Why Are My Eyes So Dry?

Many patients that come into my practice suffer from Dry Eye Disease, and while the world prevalence has historically been between 5 - 34% of the population, I would argue this number is, in reality, much higher.1

Symptoms of dry eye can manifest as red eyes, scratchiness, itchiness, a sensation that a foreign body is in the eye, vision that fluctuates upon blinking, and/or excessive tearing especially when outdoors in windy environments. In order to treat dry eye, you must understanding what type of dry eye you have. Read on to learn more about the two main types of dry eye disease and how you can use basic tools to treat this condition at home.

What kind of dry eyes do I have?

You have many small oil glands called meibomian glands, that are situated in the upper and lower lids of both eyes. They secrete oil near the base of your lashes. This oil lies on top of your tears, creating a barrier to evaporation. If your meibomian glands are not creating enough oil to keep the aqueous tears on your eye from evaporating, then you are have hyper-evaporative dry eye.

If you are considered aqueous deficient your lacrimal glands do not produce enough tears. Less common than hyper-evaporative patients, about 10% of dry eye patients are solely aqueous deficient.1 Dry eye that is mainly aqueous deficient is often associated with autoimmune disorders such as Sjogren’s Syndrome, lupus, and rheumatoid arthritis, because of the ability for the disease to damage the lacrimal gland.

About 80% of dry eye patients have a mixed hyper-evaporative and aqueous-deficient dry eye.1

Beginning Dry Eye Treatment

You can combate ocular dryness with a few basic tools:

Artificial tears

I always recommend preservative-free artificial tear drops because there is no chance of damage to the ocular surface from the preservatives in standard artificial tears. However, as a general rule, you do not have to use preservative-free drops unless you are using them more than four times a day. It's also important to note that not all tears are created equal - a topic to be covered in a future blog post.

Warm compresses

A clean, warm compress can help to soften the meibum, or oil, created by the meibomian glands. This softened meibum is able to secrete more easily from the lids and maintain the aqueous tears on the eyes for longer, preventing evaporation and can easily be accomplished at home. Simply heat a clean towel or washcloth with warm water and gently hold over closed eyes. My starting recommendation is to do this for 3 - 5 minutes twice a day.

Adopting a New Routine

Ocular dryness is a chronic condition, and results are best seen if you can work treatment into your daily routine. Try inserting an artificial tear at breakfast, lunch, dinner, and before going to bed. Apply warm compresses every time you wash your face - in the morning and at night. Consistency is key.

1 Messmer E. The Pathophysiology, Diagnosis, and Treatment, of Dry Eye Disease. Dtsch Arztebl Int. 2015 Jan; 112(5): 71-82.

Dr. Caitlin Morrison, OD, FAAO, FSLS, is an optometrist at the New York Eye and Ear Infirmary of Mount Sinai in Manhattan. She specializes in treating advanced corneal diseases and management with specialty contact lenses.