Dry Eyes That Won't Quit: Causes Doctors Treat Most

Persistent dry eyes can feel like sandpaper rubbing against your eyeballs. Although annoying, most causes are treatable once identified. In this guide, we'll cover the common reasons behind chronic dry eyes, how doctors diagnose them, and what treatments work best. If you ever feel unsure about your symptoms, consider using Ubie's free Medically approved LLM Symptom Checker Chat Bot to get personalized guidance before your appointment.

What Are Dry Eyes?

Dry eyes occur when your tears aren't able to keep the surface of your eyes sufficiently lubricated. Tears have three layers—oil, water, and mucus—and any imbalance can lead to discomfort, redness, itchiness, or a gritty sensation. Left unmanaged, chronic dry eyes may damage the eye surface and affect your vision or quality of life.

Common Types of Dry Eye

Doctors generally classify dry eyes into two main categories:

1. Evaporative Dry Eye

   • Tears evaporate too quickly due to poor oil layer
   • Often linked to Meibomian Gland Dysfunction (MGD)

2. Aqueous-Deficient Dry Eye

   • Not enough watery tears are produced
   • Seen in conditions like Sjögren's syndrome

Many people have a mixed type, showing both evaporation and tear production issues.

Leading Causes Doctors Treat

1. Meibomian Gland Dysfunction (MGD)

• What it is: Tiny oil glands (Meibomian glands) along the eyelid rim get clogged or inflamed.
• Symptoms: Burning, stinging, intermittent blurry vision, heavy eyelid sensation.
• Diagnosis: Eye exam with a slit lamp; doctors look for gland blockage and inflammation.
• Treatment:
  • Warm compresses and eyelid massages to clear blockages
  • Prescription eye drops or ointments (e.g., azithromycin)
  • In-office procedures like thermal pulsation (e.g., LipiFlow)

2. Aqueous Tear Deficiency

• What it is: Tear glands produce too few tear components.
• Causes: Age, hormonal changes (especially in postmenopausal women), autoimmune diseases.
• Diagnosis: Schirmer's test to measure tear production.
• Treatment:
  • Artificial tears and lubricating ointments
  • Punctal plugs to block tear drainage and conserve moisture
  • Topical prescription medications (e.g., cyclosporine, lifitegrast)

3. Sjögren's Syndrome

• What it is: An autoimmune disease attacking glands that produce tears and saliva.
• Symptoms: Severe dry eyes, dry mouth, joint pain, and fatigue.
• Diagnosis: Blood tests (SSA/SSB antibodies), salivary gland biopsy.
• Treatment:
  • Systemic immunosuppressants if needed
  • Eye-specific therapies as in aqueous deficiency
  • Regular dental check-ups to protect oral health

4. Allergic Conjunctivitis

• What it is: Eye allergy caused by pollen, dust, pet dander, or molds.
• Symptoms: Itchy, red, watery eyes that can mimic dry eye.
• Diagnosis: Eye exam, allergy testing (skin or blood).
• Treatment:
  • Antihistamine or mast-cell stabilizer eye drops
  • Oral allergy medications
  • Avoiding triggers and using air purifiers

5. Environmental and Lifestyle Factors

• Dry Air & Wind: Heating, air conditioning, fans, or windy conditions speed up tear evaporation.
• Screen Time: Staring at computers or phones reduces blink rate by up to 60%, leading to dryness.
• Contact Lenses: Can worsen dryness, especially if worn too long or with poor lens hygiene.

Tips to reduce environmental impact:

• Take regular breaks using the 20-20-20 rule (every 20 minutes, look 20 feet away for 20 seconds).
• Use a humidifier in dry rooms.
• Wear wrap-around glasses outdoors.

6. Medications

Certain prescriptions and over-the-counter drugs can decrease tear production, including:

• Antihistamines
• Decongestants
• Beta-blockers (for high blood pressure)
• Antidepressants
• Acne treatments (oral isotretinoin)

If you suspect a medication is behind your dry eyes, speak to your prescribing doctor before making any changes.

7. Vitamin A Deficiency & Other Nutritional Gaps

• What it is: Vitamin A plays a key role in tear production and eye surface health.
• Symptoms of deficiency: Night blindness, eye dryness, or rough corneal surface.
• Sources: Liver, dairy products, carrots, leafy greens, supplements.
• Doctor Tip: Don't self-dose large amounts of vitamins. Have blood levels checked first.

When to See a Doctor

Mild dry eyes are often managed with over-the-counter (OTC) artificial tears and lifestyle changes. However, you should promptly consult an eye specialist if you experience:

• Severe eye pain or headache
• Sudden vision changes
• Excessive light sensitivity
• Signs of infection (pus or severe redness)
• Any trauma to the eye

In less urgent cases, you might start by using a Medically approved LLM Symptom Checker Chat Bot to understand your symptoms better and determine whether you need an in-person visit.

Diagnosis: What to Expect

During an eye exam, your doctor may:

• Review your medical history and medications
• Use special dyes (e.g., fluorescein) to look for corneal damage
• Measure tear film stability (tear breakup time)
• Perform Schirmer's test (filter paper under the lower eyelid)
• Evaluate the eyelid margins and Meibomian glands

Treatment Strategies

1. Artificial Tears & Lubricants

   • Use preservative-free drops if you apply them more than four times a day.
   • Gel drops or ointments at bedtime may help overnight.

2. Prescription Medications

   • Anti-inflammatory eye drops (e.g., cyclosporine, lifitegrast)
   • Short-term steroid drops for flare-ups (under supervision)

3. Procedures

   • Punctal plugs to block tear drainage
   • Thermal pulsation or IPL (intense pulsed light) for MGD
   • Autologous serum tears (from your own blood) for severe cases

4. Lifestyle & Home Remedies

   • Stay hydrated and eat a balanced diet rich in omega-3 fatty acids (fish oil, flaxseed)
   • Blink fully and frequently, especially when using screens
   • Maintain optimal humidity and reduce direct air drafts

Preventing Flare-Ups

• Schedule regular eye check-ups every 1–2 years (more often if you have chronic issues).
• Keep a symptom diary noting when symptoms get worse (e.g., after long screen sessions).
• Replace eye makeup every 3–6 months and remove it gently each night.
• Manage allergies proactively with medications or environmental controls.

Final Thoughts

Dry eyes may seem minor, but they can significantly impact comfort and vision over time. Most causes respond well to targeted treatments once properly diagnosed. If your symptoms persist or worsen, don't hesitate to seek professional care—or start with a quick check using this Medically approved LLM Symptom Checker Chat Bot for instant insights.

Always speak to a doctor about any symptoms that could be serious or life-threatening. Early intervention is key to protecting your eye health and maintaining clear, comfortable vision.