract your dry eyes, so it then starts to produce more tears, but then it ends up flooding your eyes with too much tears, resulting in a vicious cycle of dry and then teary eyes. That is why it’s important to deal with the root of the cause of the tearing, which is your dry eyes, to stop this sequence of events from happening. But it’s important to also note that watery eyes can be caused by other conditions as well, so be sure to get a thorough evaluation by your eye doctor to determine the proper diagnosis and treatment.
There are various symptoms of dry eyes such as your eyes feeling gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, blurry vision, or you may experience light sensitivity. Dry eyes can also cause your eyes to feel tired. However, there can also be other causes of eye fatigue. Some activities that can result in your eyes feeling tired is prolonged use of digital devices, reading without breaks, activities that involve extended focus, being exposed to bright light/glare or straining your eyes because of dim lighting, uncorrected vision, or being stressed/fatigued.
There are ways to alter your environment in order to prevent dry eyes. For instance, avoid air blowing in your eyes such as a fan, air conditioner, hair dryers, or car heaters. Also consider adding a humidifier to add moisture to dry indoor air, which is especially useful when the heaters are on in the winter. Also, when you go outside the wind and dry air can cause your eyes to tear and be dry, so to prevent this and to protect your eyes it’s important to wear sunglasses or other protective eyewear when you go outside. Furthermore, if you are working with your digital device it’s important to take breaks and follow the 20/20/20 rule, which is every 20 minutes look 20 feet away for 20 seconds. Additionally, sometimes your eye doctor may notice early signs of dry eyes before you experience symptoms, so you can prophylactically treat dry eyes by applying warm compresses over your eyes and doing lid massage, as well as using artificial tears to keep the front surface of your eyes lubricated.
Typically first your eye doctor would take a thorough case history reviewing your symptoms and the severity of the symptoms. (Some symptoms of dry eyes include burning, itching, excessive tearing, gritty/foreign body sensation, eye discomfort, inflammation, or blurry vision.) Your eye doctor will also review your medical history, any medications you’re taking, your day to day activities, as these can all contribute to dry eyes as well. Then a thorough dry eye evaluation will be conducted. Your eye doctor will look at your eyes under a microscope where they will assess your meibomian glands on your upper and lower lid margin. To get a better image of the inside of your meibomian/oil glands your doctor may also take an image of them using a Lipiscan/Meibography. If any of your oil glands are capped, truncated or atrophied this may indicate you have dry eyes. Also your tear layer will be assessed, typically a sodium fluorescein dye would be used. Here we can examine your tear break up time (TBUT), tear meniscus height, and blink rate. Various other tests can be used to detect dry eyes such as Lissamine green and Rose Bengal dye, Schirmer test 1 and 2, and Phenol red thread test. For the Schirmer Test your eye doctor will place a strip of medical paper inside of your lower eyelids, and the paper will then absorb your tears, which will show us the amount of tears you have. For the phenol red test it’s the same concept as the Schirmer test but instead a thin red thread string is placed inside your lower eyelids to determine the volume of your tears. If any of these values are below normal this can also help us detect dry eyes.
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Summary

To schedule a dry eye exam, please contact the nearest listed practice for a consultation or visit. Their team of eye care professionals is ready to provide the care you need.

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