Page contents
- What Is Dry Eye?
- Causes of Dry Eye
- What are the symptoms of dry eye?
- Dry Eye Treatment
- Dry eyes in winter: treatments and everyday tips
- Diet
- Contact Lenses
- When to See an Ophthalmologist
- The two main types of dry eye
- Who is at greater risk
- How dry eye is diagnosed in the clinic
- How to choose artificial tears
- Treatments when artificial tears are not enough
- Why do my eyes water when I have dry eye?
- Dry eye after laser or cataract surgery
- Dry eye and screen work
- Can dry eye damage your sight?
- Dry eye, menopause and hormones
- Dry eye and Sjögren’s syndrome
- When the eyelids do not close properly during sleep
- Air travel and dry eyes
- How long does dry eye take to improve?
- Dry eye in children and teenagers
- Omega-3 supplements: do they help?
- When dryness hides something else
- Conclusion
- Frequently Asked Questions about Dry Eye
Dry eye is a common eye condition that affects millions of people worldwide. It is caused by insufficient tear production or a poor-quality tear film, resulting in a feeling of dryness, irritation and discomfort in the eyes. In this article we look at the causes and symptoms of dry eye and the most effective ways to treat it.
What Is Dry Eye?
Dry eye is a condition that affects the surface of the eye because of inadequate lubrication by the tears. The tear film is made up of three main layers:
- Lipid (oily) layer: provides stability and reduces evaporation of the tears.
- Aqueous (watery) layer: keeps the eye moist and supplies oxygen to the cornea.
- Mucin layer: helps the tears spread evenly over the surface of the eye.
When one of these layers does not work properly, the eyes are not lubricated correctly, causing discomfort and other vision problems.
Causes of Dry Eye
Many factors can cause or worsen dry eye, such as:
- Environmental Factors
- Dry surroundings
- Air conditioning and heating
- Long hours using electronic devices (screens)
- Hormonal Changes
- Menopause
- Pregnancy
- Hormonal disorders
- Underlying Conditions
- Sjögren’s syndrome
- Diabetes
- Rheumatoid arthritis
- Medicines
- Antihistamines
- Antidepressants
- Diuretics
- Other Factors
- Contact lens wear
- Vitamin A deficiency
- Smoking and alcohol
What are the symptoms of dry eye?
Dry eye can show itself through a range of symptoms, such as:
- A burning or foreign body sensation in the eyes
- Redness and pain from inflammation
- Blurred vision
- Watering eyes (a paradoxical overproduction of tears)
- Sensitivity to light
- Eye strain
If left untreated, dry eye can lead not only to vision problems but also to serious damage to the cornea.
Dry Eye Treatment
The treatment of dry eye depends on its cause. There are, of course, several ways to manage it, and the most effective are listed below:
- Artificial Tears
Lubricating eye drops are the simplest and quickest way to relieve dry eye. They come as liquids, gels or ointments and help keep the eyes moist.
- Diet
Diet plays an important part in keeping the eyes healthy. The omega-3 fatty acids found in foods such as salmon, flaxseed and walnuts contribute to the production of better-quality tears.
- Using a Humidifier
A humidifier can help reduce the dryness of indoor air, especially during the winter months.
- Limiting Screen Time
Long hours on electronic devices reduce how often we blink, making dry eye worse. The 20-20-20 technique is recommended: every 20 minutes, look at something 20 feet (about 6 metres) away for 20 seconds.
- Warm Compresses and Eyelid Massage
Applying warm compresses to the eyelids can help unblock the meibomian glands, improving the quality of the oily layer of the tears.
- Medication
In severe cases, your ophthalmologist may recommend special anti-inflammatory eye drops or medicines that increase tear production.
- Blocking the Tear Ducts
Where dry eye is severe, blocking the tear drainage channels with special plugs (punctal plugs) can help keep the tears on the surface of the eye by limiting their drainage.
