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A thin, wet layer of tear film covers our eyes. If there is not enough tear film is to cover the eyes or if the tear film is of poor quality, symptoms of dry eyes can present itself.  There are many ways to prevent dry eyes, as well as to treat dry eyes.

Everyone can tell when their eyes are dry. But everyone describes their dry eyes differently. Symptoms of dry eyes range from sticky eyelids, blurry vision, red eyes, gritty feeling, discomfort and sometimes even pain. 

An estimated 18 million Americans have dry eyes. Many factors contribute to dry eyes: such as increasing age, systemic diseases (like Sjogren's syndrome, Rheumatoid arthritis), hormonal changes (menopause), dry environments like Colorado, excessive screen time (phones, tablets, computers), air conditioning/fans all lead to dry eyes. Each person's dry eye condition exists at different levels of increasing severity.

In general, dry eye conditions are categorized as not having enough tear production, excessive tear loss from evaporation or an inflammatory process resulting in dry eyes. In many cases, the causative factors overlap. Therefore, not everyone has the same type of dry eye. That's why the same treatment does not work for everyone's dry eyes. 

Dry eyes usually gets worse over time. It is a chronic condition. For example, in Sjogren's syndrome, the lacrimal gland (that produces tears) continues to degrade over a lifetime. If someone uses computers daily for many years, it causes cumulative dryness to the corneas. Therefore, "a stitch in time saves nine" when it comes to dry eye care. Or prevention is better than cure in many cases. 

Extreme cases of dry eye neglect can lead to severe drying and thinning of the corneas (the clear surface of the eyes) which can result in perforation of the eye. This can lead to blindness. 

The tear film is produced by lacrimal glands, which are usually hidden behind the bony rim under eyebrows. Complex mechanisms cause these glands produce tears. Many types of stimuli can cause the lacrimal glands to make tears like chemical exposure (cutting onions), cold temperature, windy conditions, bright lights and strong emotions, etc. Notably, one of the main triggers for tear production is a dry eye surface.  

Tears have many important functions that result in good eye health. The tear film is covers most of the surfaces of eyes like the cornea (clear part of the eye ball), conjunctiva (white part) and some areas of the inner eyelids. Tears contain many biological components that provide nourishment to the cornea and conjunctiva. And tears also contain chemicals that provide protection from infections. Therefore, a healthy tear film leads to healthy eyeballs and results in great vision. 

The tear film contains three important layers. The innermost mucous layer helps keep the other layers attached to the eye ball. The middle (thickest) watery layer helps to lubricate the eye and protects it. This layer contains important chemicals that help fights bacterias. The outer oily layer keeps the watery layer from evaporating and creates a smooth surface for light to pass through the eye. 

Each layer of the tear film plays an important role together to prevent dry eyes. Decrease in any layer or poor quality of the tear film can lead to dry eyes. 

Eyes feel scratchy (like having a hair on your eye)

Vision changes rapidly from clear to blurry, blinking helps to reduce blurriness

Eyes get red like you have not slept enough

Eyes burn or sting is how most people describe the discomfort

Some become light sensitive or bright lights bother them

and other symptoms ...

Dry eyes can be the result of not enough tear production, poor quality of the tears produced, or too much tear loss by evaporation. Age may be the most common contributing factor to dry eyes, but many factors such as environment (wind, smoke, humidity), profession (computer use, prolonged reading), eyelid deformities, contact lens use, eye make up use, dehydration, medication side effects, hormone status and many other factors can lead to dry eyes. 

Some conditions make having dry eyes more likely such as:

Increasing age, usually over age 50

Wearing contact lenses for many years

Poor diet/nutrition (low vitamin A or omega 3 fatty acids)

Females tend to have more dry eyes than males

People whose eyelids do not close properly or completely

People who have blepharitis, rosacea, allergies, etc

People who have diseases like Sjögren's, Lupus, Rheumatoid arthritis, etc

People who focus their eyes for long periods of time to read, use computers, phones

Some medications or eye drops can also cause dry eyes as a side effect

Latest data indicate than nearly 16 million Americans have dry eyes.

However, not everyone is symptomatic and many have mild symptoms. 

