Dry eyes occur when your tears aren't able to provide adequate moisture for your eyes. Tears can be inadequate for many reasons. For example, dry eyes may occur if you don't produce enough tears or if you produce poor-quality tears. Dry eyes feel uncomfortable. If you have dry eyes, your eyes may sting or burn. You may experience dry eyes in certain situations, such as on an airplane, in an air-conditioned room or after looking at a computer screen for a few hours. Dry eyes treatments may make you more comfortable. Dry eyes treatments can include lifestyle changes and eyedrops. For more serious cases of dry eyes, surgery may be an option.

Complications of Dry Eyes

Most people don't experience complications caused by dry eyes. Complications that can occur include:

• More frequent eye infections. Your tears protect the surface of your eye from infection. Without adequate tears, you may have an increased risk of eye infection.
• Scarring on the surface of your eye. If left untreated, severe dry eyes may lead to eye inflammation, scarring on the surface of your cornea and vision problems.

Causes of Dry Eyes

Dry eyes are caused by a lack of adequate tears. Your tears are a complex mixture of water, fatty oils, proteins and electrolytes. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eyes from infection. For some people, the cause of dry eyes is an imbalance in the composition of their tears. Other people don't produce enough tears to keep their eyes comfortably lubricated. Eyelid problems, medications and other causes, such as environmental factors, also can lead to dry eyes.

Poor tear quality

The tear film has three basic layers: oil, water and mucus. Problems with any of these layers can cause dry eyes symptoms.

• Oil. The outer layer of the tear film, produced by small glands on the edge of your eyelids (meibomian glands), contains fatty oils called lipids. These smooth the tear surface and slow evaporation of the middle watery layer. If your oil glands don't produce enough oil, the watery layer evaporates too quickly, causing dry eyes. Dry eyes are common in people whose meibomian glands are clogged. Meibomian dysfunction is more common in people with inflammation along the edge of their eyelids (blepharitis), rosacea and other skin disorders.
• Water. The middle layer is mostly water with a little bit of salt. This layer, produced by the tear glands (lacrimal glands), cleanses your eyes and washes away foreign particles or irritants. If your eye produces inadequate amounts of water, the oil and mucus layers can touch and cause a stringy discharge.
• Mucus. The inner layer of mucus helps spread tears evenly over the surface of your eyes. If you don't have enough mucus to cover your eyes, dry spots can form on the front surface of the eye (cornea).

Decreased tear production

Dry eyes can occur when you're unable to produce enough tears. The medical term for this condition is keratoconjunctivitis sicca (ker-uh-to-kun-junk-ti-VIE-tis sik-uh).

You may not produce enough tears if you:

• Are older than 50. Tear production tends to diminish as you get older. Dry eyes are common in people older than 50.
• Are a postmenopausal woman. A lack of tears is more common among women, especially after menopause. This may be due in part to hormonal changes.
• Have a medical condition that reduces your tear production. Dry eyes are also associated with some medical conditions such as diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren's syndrome, thyroid disorders and vitamin A deficiency.
• Have had laser eye surgery. Refractive eye surgeries such as laser-assisted in-situ keratomileusis (LASIK) also may cause decreased tear production and dry eyes. Symptoms of dry eyes related to these procedures are usually temporary.
• Have tear gland damage. Damage to the tear glands from inflammation or radiation can hamper tear production.

Eyelid problems

Blinking spreads a continuous thin film of tears across the surface of your eyes. If you have an eyelid problem that makes it difficult to blink, tears may not be spread across your eye adequately or your tears may evaporate too quickly, causing dry eyes. Eyelid problems can include an out-turning of the lids (ectropion) or an in-turning of the lids (entropion).

Medications that cause dry eyes

Medications that can cause dry eyes include:

• Certain types of drugs used to treat high blood pressure, such as central-acting agents and diuretics
• Antihistamines and decongestants
• Birth control pills
• Certain antidepressants
• Pain relievers, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)
• Isotretinoin-type drugs for treatment of acne

Other dry eyes causes

Other causes of dry eyes include:

• Wind
• High altitude
• Dry air
• Tasks that require concentration, such as working at a computer, driving or reading

Signs & Symptoms of Dry Eyes

Signs and symptoms of dry eyes, which usually affect both eyes, may include:

• A stinging, burning or scratchy sensation in your eyes
• Stringy mucus in or around your eyes
• Increased eye irritation from smoke or wind
• Eye fatigue after short periods of reading
• Sensitivity to light
• Difficulty wearing contact lenses
• Periods of excessive tearing
• Blurred vision, often worsening at the end of the day or after focusing for a prolonged period

Diagnosis of Dry Eyes

Tests and procedures used to determine the cause of your dry eyes may include:

• Measuring the volume of your tears. Your doctor may measure your tear production using the Schirmer tear test. In this test, blotting strips of paper are placed under your lower eyelids. After five minutes your doctor measures the amount of strip soaked by your tears.
• Determining the quality of your tears. Other tests use special dyes in eyedrops to determine the surface condition of your eyes. Your doctor looks for staining patterns on the cornea and measures how long it takes before your tears evaporate.

