The Complete Guide to Dry Eyes

Everything You Need to Know for Lasting Relief

Did you know that 344 million people worldwide suffer from dry eye disease?  Unfortunately, the numbers are expected to rise even further Dry eye syndrome is a widespread issue that deserves our attention.

Here in India, the prevalence of dry eye disease (DED) is higher than the global average, ranging from 18.4% to 54.3%. Dry eyes cause itching, burning, blurry vision, and sensitivity to light. However, it’s surprising how often these symptoms go unnoticed or are brushed off as insignificant.

This article will teach us about the causes, symptoms, and available dry eye treatments. By understanding this common condition better, you can take proactive steps to manage and improve your eye health.

Let’s get started!

Understanding Dry Eye Disease

Tears play a crucial role in maintaining eye health by lubricating the ocular surface, moisturizing the eyes, and protecting them from irritants and infections. When the complex three-layered tear film is compromised, individuals may experience symptoms such as eye dryness, burning, redness, and blurred vision.

To comprehend the underlying mechanisms of dry eye disease, it is important to understand the anatomy and function of tears. This understanding will help us develop effective strategies for diagnosis and treatment.

Three Layers of the Tear Film and Their Functions

The tear film consists of three layers, each serving a specific function:

1. Outer Lipid Layer:

This layer is made from oils produced by the meibomian glands in the eyelids. It is a barrier that prevents tears from evaporating and maintains their stability on the ocular surface.

2. Middle Aqueous Layer:

Predominantly comprised of water and various proteins, this layer nourishes the cornea and conjunctiva, ensuring their health and optimal functioning.

3. Inner Mucin Layer:

Produced by goblet cells in the conjunctiva, this layer helps spread tears evenly across the ocular surface. It promotes a smooth optical interface and enhances tear adhesion to the eye.

These three layers work together to provide lubrication, moisture, and protection to the eyes, maintaining overall eye health and visual clarity.

Role of Tears in Maintaining Eye Health

Let’s find out how tears help keep the eyes healthy.


Tears facilitate smooth blinking, reducing friction between the eyelid and the cornea.


Tears moisten the ocular surface and prevent eye dryness and discomfort.


Tears contain antibodies, enzymes, and other substances that defend against infections, lowering the risk of eye-related illnesses.

Nutrient Supply: 

Tears deliver oxygen and nutrients to the cornea, ensuring optimal health and function.

Clear Vision:

Tears help maintain a clear optical surface by evenly distributing tears across the eye and smoothing any irregularities.

Wound Healing: 

Tears contain growth factors that aid in the healing process of minor eye injuries and promote tissue repair.

Debris Removal: 

Tears flush away foreign particles, allergens, and dust, keeping the eye clean and preventing irritation.

When we understand the role of tears in our eye health, we can better understand the causes of dry eye syndrome and find more effective treatments for dry eye.

Types of Dry Eye

Dry eye can be classified into three main types: evaporative dry eye, aqueous deficient dry eye, and mixed dry eye. Each type has distinct underlying causes and characteristics that contribute to eye dryness. Let’s explore each type in detail below.

1. Evaporative Dry Eye

Evaporative dry eye is a common condition characterized by a lack of lubrication and moisture on the eye’s surface. It occurs when tears evaporate too quickly or fail to provide enough lubrication, resulting in discomfort, irritation, and vision problems.

Meibomian Gland Dysfunction

Meibomian gland dysfunction is the primary cause of evaporative dry eye, accounting for approximately 86% of all dry eye cases. The meibomian glands, located along the eyelid margins, secrete an oily substance called meibum. When the meibomian glands don’t work properly, less oil is present in tears. This causes tears to evaporate quickly and not provide enough lubrication, affecting their stability.

Rapid Evaporation Due to Reduced Oil in Tears

When tears evaporate too quickly, it causes discomfort, redness, and a gritty or burning sensation due to insufficient lubrication. It also changes the composition of tears, resulting in higher salt and protein levels. These imbalances worsen symptoms and can harm the surface of the eyes. Moreover, the cornea, the front part of the eye, becomes vulnerable to potential damage. 

2. Aqueous Deficient Dry Eye

Aqueous deficient dry eye occurs when the lacrimal glands, which produce tears,  don’t make enough of the watery component (also called the aqueous layer). As a result, moisture loss on the eye’s surface leads to dryness, burning, and a gritty feeling in the eyes.

Causes of Aqueous Deficient Dry Eye

Several factors can lead to aqueous deficient dry eye:

  • Autoimmune Diseases: Conditions like Sjögren’s syndrome and rheumatoid arthritis can cause inflammation and damage the lacrimal glands, reducing tear production.