It is important to diagnose dry eyes early and to prevent dry eyes. Starting treatment earlier is also better than waiting until excessive damage occurs to the eyes from long standing dry eyes. Just like it is better to brush teeth daily and professionally clean your teeth periodically rather than to fix a dental cavity. 

A visit to your eye doctor is the easiest way to diagnose dry eyes. However, due to time constraints due to work or life events, if it is difficult to go see an eye doctor, you can consult with an eye doctor virtually using a phone or tablet or a computer. 

If you are reading this at home, you can do a simple, short questionnaire to find out if you have dry eyes. It is not a perfect test but it is a reasonable alternative to learn more about the condition of your eye. Click on this link to the questionnaire if you would like to find out if you have dry eyes:  https://intakeq.com/new/rnpsco

The most common treatment for mild dry eyes is to use over the counter artificial tears, gels and ointments. Using warm compresses and cleaning the lids and lashes daily is also very helpful. These do not require prescriptions from doctors. If your dry eyes are more severe, you will need prescription medications that increase tear production, improve tear quality or prevent evaporation of tears. There are also many new treatment modalities to address dry eyes such as Lipiflow, IPL (intense puled light), etc. However, these treatments require a visit to the doctor's office. 

In general, treatment for dry eyes is a long-term treatment. Unlike a bacterial infection that resolves with antibiotics, the treatment for dry eyes is quite complex. There are no quick fixes for dry eyes. Mild dry eyes, if diagnosed early, respond better to treatments. As the dry eye disease gets more severe, it gets increasingly more difficult to treat. Therefore, like the old saying "a stitch in time saves nine", please do not wait until your dry eyes get really bad before seeking help. 

A detailed examination of your lifestyle and environment will provide many clues to factors that may be contributing to your dry eye symptoms. In line with the thought that "prevention is better than cure", I may advise you to stop smoking, stay away from smoke, wind, air conditioning, use a humidifier, learn to blink more, take frequent breaks from screens (phones, tablets, computers), use wrap around glasses when going outside in dry air, drink plenty of water daily and get enough sleep, etc. 

Some people may benefit from plugging the tiny holes than drain tears away from the eyes. Some people who may require surgery to fix the position of eyelids or if the eyelids are too loose, and some may need to make the eyelid opening smaller. For these particular situations, I will help you find the nearest eye surgeon who can perform the procedure for you. I will not be able to do these virtually. 

Unfortunately, YES. As you read this on a screen :) let me tell you that nowadays, kids spend a lot of time staring at their phones, tablets or computer screens, both at school and at home. They also have to read and do homework. All these activities require visual attention and that means they are not blinking enough. So please limit screen time for your kids (and yourself). 

YES. A person normally may blink 20 times a minute subconsciously. However, while paying visual attention (like looking at a screen), the blink rate falls as low as 4 blinks a minute. The only physical way for the eye to spread the tear film all over the surface of the eye is through blinking. So if you don't blink enough times in a given minute, the tear film on surface of your eye will evaporate and you will feel the symptoms of dry eyes like grittiness, blurry vision, discomfort, etc. If you sit near an air conditioning vent, the blowing air will evaporate the tear film even faster, making your symptoms worse over time. So please limit screen time if you can. Use the 20-20 rule. Every 20 mins, close your eyes for 20 seconds. Say a little mantra to yourself. Your eyes will thank you.

When the eyes come into contact with certain substances (irritants called allergens), the eyes release chemicals (called histamine). Histamine causes the eyes to become teary and red. The eyes become itchy. This is eye allergy                         (called allergic conjunctivitis).

An allergen is a substance that causes allergic reaction. Some examples of common allergens are: dust, pet dander, mold, pollen and smoke. Some people are allergic to medications in eye drops, preservatives in eye drops, perfumes and eye make-up. 

Almost everyone who has eye allergy complaints of itchy eyes. Most people also have teary eyes and they look red. Even the eyelids can get swollen. Some may have burning sensations, discomfort and even sensitivity to bright lights. 

Most people who have seasonal allergies- itchy noses, sneezes, stuffy/runny noses, headaches - also have eye allergies.