Treatments of Dry Eyes

For most people with occasional or mild dry eyes symptoms, treatment involves over-the-counter eyedrops and other home remedies. If your dry eyes symptoms are persistent and more serious, your treatment options will depend on what's causing your dry eyes. Some conditions that cause dry eyes can be reversed or managed. Other treatments can improve your tear quality or stop your tears from quickly draining away from your eyes.

Treating the underlying cause of dry eyes

Your doctor will work to determine what's causing your dry eyes. In some cases these situations can be reversed. For instance, if a medication is causing your dry eyes, your doctor may recommend a different medication that doesn't cause that side effect. If you have an eyelid condition, such as an anatomic abnormality or a condition that makes it difficult to close your eye completely when you blink, your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids (oculoplastic surgeon). If your signs and symptoms suggest an autoimmune condition, such as rheumatoid arthritis or Sjogren's syndrome, your doctor may refer you to a rheumatologist for evaluation.

Medications

Prescriptions used to treat dry eyes include:

• Antibiotics to reduce eyelid inflammation. If inflammation along the edge of your eyelid keeps the oil glands from secreting oil into your tears, your doctor may recommend antibiotics to reduce inflammation. Antibiotics can be administered as eyedrops or ointment, or they can be taken in pill form.
• Prescription eyedrops to control cornea inflammation. Inflammation on the surface of your eye may be controlled with prescription eyedrops that contain the immune-suppressing medication cyclosporine (Restasis) or that contain corticosteroids to control inflammation.
• Prescription eye inserts that work like artificial tears. For people with moderate to severe dry eyes symptoms who can't use artificial tears, one option may be a tiny eye insert that looks like a clear grain of rice. Once a day, you place the hydroxypropyl cellulose (Lacrisert) insert between your lower eyelid and your eyeball. The insert dissolves slowly, releasing a substance that's used in eyedrops to lubricate your eye.

Closing your tear ducts to reduce tear loss

Your doctor may suggest treatment to keep your tears from leaving your eye too quickly. This can be done by partially or completely closing your tear ducts, which normally serve to drain tears away. Tear ducts can be plugged by:

• Tiny silicone plugs. The closure conserves both your own tears and artificial tears you may add. Silicone plugs can be removed or left in.
• A procedure that uses heat to close the tear ducts. In a more permanent procedure called thermal cautery, your doctor numbs the area with an anesthetic and then applies a hot wire that shrinks the tissues of the drainage area and causes scarring, which closes the tear duct.

Covering your eyes with a special contact lens

People with severe dry eyes may opt for special contact lenses. These contact lenses help protect or shield the surface of your eye, trapping moisture close to your eye in order to relieve your dry eyes symptoms. Ask your eye doctor whether these special lenses, called bandage lenses or corneal shields, are an option for you.

Prevention of Dry Eyes

If you experience dry eyes, pay attention to the situations that are most likely to cause your symptoms. Then find ways to avoid those situations in order to prevent your dry eyes symptoms. For instance:

• Avoid air blowing in your eyes. Don't direct hair dryers, car heaters, air conditioners or fans toward your eyes.
• Wear glasses on windy days and goggles while swimming. The wraparound style of glasses may help reduce the effects of the wind. Goggles protect your eyes from chemicals in pool water that can dry your eyes.
• Add moisture to the air. In winter, a humidifier can add moisture to dry indoor air.
• Consider eyeglass shields to protect your eyes. Safety shields can be added to the tops and sides of eyeglasses to block wind and dry air from getting to your eyes. Ask about shields where you buy your eyeglasses. Swim goggles may create the same effect.
• Take eye breaks during long tasks. If you're reading or doing another task that requires visual concentration, take periodic eye breaks. Close your eyes for a few minutes. Or blink repeatedly for a few seconds to help spread your tears evenly over your eye.
• Position your computer screen below eye level. If your computer screen is above eye level, you'll open your eyes wider to view the screen. Position your computer screen below eye level so that you won't open your eyes as wide. This may help slow the evaporation of your tears between eye blinks.
• Stop smoking and avoid smoke. If you smoke, stop. Ask your doctor for help devising a quit-smoking strategy that's most likely to work for you. If you don't smoke, stay away from people who do. Smoke can worsen dry eyes symptoms.

When to seek Medical Advice

See your doctor if you've had prolonged signs and symptoms of dry eyes, including red, irritated, tired or painful eyes. Your doctor can take steps to determine what's bothering your eyes or refer you to a specialist.