  • Hormonal Changes: Imbalances in hormones, such as those occurring during menopause, thyroid disorders, or diabetes, can decrease tear production.

  • Medications: Certain medications, including antihistamines, decongestants, and antidepressants, can interfere with tear production and lead to aqueous deficient dry eye.

  • Lacrimal Gland Dysfunction: Structural abnormalities or damage to the lacrimal glands can impair their ability to produce tears.

  • Ageing: Tear production naturally decreases with age, making older individuals more prone to aqueous deficient dry eye.

Consequences of Inadequate Tear Volume

  • Dryness and Discomfort:  Insufficient tear production is a primary cause of dryness in the eyes, causing discomfort, itchiness, and a gritty sensation in the eyes.
  • Corneal Damage: Tears play a crucial role in protecting the cornea. Insufficient tear volume increases the risk of corneal abrasions, ulcers, and infections, potentially resulting in vision loss.
  • Blurred Vision: Insufficient tears compromise the optical surface, leading to blurred or fluctuating vision.
  • Eye Fatigue: Without adequate lubrication, the eyes may become strained, causing fatigue, redness, and increased sensitivity to light.
  • Increased Infection Risk: Tears contain antibodies that help fight off infections. Insufficient tear volume increases susceptibility to eye infections, such as conjunctivitis and keratitis.
  • Impact on Daily Activities: Inadequate tear volume can interfere with activities like reading, working on screens, or wearing contact lenses, negatively affecting the overall quality of life.

Mixed Dry Eye

Mixed dry eye occurs when enough tears are not formed and evaporate quickly from the eye’s surface. This type combines evaporative and aqueous deficient dry eye characteristics, leading to overall dryness and discomfort.

Understanding the different types of dry eye is crucial in determining the underlying causes of dry eye disease. You can take appropriate steps to manage your symptoms and improve your eye health. 

Common Symptoms of Dry Eye Disease

Let’s take a detailed look at these common dry eye symptoms that can significantly impact daily life.

Recognizing Dry Eye Symptoms

People with dry eyes generally experience the following:

  • Burning or stinging sensation in the eyes.
  • Scratchy or gritty sensation in the eyes.
  • Redness of the eyes.
  • Sensitivity to light.
  • Excessive tearing.
  • Hazy vision.
  • Feeling like something is in the eye.
  • Uneven distribution of tears across the eye.
  • Difficulty wearing contact lenses.

Worsening of Dry Eye Symptoms in Specific Environments

Dry eye symptoms can worsen in certain situations, such as:

  • Windy conditions: Wind can dry out the eyes and aggravate dry eye problems.
  • Air-conditioned environments: Constant air conditioning exposure can reduce the air’s moisture and contribute to dry, itchy eyes.
  • Dry climates: Living in arid environments with low humidity can increase the risk of developing dry eyes.
  • High altitudes: Higher altitudes often have lower humidity levels, exacerbating dry eye symptoms.
  • Indoor heating: Heaters can decrease indoor humidity, leading to dryness and worsening dry eye symptoms.
  • Swimming pools and hot tubs: Chlorine in swimming pools and hot tubs can irritate the eyes and worsen dry eye conditions.
  • Prolonged computer use: Dry eyes can be exacerbated by extended computer use because people tend to blink less, leading to increased dryness.

Risk Factors for Dry Eye

Understanding these risk factors helps prevent and treat dry eye disease. Let’s explore these factors in depth:


Tear glands produce fewer tears as we age. The glands shrink, and the nerves that control them become less sensitive, resulting in insufficient eye moisture. 

Hormonal Changes 

Hormonal changes: Hormonal fluctuations during pregnancy, menopause, and menstruation can also cause dry eyes. Estrogen, for example, plays a role in tear gland health and function. As estrogen levels decline during menopause, tear production can decrease.


Various medications increase the risk of dry eyes. Common examples include:

  • Beta-blockers
  • Antidepressants
  • Replacement hormone therapy
  • Acne treatments
  • Birth control pills

Medical Conditions:

Certain conditions may cause chronic dry eye. These include:

  • Thyroid disorders
  • Vitamin A deficiency
  • Sjögren’s syndrome
  • Allergic eye disease
  • Rheumatoid arthritis

Contact Lens Wear

People are more prone to experiencing dry eyes when using contact lenses.

  • Soft contact lenses: Soft contact lenses are more likely to cause dry eyes than hard contact lenses.
  • Extended-wear contact lenses: Wearing contact lenses for more than 12 hours a day increases the risk of dry eyes due to limited rest and healing time for the eyes.

Eye Surgeries:

Dry eyes are a common occurrence after eye surgery. The procedure can disrupt the tear film that lubricates the eye’s surface. Additionally, the surgery may cause nerve damage which causes dry eye syndrome. 

