– What’s it like to have dry eye?
– Why have I developed dry eye?
– What is the tear film?
– What are the causes of dry eye?
– What is the treatment for dry eye?
– Is there anything I can do to help with dry eye?
– Further information and support
What’s it like to have dry eye?
Watch Alison talk about her experience of living with dry eye in our video:
Why have I developed dry eye?
Dry eye is caused by a problem with your tears. You may develop dry eye if:
- you don’t produce enough tears
- your tears aren’t of the right quality
- your tears aren’t spread across the front of your eye properly.
Dry eye is usually more common as people get older. As we age, our eyelids aren’t as good at spreading tears each time we blink. The various glands in our eyes that produce tears may also become less effective. Essentially, the quality of something known as your tear film gets worse.
What is the tear film?
When you blink, you leave a thin layer, called the tear film, over the front of your eye. The tear film keeps the front of your eye healthy and it also helps the eye focus properly, giving you clear vision.
The tear film is made up of three layers: the mucin (mucous) layer, the aqueous (watery) layer, and the lipid (oily) layer. Each one of these layers is needed to keep your tear film healthy.
Anything that affects the make-up of your tear film – for example if you produce too little or too much of one of the layers – will stop the tear film working properly and potentially cause dry eye.
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What are the causes of dry eye?
While dry eye can occur at any age, it is more common in women, especially after the menopause. Changes in hormonal levels such as in pregnancy and menopause can contribute to dry eye. The following can also affect your tear film and contribute to dry eye:
Blepharitis and meibomian gland dysfunction
Blepharitis and meibomian gland dysfunction (MGD) are both very common causes of dry eye.
Blepharitis is an inflammation of the eyelids and can sometimes be caused by a bacterial infection. It can be divided into two types based on the location:
- Anterior blepharitis is when the inflammation is primarily around the lashes and in front of the lid margin.
- Posterior blepharitis is when there is inflammation present behind the lid margin and is often caused by MGD.
MGD happens when the glands lining your upper and lower lids are blocked. You have about 30 of these small meibomian glands on each upper and lower lid located just behind your lashes. These glands secrete oil onto the front of your tears. If too much or too little is produced, the tears tend to evaporate too fast leaving your eyes dry and uncomfortable.
If you’re taking certain drugs, such as antihistamines, antidepressants, pain medications and oral contraceptives, you may develop dry eye symptoms.
Using contact lenses can put you at risk of developing dry eye. You should follow the advice for wearing contact lenses and look after them carefully.
Other health conditions
There are a number of health conditions, particularly inflammatory conditions, that are associated with dry eye, such as rheumatoid arthritis and Sjögren’s syndrome. Sjögren’s syndrome is a condition that may cause you to have dry eye and a dry mouth.
Surgery to the eye or injury to the eye surface
If you have surgery on your eye (for example laser eye surgery) or an accident which affects or scars your eye, you may develop dry eye. Your dry eye symptoms usually improve once the eye has healed, but this can take time.
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What is the treatment for dry eye?
You cannot cure dry eye but there are some treatments that can help your eyes feel more comfortable.
If your dry eye is caused by medication, then your GP may consider switching your medication to another. If your dry eye is caused by wearing contact lenses, then having a break from your lenses may help the dry eye to improve.
Often dry eye is caused by getting older, which can’t be helped, but there is treatment that can help with your symptoms. There are three main ways to help your dry eye:
- making the most of your natural tears
- using artificial tears (eye drops)
- reducing the draining away of the tears.
Making the most of your natural tears
There are things that you can do yourself which may help reduce the symptoms of dry eye. High temperatures and central heating can make tears evaporate more quickly, so sometimes lowering temperatures can help. Another option would be to use a humidifier (a small machine that helps puts water into the air), which may help slow down the evaporation of your tears and keep your eyes comfortable.
Many people find that their dry eye is worse when they’re reading or using a computer. This is because you blink less when you are doing a task like this, giving the tears more chance to evaporate. You can try to blink more when you’re doing these tasks, or use eye drops before you read, watch TV or use a computer, as this may help to keep your eyes comfortable.
If you have blepharitis or MGD, practising lid hygiene can really help make your eyes feel more comfortable. You will need to do this twice a day for two to three weeks before you see an improvement.
Lid hygiene for anterior blepharitis
Removing the crusts or debris from your lashes can be helpful if you have anterior blepharitis. Follow these steps (remember to always wash your hands before you start and after you finish):
- Prepare a cleaning solution of sodium bicarbonate in cooled boiled water. To do this, boil the kettle and let the water cool to room temperature. Pour out one cup of water into a clean mug or glass and add a quarter teaspoon of sodium bicarbonate.
