Dry Eyes: Causes & Remedies
Thanks to modern lifestyles, more and more people are experiencing the problem of dry eyes (or dry eye syndrome). According to the National Institute of Health and Care Excellence (NICE), dry eyes is estimated to affect up to a third of adults worldwide (i). Many experts believe the condition will become even more common, with the number of those affected expected to reach 250 million people by 2022 (ii). One likely explanation for this increase is that your chances of developing a problem with dry eyes becomes more common as you get older (around 7.5 per cent of people in their fifties have dry eyes, but this increases to 15 per cent in people aged 70 and older (i) ). In fact dry eyes, which is also known as keratoconjunctivitis sicca, is so common as you get older, most people aged 65 or older are thought to have one or more of the symptoms (iii).
Quite why dry eyes is more common in older people isn’t clear, though some experts suggest older people may produce fewer tears. Dry eyes is also about 50 per cent more common in women than in men (iv).
How do eyes become dry?
Your eyes can become dry when there’s a problem with the tear film that normally keeps them lubricated – in other words, when the quality or quantity of tears isn’t sufficient enough to keep the surface of your eye moist. Each time you blink, tears are spread across the surface of your eye by your eyelid. Tears are a fluid made mostly of salt and water and are produced by the lacrimal glands underneath the skin of the upper eyelids. You also have other glands on the edges of your eyelids that make oils, called meibomian glands. This oil is also important as it keeps your tears from evaporating too quickly. After blinking, the tears drain away through openings inside the edges of the upper and lower eyelids near the nose, called puncta, and evaporate in your nose.
But if you don’t produce enough tears or your tears evaporate too quickly, the result can be eyes that feel dry, painful and irritated. Other symptoms include a burning sensation, itchiness, redness and a feeling that you have dust or grit in your eye. The symptoms alone can be distressing, but dry eyes can come with complications including eye infections such as conjunctivitis and keratitis – which, if left untreated, can cause more serious corneal problems.
Do you have dry eyes?
If you’re not sure your eyes are dry, try this test:
Look straight ahead at a clock or watch with a second hand.
Blink twice, then start timing how long you can go without blinking before your eyes start to feel uncomfortable.
If your eyes felt dry or sore within five seconds, your tear film is breaking up too soon and leaving your eyes’ unprotected.
What causes dry eyes?
Besides getting older, there are lots of things that could make you more susceptible to having dry eyes. Here are the most common:
Low blink rate
In other words, you’re not blinking enough. For instance, if you work with computers, it’s likely you have a reduced blink rate because your eyes tend to blink less often when you’re concentrating (because of the number of hours most people spend staring at a screen, computer use is thought to be the most significant factor in lifestyle-related eye health problems). The same thing can happen when you watch TV – some experts believe your blink rate reduces from an average of 22 blinks per minute to as low as seven times a minute when you’re staring at a screen.
If you drive a lot, you may blink less frequently too. That’s because each time you blink, half a second’s worth of visual information fails to reach your brain, and that information could be crucial when you’re behind the wheel, especially when you’re driving at speed.
If you use a computer at work and your office has air conditioning, you’re an ideal candidate for sore, dry and strained eyes. That’s because air conditioning can create a dry atmosphere, which could make your tears evaporate too quickly. Central heating – which also tends to create a dry environment – can also cause problems with dry eyes, as can being outdoors in windy conditions, spending time in a dry climate, coming into frequent contact with hot blowing air or being at a high altitude.
Dry eyes is a possible side effect of several medicines, including antihistamines, some antidepressants, certain anxiety treatments, some acne treatments, diuretics (water tablets) and some beta-blockers. Nasal decongestants and oral contraceptives may also cause dry eyes (or make existing dry eyes worse).