- IPL Treatment
The most up-to-date and effective treatment for dry eye caused by blepharitis. Completely painless, this device improves the function of the meibomian glands. It is a short treatment that can be repeated 3 to 4 times for better results.
Dry eyes in winter: treatments and everyday tips
Eyelid scrubs help reduce the debris and bacteria that build up on the lashes and eyelids. This is done with a special foam or wipes that you apply over the lashes.
Warm compresses and massage: use a small towel warmed with hot water and repeat for 10 minutes. A gentle massage at the end helps clear the blocked glands.
Punctal Plug Insertion
The aim of this treatment is to slightly reduce the drainage of tears so that they stay on the eye for longer. This is done by placing small devices called “punctal plugs” in the tear drainage channels. The procedure takes a few seconds, is completely painless and costs very little. Another big advantage is that the plugs can be removed as easily as they are inserted.
Innovative IPL Technology
A very effective treatment is carried out with a device called IPL (intense pulsed light), which has been shown to significantly improve blepharitis, especially when skin conditions are also present. The technique was developed in the United States in recent years and appears to give excellent results. It is completely painless, needs no eye drops or ointments afterwards and takes 15 minutes to complete.
Diet
Including more omega-3 fatty acids in the diet has been shown to help improve the mechanisms that lead to dry eye.
Contact Lenses
Contact lenses dry out your eyes because they form a barrier over the cornea, which blocks the flow of tears and nutrients. Try to limit how much you wear your contact lenses and wear your glasses more often. Newer-generation contact lenses also tend to use materials that are much better for your eyes.
When to See an Ophthalmologist
If your dry eye symptoms persist or get worse, it is important to see an ophthalmologist. After a detailed examination, the cause of the problem can be identified and a management and treatment plan put in place.
The two main types of dry eye
The tear film consists of three layers: a thin layer of mucus on the cornea, a watery layer in the middle and an oily layer on top that prevents evaporation. Depending on which layer “fails”, we talk about two main types of dry eye, which often coexist.
- Aqueous-deficient dry eye: the lacrimal glands do not produce enough watery tears. It becomes more common with age, and occurs in autoimmune diseases such as Sjögren’s syndrome and with certain medicines.
- Evaporative dry eye: tears are produced but evaporate too quickly because the oily layer is deficient. The cause is almost always dysfunction of the meibomian glands in the eyelids, which is closely linked to blepharitis. It is the most common type.
The distinction is of practical value: in evaporative dry eye, simple artificial tears help only a little unless the eyelids are treated at the same time.
Who is at greater risk
- Women, especially around the menopause, because of hormonal changes.
- People over 50, as tear production decreases with age.
- People taking certain medicines, such as antihistamines, some antidepressants and anti-anxiety drugs, diuretics, some blood pressure medicines, contraceptives and acne treatments. Do not stop any medicine without the advice of the doctor who prescribed it.
- Patients with autoimmune diseases, such as Sjögren’s syndrome, rheumatoid arthritis, lupus or thyroid disease.
- People with diabetes, because of reduced corneal sensation.
- People who wear contact lenses for many hours.
- People who have had laser vision correction or cataract surgery, where dryness is common in the first few months.
How dry eye is diagnosed in the clinic
Because the symptoms of dry eye are similar to those of allergy or conjunctivitis, a correct diagnosis relies on specific tests:
- Tear break-up time: using a drop of dye, we see at the slit lamp how many seconds the tear film stays stable.
- Staining of the cornea and conjunctiva: reveals small surface lesions caused by dryness.
- Schirmer test: a thin paper strip placed in the lower eyelid measures the amount of tears in five minutes.
- Examination of the meibomian glands: we assess whether they are open and the quality of their secretion.
- Examination of the eyelids: for blepharitis, incomplete closure or other abnormalities that strain the eyes.
Stinging, burning or a gritty feeling in your eyes?
