Even when you’re happy, your eyes are full of tears. They provide moisture and lubrication to help you see and keep your peepers comfortable.
What’s in a tear? They’re a mix of:
- Water, for moisture
- Oils, for lubrication
- Mucus, for even spreading
- Antibodies and special proteins that keep infection at bay
The ingredients come from special glands around your eye. Dry eyes often mean your tear system is out of whack.
When tears don’t provide enough moisture, you might notice:
- A gritty feeling
- Feeling like there’s something in your eye
- Itching
- Pain
- Redness
- Blurry vision
- Light sensitivity
Sometimes, dry eyes create watery eyes. This confusing condition is called reflex tearing. It happens because the lack of moisture irritates your eye. It sends a distress signal through your nervous system for more lubrication. Your body sends a flood of tears to try to make up for the dryness. It’s a lot like what happens when you get sand in your eye and it runs. But these tears are mostly water, so they don’t act like normal tears. They can wash debris away, but they can’t coat your eye’s surface.
What Causes Dry Eyes?
Sometimes, there's a lack of balance in your tear-flow system. Or too much evaporation dries out your tear film. Other causes include:
- The natural aging process, especially menopause
- Side effects of certain drugs like antihistamines
- Diseases that affect your ability to make tears, like Sjogren's syndrome, rheumatoid arthritis, and collagen vascular diseases
- Problems that don’t allow your eyelids to close the way they should
How Are Dry Eyes Treated?
There are a number of options. Ask your eye doctor what to do. Treatments include:
Artificial tear drops and ointments. This is the most common treatment for mild cases of dry eye. Many types of drops are available over the counter. No one product works for everyone, so you might have to try a few to find one that’s right for you. If you have chronic dry eye, you need to use the drops even when your eyes feel fine, or they won’t stay wet enough. If your eyes dry out while you sleep, you can use a thick product, like an ointment, at night. You might think about sleeping with airtight goggles on. They'll create a mini "moisture chamber" for your eyes.
Temporary punctal occlusion. Your doctor might insert a tiny device to plug up the punctum, which is the duct that drains tears from your eye. They might start with a temporary plug designed to dissolve over time. Based on how it works, your doctor will know whether permanent plugs will help.
Non-dissolving punctal plugs and punctal occlusion by cautery. If temporary plugs work well, your doctor may move to longer-lasting ones. Sometimes they start with the long-lasting plugs. They could also choose a procedure called cautery. For this procedure, you might get a drug that relaxes you. Your doctor then uses a tool to burn the punctum opening shut. The scar that forms makes a permanent plug.
These measures increase your tear level by blocking the “drainpipe” through which tears usually drain from your eye to your nose. Tear plugs are easy to remove, but sometimes they come out on their own or fall down the tear drain. They can make your eyes feel better and lower your need for artificial tears.
Devices to unblock oil glands. Your doctor can choose from among several medical devices that use methods such as heat, pressure, or light to help clear blocked oil glands on your eyelids. These procedures are generally done in your doctor's office.
Therapeutic contact lenses. These special lenses help keep your eyes moist and protect them so they can heal.
Testosterone cream. Dry eye can be related to a lack of testosterone in the oil glands on your eyelids. The doctor might give you a testosterone cream that you apply to your eyelids. It can help your oil glands work better.
Autologous serum drops. If you have serious symptoms and other treatments haven't worked, your doctor could recommend this custom-made type of artificial tears. They're made from a substance in your own blood.
Other prescription medications to treat dry eye include:
Cyclosporine (Cequa, Restasis, Vevye). These eye drops contain the immune-suppressing drug cyclosporine, which fights inflammation on the eye's surface.
Lifitegrast (Xiidra). These eye drops work in a different way to fight inflammation. They stop immune cells called lymphocytes from attaching to other cells in your body,
Loteprednol (Eysuvis). This is afast-acting corticosteroid drug you apply as an eye drop. It's meant for short-term use (two weeks or less).
Perfluorohexyloctane (Miebo). These lubricating eye drops coat the eye’s surface to help prevent evaporation.
Varenicline (Tyrvaya). This is a nasal spray that helps increase tear production. Some people find it easier to use than eye drops.
Environment and lifestyle
Your doctor may also suggest that you:
- Use warm compresses on your eyes
- Wear wraparound sunglasses when you're out in the wind
- Use a humidifier or air purifier at home
- Stay away from smoke
- Blink often
- Rest your eyes frequently
