What is dry eye?
In short The surface of the eye isn’t well-lubricated because tears are too few, evaporate too fast, or are poor quality. Symptoms include stinging, burning, grittiness, fluctuating vision, light sensitivity, and tearing that comes and goes.
Why it matters: Dry eye can blur vision, increase fall risk outdoors (glare/wind), and raise the chance of corneal infection if severe.
Urgent warning signs
- Sudden vision loss, severe eye pain, or halos around lights
- Marked light sensitivity with a very red eye
- Eye injury, chemical exposure, or contact lens pain
- Yellow/green discharge or eyelid swelling with fever
These can be emergencies — seek care immediately.
Common causes & triggers
Age & eyelid oil glands
- Meibomian gland dysfunction (oily layer problems → fast evaporation)
- Eyelid inflammation (blepharitis), rosacea
Environment & habits
- Air-conditioning, heaters, wind, smoke
- Screen time with low blinking; long reading sessions
- CPAP air leak toward eyes
Body conditions
- Autoimmune (e.g., Sjögren’s), thyroid disease
- Diabetes, vitamin A deficiency (rare), low omega-3 intake
Medicines that dry eyes
- Antihistamines, some antidepressants/antipsychotics
- Diuretics, beta-blockers, isotretinoin
- Glaucoma drops with preservatives (check with eye doctor)
At-home care that helps
Blink & break routine
- 20-20-20: every 20 minutes, look 20 feet away for 20 seconds and blink fully 5–10 times
- “Close-squeeze-open” blinks (x10) to spread tears
Warm compress & lid hygiene
- Warm compress 5–10 min, then gently massage lids toward lash line
- Lid cleansing foam or diluted baby shampoo on lash margins (if advised)
Protect the surface
- Humidifier, avoid fans blowing at face, wraparound glasses outdoors
- Artificial tears during day; gel/ointment at night if lids don’t close fully
Drops, gels & ointments — how to choose
| Type | When to use | Notes |
|---|---|---|
| Artificial tears (low–mid viscosity) | Daytime, mild–moderate symptoms | Use 3–6×/day. If frequent, choose preservative-free vials. |
| Gel drops | More dryness or windy days | Last longer; may blur for a minute after instilling. |
| Night ointment | Overnight dryness, incomplete lid closure | Thicker; expect blur until morning. |
| Redness-relief vasoconstrictors | Generally avoid | Can cause rebound redness and irritation. |
Tip: Chill preservative-free tears for comfort. Discard single-use vials after opening.
Medicines that may worsen dryness
- Antihistamines (diphenhydramine, cetirizine), decongestants
- Antidepressants (tricyclics, some SSRIs/SNRIs), antipsychotics
- Diuretics, beta-blockers, isotretinoin
- Some glaucoma drops with preservatives — ask about preservative-free options
Never change prescriptions without a clinician’s advice. A review can often improve symptoms.
How doctors check
Surface & tear tests
- TBUT (tear breakup time): how quickly tears evaporate
- Staining with special dyes to see dry spots
- Schirmer test to measure tear production
Oil gland & lids
- Eyelid margin exam for blepharitis
- Meibography (imaging of oil glands) in some clinics
Clinic treatments & prescriptions
Prescription drops
- Cyclosporine or lifitegrast to reduce inflammation
- Short courses of steroid drops for flares (monitored)
Conserving tears
- Punctal plugs to slow tear drainage
- Moisture chamber glasses; taping lids at night if they don’t close
Oil gland therapies
- In-office thermal pulsation, IPL (intense pulsed light)
- Lid debridement of thickened oils
Advanced options
- Scleral lenses to protect the cornea in severe cases
- Autologous serum tears under specialist care
When to contact your eye doctor
- Pain, light sensitivity, or vision changes
- No improvement after 2–4 weeks of routine and drops
- Frequent tearing, burning, or mucus despite care
- History of autoimmune disease, eyelid problems, or prior corneal issues
Quick answers
Are preservative-free drops worth it?
Yes if you use drops more than 4 times daily or feel stinging — they’re gentler on the surface.
Do omega-3s help?
Some people report benefit, but results vary. Discuss supplements and medicine interactions first.
Best way to use ointment?
At bedtime. A rice-grain amount inside the lower lid; expect blur until morning.
Can CPAP worsen dry eye?
Yes if air leaks toward the eyes. Ask about mask fit or eye shields; add bedtime gel.
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