A dry eye examination shows the cause and the treatment you need. Book an appointment at our clinic in Neo Psychiko, Athens.
How to choose artificial tears
Pharmacies stock dozens of lubricating eye drops and choosing can be confusing. A few basic rules:
- Preservative-free: if you use them more than four times a day, choose single-dose vials or preservative-free bottles, because preservatives irritate the surface of the eye.
- Hyaluronic acid: suitable for everyday dryness, with a good duration of action.
- Lipid-based drops: help more in evaporative dry eye, because they strengthen the oily layer.
- Gel or ointment at night: thicker, they protect the eyes during sleep but blur vision temporarily.
- Avoid “red eye” drops: vasoconstrictors whiten the eye temporarily, but with frequent use they make redness and dryness worse.
Treatments when artificial tears are not enough
In moderate and severe dry eye there are prescription treatments that target inflammation of the eye surface:
- Immunomodulating eye drops, such as ciclosporin, which gradually increase tear production. Their effect becomes apparent after a few weeks.
- Short courses of anti-inflammatory eye drops for flare-ups, always under medical supervision.
- Eyelid treatment: hygiene, warm compresses and, where needed, treatment for blepharitis or rosacea.
- Punctal plugs, which keep the tears on the eye for longer.
- Intense pulsed light treatment for meibomian gland dysfunction.
Why do my eyes water when I have dry eye?
It sounds contradictory, but many patients with dry eye complain that their eyes “run”. When the surface of the eye dries out and becomes irritated, the corneal nerves signal the lacrimal glands to produce a large amount of reflex tears. These tears are mainly water, do not have the right composition to lubricate the eye and quickly run down the cheek. So the cycle continues: dryness, irritation, watering and dryness again. Proper treatment of dry eye usually reduces the watering as well.
Dry eye after laser or cataract surgery
After laser vision correction or cataract surgery temporary dryness is common, because the corneal nerves are temporarily affected. It usually improves within a few months with lubricating eye drops. That is why, before any planned procedure, we check for and treat existing dry eye, so that recovery is more comfortable and measurements are more accurate.
Dry eye and screen work
When we look at a screen, the blink rate drops to almost half, and many blinks are incomplete. For office work the following help:
- the 20-20-20 rule: every 20 minutes, look at something in the distance for 20 seconds
- placing the screen slightly below eye level
- avoiding air conditioning or heater airflow directly on the face
- a room humidifier during the winter months
- lubricating drops before long hours of work, not only once discomfort appears
You will find more practical tips in our article on dry eyes at the office.
Can dry eye damage your sight?
In most cases dry eye is uncomfortable but does not threaten sight. In severe forms, especially in autoimmune diseases or when the eyelids do not close properly, constant dryness can cause damage to the cornea, ulcers and infections. That is why pain, marked sensitivity to light or reduced vision need an urgent eye examination.
Dr Vasileios Skouteris diagnoses and treats dry eye at his clinic in Neo Psychiko, Athens. To book an appointment, call 210 677 0007.
Dry eye, menopause and hormones
Hormones directly affect how the lacrimal and meibomian glands work. That is why dry eye is noticeably more common in women, especially around the menopause, but also during pregnancy or with certain hormonal treatments. Many women notice for the first time during this period that they can no longer tolerate contact lenses or that their eyes burn at the end of the day. Treatment follows the same principles, with particular emphasis on eyelid care and lipid-based artificial tears.
Dry eye and Sjögren’s syndrome
Sjögren’s syndrome is an autoimmune disease that affects the glands of the body that produce fluids. Apart from dry eyes, typical features are a dry mouth, difficulty swallowing dry food and often joint pain and fatigue. If you have severe dry eye together with these symptoms, your ophthalmologist may refer you to a rheumatologist for further tests. Early diagnosis helps both the eyes and your general health.