Autoimmune diseases such as an underactive or overactive thyroid, rheumatoid arthritis and multiple sclerosis can affect tear production. Another, called Sjögren’s Syndrome, causes inflammation in the lacrimal gland, which reduces tear production. Other medical conditions that may increase your risk of developing dry eyes include blepharitis (inflammation of the eyelids), allergic conjunctivitis, eczema, Bell’s palsy and HIV.
More women are thought to be affected by dry eyes because of the hormonal changes they experience during menopause or pregnancy, or while using oral contraceptives. Hormones play an important part in tear production, say experts.
People who wear contact lenses are more susceptible to having dry eyes because lenses absorb a lot of fluid. According to one study, dry eyes is a common cause of contact lens discomfort, affecting around 40 per cent of people who use soft contact lenses (v). Changing to a different type of lens or using your lenses less frequently may solve the problem.
Laser eye surgery
Some people who have laser eye surgery to correct their vision experience a problem with dry eyes afterwards, though in most cases it’s not permanent.
How are dry eyes treated?
While there’s no cure for dry eyes, the most common treatment – that is, eye drops – is usually straightforward and effective. In mild to moderate cases, eye drops can help lubricate the eyes and counteract dryness. There is a range of eye drops available over the counter, via opticians and on prescription. These consist of drops such as artificial tears, gel-like drops and ointments. Artificial tears are liquid and can be used throughout the day, as often as you need them. However, if you need to use artificial tear drops for long periods or regularly throughout the day, it’s a good idea to use preservative-free drops. That’s because some of the preservatives used in some artificial tears – such as benzalkonium hexachloride – can damage the cornea if used too frequently or in the long term.
Also take care over your choice of eye drops if you’re pregnant, as certain ingredients in some products should be avoided during pregnancy. And if you wear contact lenses, make sure any drops you use are suitable. Gel-like drops and ointments are thicker and therefore longer lasting than liquid artificial tears, and are designed to be used less frequently (in the case of ointments, they’re usually applied last thing at night because they can cause blurred vision).
Newer products that come in the form of sprays are designed to reduce evaporation from the surface of the eye by replenishing the oily part of the tear film. These products - called liposomal sprays – are available over the counter without a prescription.
If you’ve had dry eyes for a long time, your GP or optician may also recommend something to counteract inflammation in and around the eye, such as corticosteroid eye drops or ointments, or tablets called tetracyclines.
Severe cases of dry eyes may require surgery. One procedure involves inserting small plugs called punctal plugs into your tear ducts to stop your tears from draining after blinking. Temporary plugs made from silicone are often used initially – you will be given anaesthetic drops to numb your eyes first – and if the treatment helps to keep your eyes moist, permanent plugs can replace them at a later date. Sometimes, the puncta are also permanently sealed using a procedure called cauterisation.
There is another surgical procedure for dry eyes called salivary gland autotransplantation, though this is only used in very severe cases where other treatments haven’t been successful. This operation removes some saliva-producing glands from the lower lip and transplants them under the skin around the eyes.
Self-help for dry eyes
If you know what’s making your eyes dry, avoiding it can often be enough to make them more comfortable. For instance, you could stop wearing contact lenses altogether (or at least wear them less frequently), or ask your GP if there is an alternative to any medicine that may be causing the problem.
Using a humidifier to moisten the air in dry indoor environments can be a big help too, as can staying away from windy conditions – or, if that’s not possible, try protecting your eyes from the wind by using special wrap-around glasses (ask your optician for details).
Many optical health experts also recommend practising good eye hygiene, especially for those who have blepharitis.
Diet and eye health
There are certain foods you could include in your diet that are widely thought to support the eyes, including green vegetables such as spinach and kale, plus brightly coloured fruit and veg including tangerines, blueberries, beetroot and red grapes. Also try to eat at least two portions of fish a week, one of which should be oily (oily fish include mackerel, salmon, sardines, herring, pilchards and fresh tuna). Meanwhile, drink plenty of water to keep yourself – and your eyes – hydrated.