- Clean both the upper and lower lids using a clean tissue (folded several times) or a cotton bud. Dip the tissue or cotton bud in the prepared solution and wring out excess water. Wipe along the lid from the nose outwards; use a clean tissue/bud for every wipe. You will need several tissues/buds for each eye. Do not dip a used tissue or bud back into the solution – use a new one each time.
Your optometrist or pharmacist may recommend wipes or cleaning solutions that you can purchase as an alternative to this.
Lid hygiene for posterior blepharitis or MGD
A warm compress is often recommended for posterior blepharitis or MGD. The heat of the compress can help to unblock the meibomian glands. Along with gentle massage and washing, the compress will help to release any oil that may be trapped in your glands. Here are the steps to follow:
- Apply a warm compress over your eyes for five to 10 minutes – use a clean flannel rinsed in hot water, reheating regularly to keep it warm.
- Use your finger or cotton bud to massage the skin towards your lashes. For your top lashes, you would be applying pressure downwards to the lashes and for the bottom lashes, you would move in an upwards direction.
- Follow the lid hygiene process for anterior blepharitis.
As an alternative, you can also buy commercially-made eye bags that can be heated in the microwave.
Using eye drops
Most people with dry eye need to use some form of eye drops, also known as artificial tears. Eye drops aim to supplement and replace your natural tears and make the eye more comfortable. They can also prevent any damage to the front of your eye, which can happen if the eye is dry for a long time.
You should use your eye drops as prescribed. If you are having to use your drops more than four times a day, then you should let your ophthalmologist or optometrist know, as you may need a different type of drop or treatment to the drops you’re using.
There are three main types of eye drops which your GP or eye health professional may recommend or prescribe:
Artificial tears are made by many different companies. Some people find one brand works better for them than another, though the reasons for this aren’t clear. Your doctor may suggest a selection of different brands for you to try. It is usually best to try one type for at least a month.
Most artificial tear drops can be bought over the counter from the pharmacist. If you’re entitled to free prescriptions, or have a pre- payment certificate, you can ask your doctor to prescribe them. Some people develop sensitivity to the preservative used in the drops, especially if they’re using them a lot. This can make your eyes sore. You can ask for preservative-free eye drops if this is the case.
Some people may prefer to use thicker gel- like drops. The gels are made from different chemicals and may stay in the eye for longer. They do the same thing as ordinary drops, but you don’t have to put them in as often.
When you sleep, sometimes your eyes aren’t fully closed, so tears can evaporate leaving your eyes very dry when you wake up. Ointments help stop the eyes drying out overnight so that they feel more comfortable in the morning. Ointments are usually used before bedtime because they are sticky and cause blurry vision, while eye drops are used during the day.
Reducing the draining away of tears
It’s possible to help dry eye by blocking up the drainage holes in your eyelids. Stopping the tears from draining away may help your tears stay in your eye for longer. The medical term for blocking the tear ducts is “punctal occlusion”.
Usually, punctal occlusion is tried for a period of time to see if it helps. The small drainage channels are blocked by small devices called punctal plugs. If it helps you with the symptoms of dry eye then the plugs are left in place.
Occasionally, a permanent small surgical procedure can also be performed, if temporary blocking has been useful.
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Is there anything I can do to help with dry eye?
Having dry eyes can be difficult. Eyes that are red, itchy and painful for long periods can be tiring. When your eyes first become dry, you may feel upset and worried. However, dry eye doesn’t usually cause any damage to your eye and typically doesn’t lead to permanent changes to your vision. There are many things that you can try to help you manage it better:
- Use your prescribed eye drops regularly. Finding eye drops that work for you can make a huge difference.
- Adjust your environment. Lowering temperature and using a humidifier may help, as central heating and air conditioning can worsen your symptoms.
- Avoid dusty, windy and smoky areas or use wrap-around glasses when you are exposed to these environments.
- Take rest periods and remember to blink often when you are using the computer, watching television and reading.
- Try to have a healthy balanced diet, with flax seed as well as foods containing omega 3 and 6, such as oily fish, nuts, seeds, eggs, green leafy vegetables, etc.
- Avoid using eye make-up when there’s infection or inflammation present.
- If you wear contact lenses, have regular eye follow-ups. You may need a break from wearing contact lenses if your eyes are dry, or explore different types of lenses which may be more suitable for dry eye.
Finding the right eye drops to suit you and trying different things to help cope with the symptoms of dry eye can take some time and commitment. Although there is no cure for dry eye, most people will learn how to manage their dry eye so that it doesn’t have too much impact on their everyday lives.
Further information and support
If you have any questions about dry eye, we're here for you. Just get in touch with our Sight Loss Advice Service.
Moorfields Eye Hospital has a useful information resource called Know Your Drops, with advice and tips on the best techniques to administer eye drops and information about compliance aids.
NHS Choices has advice and information on dry eye and blepharitis.
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