What Is Dry Eye? Causes, Symptoms, and How It’s Treated

By Dr. Kenneth King | Alliance Vision Institute Dr. King is an ophthalmologist at Alliance Vision Institute in Fort Worth, TX.

Dry eye sounds simple. It is not. It is a whole constellation of ocular surface problems, and the name barely scratches the surface of what is actually happening. Here is what you need to know about dry eye disease, why it happens, and what can actually be done about it.

What Is Dry Eye Disease?

Dry eye is not just a low-tear-production problem. It is an ocular surface disease involving the quality, composition, and balance of the tear film, as well as the health of the glands and tissue that produce it.

Healthy tears are not thin and watery. They should be thick, like lotion, layered with water, oils, and mucins that work together to coat and nourish the eye surface. When any part of that system breaks down, inflammation follows. Inflammation reduces tear quality further, which creates more inflammation, and the cycle escalates.

When the tear film is out of balance, it becomes almost toxic to the surface it is supposed to protect.

What Are the Symptoms of Dry Eye?

Dry eye symptoms are more varied than most people expect. Patients come in describing:

• Gritty or scratchy eyes
• Redness
• Fluctuating vision that clears when you blink
• Itchiness
• A sensation like something is stuck in the eye
• Pressure or heaviness around the eyes
• Eyes that want to close by the end of the day
• Watery eyes that will not stop tearing

That last one surprises people. Watery eyes with dry eye is very common. When the tear film is so out of balance that it irritates the eye surface, the body floods the eye with extra water as a reflex. But reflex tears do not have the right components to actually soothe the surface. They are a cry for help, not a solution.

Fluctuating vision is another frequently misread symptom. Many patients assume they need a new glasses prescription when the real problem is an unstable tear film. Looking through a poor tear film is like looking through rain on a windshield. You blink to clear it, and it goes temporarily better, then blurs again. Glasses do not fix that.

Who Gets Dry Eye?

Anyone can develop dry eye at any age. Common contributors include:

• Screen use. Staring at a digital screen significantly reduces blink rate compared to reading print or having a conversation. Slower blinking means more evaporation and less gland stimulation. The meibomian glands in the eyelids that produce the oil layer of the tear film begin to block up.
• Medications. Approximately 80% of the most commonly prescribed medications in the United States can contribute to dry eye. This includes antihistamines, antidepressants, blood pressure medications, and many others.
• Autoimmune and inflammatory conditions. Patients with rheumatoid arthritis, lupus, Sjögren’s syndrome, and similar conditions are at significantly higher risk.
• Environment. Air pollution, particulates, low humidity, and air conditioning all accelerate tear evaporation.
• Age. Tear production and gland function decline over time, though dry eye is not exclusively a condition of older patients.

What Happens If Dry Eye Goes Untreated?

Dry eye is a progressive condition. Left unmanaged, it worsens.

Think of what happens to dry skin. It cracks. Cracked skin is more vulnerable to infection and takes longer to heal. The same principle applies to the ocular surface. A chronically dry, inflamed eye surface becomes increasingly susceptible to infection and damage.

If it progresses far enough, dry eye can lead to corneal scarring and permanent vision reduction. That is not a risk most patients are aware of, and it is a strong argument for getting on top of it before symptoms become severe.

Does Wearing Contacts Cause Dry Eye?

Contact lenses do not cause dry eye, but they make an existing dry eye problem significantly worse.

Contacts float on the tear film. If the tear film is poor quality, the lens sits on an unstable surface and irritates the eye. Patients who develop dry eye often find their contact lens tolerance drops before they notice other symptoms. That can be an early signal worth paying attention to.

How Is Dry Eye Treated?

There is no single treatment that works for everyone, because the causes vary. The goal is to identify what is driving the problem for each patient and build a tailored approach.

Dr. King’s basics, which he starts most dry eye patients on, include:

1. Heat mask. Applied to closed eyelids, heat dilates the meibomian glands and softens the oil buildup that blocks them. This is followed by gentle lid expression and a lid wipe to clear the debris.
2. Artificial tears. Used regularly throughout the day based on screen use and symptom level.
3. Hydration. Tears are approximately 90% water. Dehydration directly affects tear volume and quality.
4. Ocean-based omega-3 supplements. Krill oil or fish oil, rather than flaxseed-based omega-3s, because the marine form has the anti-inflammatory properties most relevant to the ocular surface. These take months of consistent use to produce results.

From there, treatment is individualized. More advanced options include:

• LipiFlow. An in-office procedure that applies heat and pressure to express the meibomian glands more thoroughly than at-home therapy.
• IPL (Intense Pulse Light therapy). A light-based treatment that targets inflammation in the skin and blood vessels around the eyes, reducing the inflammatory load that contributes to gland dysfunction. It addresses the environment driving the problem, not just the surface symptoms.
• Prescription anti-inflammatory drops. For patients with significant inflammatory components driving their disease.

The key point is that a toolbox exists. Many patients have been told to just use artificial tears and live with it. That is not the full picture. Getting evaluated by an eye doctor who specializes in dry eye opens access to a much broader range of solutions.

The Bottom Line

Dry eye is a complex ocular surface disease, not a simple lack of tears. Symptoms range from grittiness and redness to fluctuating vision and paradoxical tearing. It can happen at any age, gets worse without treatment, and in severe cases can cause permanent vision damage. The good news is that effective treatment options exist well beyond artificial tears, and the field continues to advance.

Schedule an Appointment at Alliance Vision Institute

If your eyes are frequently dry, red, or blurry and you have not found lasting relief, our dry eye clinic can evaluate what is driving your symptoms and build a treatment plan that goes beyond drops.

Schedule an appointment at Alliance Vision Institute

Explore the full Days of Our Eyes series with Dr. Kenneth King and Dr. Christopher Cha.