When the eyelids do not close properly during sleep
Some people sleep with their eyes slightly open without knowing it. This happens after facial nerve palsy, after cosmetic eyelid surgery, in thyroid disease or even for no obvious reason. The result is dryness and discomfort, mainly in the morning. The solution includes a thick gel or ointment before bed, special sleep masks and, in some cases, corrective treatment of the eyelids.
Air travel and dry eyes
The air in an aircraft cabin has very low humidity. On long-haul flights it helps to carry single-dose artificial tears, to keep the overhead air vent from blowing on your face, to drink plenty of water and, if you wear contact lenses, to wear glasses for the journey instead.
How long does dry eye take to improve?
Artificial tears give immediate relief, but real improvement takes time. Eyelid care shows results in two to four weeks, while immunomodulating eye drops usually need two to three months to reach their full effect. Dry eye is often a chronic condition, but with the right plan most patients live without significant discomfort.
Dry eye in children and teenagers
Dry eye is thought of as a problem of older age, yet we are seeing more and more children and teenagers with dry eyes. Long hours on mobile phones, tablets and computers reduce blinking, while allergies and blepharitis add to the burden. Children rarely say that their “eyes are dry”. They usually rub their eyes, blink often, are bothered by light or tire quickly when reading. Breaks from screens, outdoor play and treating allergies help considerably. If the symptoms persist, an examination by an ophthalmologist is needed.
Omega-3 supplements: do they help?
Omega-3 fatty acids have an anti-inflammatory effect and for years were recommended for dry eye. Large studies have shown mixed results, with no clear benefit for everyone. A balanced diet with fish, nuts and olive oil is certainly beneficial. Supplements can be tried as an additional option after discussing them with your doctor, but they do not replace the main treatment.
When dryness hides something else
Not every “dry” eye is dry eye disease. Allergic conjunctivitis, blepharitis, infections or irritation from contact lenses can cause similar symptoms. If the discomfort affects only one eye, comes with discharge, pain or reduced vision, or does not improve with artificial tears within two weeks, an examination by an ophthalmologist is essential to reach the correct diagnosis.
A common paradox of dry eye is that the eye may water more rather than less. If this happens to you, read in detail why your eyes water and how dry eye differs from other causes. Dryness and eye strain can also be linked to eyelid twitching.
Conclusion
Dry eye is a very common and often hard-to-manage problem that can significantly affect quality of life. With a correct diagnosis and appropriate treatment, the symptoms can be reduced or even eliminated. If you have persistent dry eye, see a specialist to find the best solution for you.
Frequently Asked Questions about Dry Eye
What are the first symptoms of dry eye?
The first symptoms are usually burning, a sandy or gritty feeling, redness and tired eyes, mainly after hours at a screen or in an air-conditioned room. Many people notice blurring that improves when they blink. Paradoxically, dry eye can also cause watering, as the eye’s reaction to the irritation.
Which eye drops help with dry eye?
In most cases the first choice is artificial tears, preferably preservative-free, especially if they are used several times a day. There are different types, such as thicker solutions or gels for the night. When there is also inflammation, the ophthalmologist may recommend anti-inflammatory treatment. The choice is made after an examination.
Can dry eye be cured?
Dry eye is usually a chronic condition, so the aim is good control of the symptoms rather than a permanent cure. When it is caused by something treatable, such as a medicine, blepharitis or meibomian gland dysfunction, the improvement can be significant. A combination of artificial tears, eyelid hygiene and treatments such as IPL gives the best results.
Does screen use make dry eye worse?
Yes. When we look at a screen we blink much less and often incompletely, so the tears evaporate faster. Regular breaks such as the 20-20-20 rule help, as do placing the screen slightly below eye level, avoiding air currents on the face and making a conscious effort to blink fully.
Questions about your case?
Dr. Skouteris will examine you at his practice in Neo Psychiko and explain your options.
Ophthalmic surgeon trained at the John Radcliffe University Hospital in Oxford and Fellow of the European Board of Ophthalmology (FEBO).
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