Dry eye syndrome is one of the most common reasons people visit an eye doctor, yet it is frequently underdiagnosed and undertreated. The condition occurs when the eyes are not adequately lubricated — either because they do not produce enough tears, or because the tears they produce evaporate too quickly. The result ranges from mild, intermittent discomfort to chronic, significant irritation that interferes with reading, screen use, contact lens wear, and quality of life.
How the Tear Film Works
Tears are not just water. Healthy tears consist of three distinct layers: an outer lipid (oil) layer that slows evaporation, a middle aqueous (water) layer that carries oxygen and nutrients to the eye surface, and an inner mucin layer that helps tears spread evenly across the cornea. A problem in any one of these layers — or a mismatch between tear production and loss — results in dry eye.
The most common type, evaporative dry eye, is caused by dysfunction of the meibomian glands — tiny oil-secreting glands along the eyelid margins. When these glands become blocked or inflamed (a condition called meibomian gland dysfunction, or MGD), they fail to produce enough lipid to prevent tear evaporation. The eyes feel dry even when tear production is technically adequate.
Aqueous-deficient dry eye — where the lacrimal gland simply does not make enough tears — accounts for a smaller proportion of cases but can be more severe. It is more common in women after menopause and in people with autoimmune conditions such as Sjögren’s syndrome.
Common Causes and Risk Factors
Age is the most universal risk factor — tear production tends to decrease with age. Women are more frequently affected than men, partly due to hormonal changes. Extended screen use dramatically reduces blink rate and is one of the leading causes of worsening dry eye in younger adults. Air conditioning, heating, low humidity environments, and prolonged exposure to wind or fans all increase evaporative tear loss.
Certain medications — including antihistamines, antidepressants, beta-blockers, diuretics, and oral contraceptives — are known to reduce tear production. Contact lens wear creates additional demands on the tear film. Previous LASIK surgery can reduce corneal sensation and temporarily worsen dry eye during healing.
Symptoms That May Surprise You
Despite its name, dry eye syndrome often causes eyes to water excessively. Paradoxically, this reflex tearing is triggered by surface irritation — the eyes flood with tears as a protective response, but these reflex tears are different in composition from basal tears and do not adequately coat the eye. Other symptoms include a stinging, burning, or gritty sensation, redness, sensitivity to light, blurry vision that fluctuates or clears briefly with blinking, and difficulty wearing contact lenses comfortably.
Treatment Options
Mild dry eye often responds well to over-the-counter preservative-free artificial tears, used several times a day. For evaporative dry eye, warm compresses applied to closed eyelids for five to ten minutes daily can help soften and express the meibomian gland secretions. Lid hygiene scrubs remove debris and bacterial biofilm from the lid margins that contribute to gland dysfunction.
Prescription treatments include cyclosporine A eye drops (Restasis) and lifitegrast (Xiidra), both of which address the underlying inflammation that perpetuates dry eye disease. Punctal plugs — tiny devices inserted into the tear drainage canals to reduce tear drainage — are a simple, reversible option for increasing tear film volume on the eye surface.
For significant meibomian gland dysfunction, in-office treatments such as thermal pulsation therapy (LipiFlow) or intense pulsed light (IPL) therapy offer sustained relief for many patients who have not responded adequately to drops and compresses.
Dietary omega-3 fatty acid supplementation has moderate evidence supporting benefit in improving tear quality and reducing evaporative dry eye symptoms.
For a proper diagnosis and personalized treatment plan, see your eye doctor. Our team evaluates and manages dry eye as part of our comprehensive eye care services. You can also use our digital eye strain risk calculator to assess how screen habits may be contributing to your symptoms.