Common eye surgeries include:

  • LASIK: A laser procedure that corrects vision by reshaping the cornea.
  • Cataract Surgery: A procedure that removes a clouded lens in the eye and replaces it with a clear lens.

By understanding these symptoms, risk factors, and environmental influences, you can better recognize and manage dry eye disease, seeking appropriate treatment when necessary.

Diagnosis and Evaluation of Dry Eye

Visiting an ophthalmologist for diagnosis is crucial when experiencing eye-related concerns, as they possess specialized knowledge for diagnosing, treating, and managing eye conditions and diseases. Here are a few reasons why it is important to see a dry eye specialist:


Ophthalmologists have specialized knowledge and expertise in identifying and diagnosing common dry eye symptoms. Their experience enables them to provide accurate and personalized diagnoses and treatment procedures.

Eye Examination

Dry eye specialists perform a thorough eye examination to evaluate the condition. This examination may include tests such as Schirmer’s test, tear breakup time (TBUT) test, meibography, and slit lamp examination. These tests help assess the quality and quantity of tears, examine the tear film stability, evaluate the meibomian glands, and examine the eyes’ overall health.

Specialized Diagnostic Tools

Dry eye doctors may use imaging technologies, such as meibography, to obtain detailed imagery of the meibomian glands in the eyes. Meibography allows for a closer examination of the gland structure and helps determine the extent of gland dysfunction commonly associated with dry eye disease.

Patient History and Symptom Assessment

During the diagnostic process, the dry eye specialist will assess your symptoms and ask specific questions to understand your condition better. Here are some common questions that may be asked to assess dry eye symptoms:

  • Do you experience a stinging or burning sensation in your eyes?
  • Are your eyes red or bloodshot?
  • Do your eyes feel dry and gritty?
  • Do you have excessive tearing or a stringy discharge from your eyes?
  • Do you feel sensitivity to light or have difficulty driving at night?
  • Have you noticed any changes in your vision or frequent fluctuations?
  • Do your eyes feel tired, especially after prolonged visual tasks?
  • Have you experienced blurred vision, particularly when focusing on near objects?
  • Are you using artificial tears or other lubricating eye drops frequently?

This will help the eye doctor understand your symptoms and diagnose them accurately.

Dry Eye Treatment Options

Treatment and precautions for dry eye can be done through simple strategies and lifestyle modifications at home. This natural treatment for dry eyes aims to alleviate symptoms, improve tear production, and create a more comfortable eye environment.

A. Lifestyle Modifications and Home Remedies for Dry Eye

Here are some tips and remedies to treat dry eyes:


Proper Hydration 

Staying well-hydrated is essential for overall health and can help with dry eye symptoms. Drink adequate water throughout the day to maintain good hydration levels. Avoid excessive consumption of caffeinated beverages, as they may contribute to dehydration.

Use Humidifiers

Dry environments can worsen dry eye symptoms, especially in winter or air-conditioned spaces. Using a humidifier can add moisture to the air and help prevent excessive evaporation of tears. Place a humidifier in rooms such as your bedroom or office.

Blinking Exercises

Perform blinking exercises regularly by consciously blinking slowly and gently several times. This helps distribute tears across the eye’s surface and prevents them from evaporating too quickly.

Follow the 20-20-20 Rule

Every 20 minutes, look away from the screen and focus on an object at least 20 feet away for about 20 seconds. This helps reduce eye strain and allows your eyes to rest.

Adjust Screen Settings

Optimize the settings on your devices to reduce eye strain. Increase font sizes and adjust screen brightness to a comfortable level. Consider using a matte screen filter to minimize glare and reflections.

Optimize Lighting

Use softer, indirect lighting and position your computer screen or reading material to avoid reflections and glare from windows or overhead lights. Avoid harsh, direct lighting that can cause glare and strain your eyes.

Maintain a Clean Environment

Keep your living and working spaces clean and dust-free. Regularly clean your glasses, as smudges can affect vision and strain your eyes. Dust, allergens, and irritants can exacerbate dry eye symptoms.

Eye-Friendly Diet

Include foods in your diet that are rich in omega-3 fatty acids, such as salmon, flaxseeds, and walnuts. Vitamin A-rich foods like carrots, spinach, and sweet potatoes also support overall eye health. A healthy diet can improve eye health and help reduce dry eye symptoms.

B. Eye Drops for Dry Eyes

Role of Artificial Tears in Providing Temporary Relief 

Artificial tears are lubricating eye drops that mimic the composition of natural tears. They play a crucial role in temporarily relieving dry eyes by moistening the eyes’ surface, providing a protective layer, and promoting better lubrication. There are different types of lubricating eye drops available.

