Dry Eye

This information should not replace advice that your optometrist or other relevant health professional would give you.

 

Overview

Dry eye is a common condition that may be caused because your eyes do not produce enough tears, or because the tears that you have evaporate too quickly or do not spread evenly across the front of your eye. The symptoms are usually in both eyes.

Dry eye can make your eye feel scratchy or irritated. In severe cases it may temporarily make your vision blurry. It can be uncomfortable, but rarely causes serious eye damage.

This page aims to help you understand the causes of dry eye and what you can do to help yourself.

 

What is dry eye?

Dry eye is a chronic (long-term) condition. This means that once you've had it, it can come back even after it has cleared up. If often affects both eyes, but one may be worse than the other. There are several treatments for dry eye, and you can do some of these at home.

Dry eye does not normally cause permanent problems with your sight, but in severe cases it can become very painful and cause permanent damage to the front of your eye.

 

Who is at risk of dry eye?

Dry eye is more common in women and in people aged over 65. It is often just a symptom of getting older. This is because as you get older, your eyelids are not as effective at spreading your tears across your eyes when you blink. Also, the glands in your eyelids that produce the oily part of your tears become less effective as you get older. In some people these glands, which are called meibomian glands, can become blocked and the lids may become red and uncomfortable. This is a condition called blepharitis.

Some drugs or health problems may affect your tear film. In women, changes in hormone levels, for example during the menopause, pregnancy or while using the contraceptive pill, can increase the risk of dry eye. Your doctor or optometrist will be able to give you advice on this.

 

Why do my eyes feel dry, but they still water?

The tear film is made of three layers. The layer closest to your eye is called the mucin layer, and helps to stick the other tear layers to your eye. The middle layer is the watery layer, which provides moisture to the eye and helps to wash away anything that gets into the eye. It is the watery layer that increases when you cry. The outer layer of your tears is an oily layer which stops the tears from evaporating too quickly. This is produced by the maibomian glands in your eyelids.

The normal time for your tear film to last between blinks is over 12 seconds. If the tear film breaks up too soon, the sensitive corneal nerves on the surface of your eye may be exposed and then you will cry. This is common in the cold, the wind or if you forget to blink when you are concentrating on the computer, TV or when driving. Crying will dilute the oily layer that reduces evaporation of the tears and make your eyes feel dry again. If your eyes water a lot you may find it helps to use a product that increases the oily layer of your tears to reduce this evaporation. Your optometrist will be able to advise you on this.

 

What can I do about dry eye?

Once your optometrist knows what is causing your dry eye, they can give you advice on how to manage it. There are four main ways to help you dry eye.

1. Avoid using make-up and keep your eyelids clean

Eyeliner, particularly when put on the rim of your eyelid, may block the maibomian glands that produce the oily part of your tear film. This may cause the area around your eyes to be inflamed. It is also important to make sure you keep your eyelids clean, particularly if you have blepharitis.

2. Be aware of your environment

There are some environments that may make your eyes feel more dry. High temperatures and central heating may increase the evaporation of your tears and make your eyes feel more dry, as can draughts and air conditioning.

You may find it helpful to reduce the temperature of your central heating at home and try to avoid draughts near your face, for example by directing car air vents away from your face. Some people find that using a humidifier to put more water into the air may help to slow down the evaporation of their tears.

If you are out on a windy day you may find it useful to wear glasses or sunglasses (ideally the wraparound type) to protect your eyes from the wind. Try to avoid smoky atmospheres as these may irritate your eyes.

3. Use eye lubricants

There are several types of eye lubricants available. Most of these aim to lubricate your eyes by giving you extra moisture. They are available as drops, gels or ointment, and most are available without a prescription. If you find the drops wash out of your eye too quickly you may find the gel-type better as they are thicker and so stay in your eye for longer.

Ointment is generally used for people whose eyes dry out at night because they do not fully close their eyes. Ointments are usually used only at night because they are sticky and cause blurry vision.

Eye lubricants do not contain any drugs and so you can use them as often as you like. However, some contain preservatives which may make your eyes sore. If you are using them more than six times a day you should use preservative-free drops.

If your dry eye is caused by your tears evaporating to quickly, you may find it helpful to use a spray rather than artificial tear drops. These sprays aim to replenish the oily layer of your tears and stop them evaporating as quickly. There are available without prescription and are sprayed onto the edges of your eyelids when your eyes are closed. When you open your eyes the solution spreads across the surface of your eye, creating a new oily film.

4. Have treatment to stop the tears from draining away

Your tears drain away into your nose through four small drainage channels in your eyelids (one in each of the upper and lower lids). Small plugs, called punctum plugs, can be put into the holes in your lower eyelids to stop the tears from draining away and help the tears to stay in your eye for longer. Your optometrist will be able to give you advice on this. The plugs can easily be removed if necessary.

 

Using a computer

Some people find that their eyes feel dry while they are looking at a computer screen (or afterwards). There is no evidence that looking at a computer screen does your eyes any harm, but it may make you blink less often. We recommend that when you use a computer you make sure you blink often and try to look away from the screen regularly, just for a few seconds, to give your eyes a rest.

 

What if I wear contact lenses?

Some people find that if they wear contact lenses their eyes may feel dry. This may be worse with some types of lenses than others. If you notice this, you may find that changing to a different type of contact lens or reducing the amount of time you wear your lenses will help you. Make sure you mention this when you go for your contact lens check-up so that your optometrist can suggest what to do about it.

 

Links

NHS National Health Foundation

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