Different Types of Lubricating Drops for Dry Eyes

  • Gel Drops: Gel-based lubricants offer longer-lasting relief by forming a protective, gel-like coating on the eyes’ surface.
  • Preservative-Free Drops: These are suitable for individuals with sensitive eyes or those who need to use eye drops frequently, as they minimize the risk of irritation from preservatives.
  • Overnight Lubricants: These thicker drops provide extended moisture during sleep and are ideal for severe dryness.
  • Eye Ointments: Lubricants in ointment form are ideal for severe dryness, as they provide prolonged lubrication, particularly during sleep.

Selecting the best eye drops for dry eyes based on your specific needs and consulting a dry eye specialist for guidance is important.

C. In-Office Procedures and Therapies

The latest treatments for dry eye syndromes include in-office procedures and therapies that can provide targeted approaches to address the underlying causes of dry eye and provide long-lasting relief. Here are some advanced treatments for dry eyes:

1. Meibomian Gland Expression

Meibomian gland expression, also known as meibomian gland debridement or probing, is a process performed by a dry eye specialist. It involves manually expressing or cleaning clogged or malfunctioning meibomian glands. This method helps restore normal gland activity, improves the secretion of healthy meibum, and prevents excessive tear evaporation.


  • Enhances the quality and flow of the meibum by clearing blockages
  • Supports normal gland function
  • Results in greater tear stability and eye lubrication.


LipiFlow treatment is a cutting-edge therapy for meibomian gland dysfunction. It uses thermal pulsation technology to gently heat the inner and outer eyelids, specifically the meibomian glands. It applies light pressure to the eyelids, encouraging meibum production and eliminating gland blockages. LipiFlow aims to increase tear film quality and restore normal gland activity.


  • Clears obstructions, stimulates gland secretion, and
  • Restores normal meibum flow by applying heat and pressure to the glands.
  • Improves general ocular health.

Intense Pulsed Light Therapy (IPL)

Intense pulsed light therapy (IPL) is a non-invasive treatment option for certain types of dry eye, especially those associated with rosacea or eyelid inflammation. IPL uses light energy bursts to target and reduce inflammation in the eyelids and surrounding tissues. It can improve meibomian gland function and alleviate dry eye symptoms by treating the underlying inflammation.

These advanced dry eye therapies should be performed under the supervision of an experienced eye care specialist. They require specific knowledge, competence, and the right equipment. An eye doctor can evaluate your unique condition, recommend the best treatment, ensure proper technique, and monitor your progress throughout the treatment process.


  • Reduction in Eyelid Inflammation
  • Improve meibum quality, boost oil flow, and
  • improve tear film stability, resulting in enhanced eye comfort.

Prevention and Long-Term Management

Preventing dry eye symptoms and managing the condition in the long term requires consistent follow-up care and ongoing treatment. Here are some essential strategies:

A. Practical Tips for Preventing Dry Eye Symptoms

  • Regular Eye Care: Schedule regular eye examinations to monitor your eye health and detect any changes or underlying conditions early.
  • Protect Your Eyes: Wear sunglasses or protective eyewear when exposed to harsh environmental conditions, such as wind, dust, or dry air.
  • Take Regular Breaks: When engaged in activities that require focused visual attention, such as using digital devices or reading, take regular breaks to rest your eyes.
  • Avoid Environmental Triggers: Minimize exposure to smoke, allergens, and irritants that can worsen dry eye symptoms.
  • Stay Hydrated: Drink adequate water throughout the day to maintain good hydration levels.

B. Long-Term Management Strategies

  • Consistent Follow-Up Visits: Regularly visit your ophthalmologist or eye care specialist for follow-up appointments to monitor your dry eye condition and adjust treatment as needed.
  • Ongoing Treatments: Continue using prescribed eye drops, lubricants, or medications as your dry eye doctor recommends.
  • Individualized Treatment Plan: Work with your eye care specialist to develop a personalized treatment plan based on the severity of your dry eye condition and your specific needs.
  • Lifestyle Modifications: Maintain the lifestyle modifications and home remedies mentioned earlier to support overall eye health and manage dry eye symptoms.
  • Address Contributing Factors: Identify and address any underlying factors that may contribute to your dry eye symptoms, such as allergies, hormonal changes, or medication side effects.

When to see Dry Eye Specialist?

Early diagnosis and treatment are key to managing dry eye symptoms effectively. By following practical tips for preventing dry eye symptoms, maintaining regular eye care, and addressing contributing factors, you can reduce the impact of dry eyes on your daily life.

Don’t hesitate to contact a dry eye specialist who can provide expert guidance, personalized care, and ongoing support on your journey to better eye health. Take control of your dry eyes and enjoy the comfort and clarity you deserve.