If you use a computer screen at work, it’s also advisable to take breaks frequently. Look up from your screen at least every five or 10 minutes, and try to get into the habit of blinking more often (try blinking every time you press the 'enter' key on your keyboard, for instance). Make sure your computer screen is set up properly too – for instance, the monitor should be at or below eye level.
Keep your eyes flexible by practicing this simple routine each time you have a screen break. First, keeping your head and neck straight, roll your eyes in each of the directions below, holding each position for one or two seconds:
Hold your thumb out six inches from your nose and focus on it for a few seconds. Then stare into the distance for a few seconds. Repeat the entire exercise up to 15 times. Finish by blinking rapidly for a few seconds to moisten your eyes.
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Natural remedies for dry eyes
Whether you have the occasional problem with dry eyes or your eyes feel dry and irritated most of the time, there are some natural supplements that may support your eye health and even make your eyes feel more comfortable:
Sea buckthorn oil
A plant originally found in high altitude regions of China and Russia, sea buckthorn has been used in traditional Chinese medicine for many years. The berries are rich in antioxidants, including vitamin C, vitamin A and several bioflavanoids and carotenoids. Indeed, evidence suggests taking sea buckthorn oil may improve dry eye symptoms by reducing tear film osmolarity – a mechanism that’s thought to cause dry eye (vi).
Many experts believe that the omega-3 fatty acids found in fish oils help reduce the risk of dry eyes as well as treat dry eyes. One study, for instance, suggests they have a definite role for dry eye syndrome, though the benefits may be more significant in those who have related conditions such as blepharitis and meibomian gland disease (vii). Another study has found that women who eat the highest amount of omega-3 fatty acids from fish may be 17 per cent less likely to develop dry eyes than women who eat less or no fish or seafood (viii).
Other ingredients combined with fish oils may also be beneficial. One study, for instance, followed postmenopausal women with dry eye whose symptoms were relieved by taking a supplement containing fish oil, blackcurrant seed oil and vitamins A, B6, C and E (ix). In another study, participants with moderate to severe dry eye were given fish oil or olive oil supplements for a year. Both found their symptoms improved, though they improved a little more in those taking the fish oils (x). There’s also evidence that fish oil supplements may also be helpful if you have dry eyes as a result of wearing contact lenses (xi).
Eating oily fish such as salmon, fresh tuna, sardines, mackerel and pilchards can help you get more omega-3s in your diet – aim for at least two portions of fish a week, one of which should be oily. If you’re not a fan of fish you could try taking a high-quality fish oil supplement. Meanwhile if you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3. This is sourced from plant organisms called microalgae rather than fish.
Many of these beneficial plant chemicals are thought to help support eye health, with studies suggesting they may also improve tear stability and quantity (ix). Substances called anthocyanidins for instance, are potent antioxidants that many believe boost eye health by supporting the capillaries in the eyes. Meanwhile, alpha lipoic acid may be useful too, as it’s a powerful antioxidant thought to help regenerate other antioxidants.
The antioxidant plant compounds lutein and zeaxanthin may help too if you tend to spend long periods of time in front of a computer. In one study, for instance, researchers found lutein and zeaxanthin supplements improved eye strain as well as eye fatigue in computer users (xiii). You can also get more lutein and zeaxanthin in your diet by eating certain foods – see What Foods Contain Lutein and Zeaxanthin: Eating for Eye Health to find out more.
Another antioxidant that may help if you use a computer screen all day is astaxanthin. Classed as a carotenoid, astaxanthin is thought to be a particularly powerful antioxidant (xiv) . It’s derived from a freshwater microalgae called Haematococcus pluvialis (it’s the red pigment in the algae that give certain fish and shellfish their red or pink colour – salmon and lobster, for instance).
There’s a growing body of evidence to suggest taking astaxanthin supplements may improve some of the symptoms of Computer Vision Syndrome, which include eye strain and fatigue. For instance, researchers in Japan have found astaxanthin supplements may help with eye strain as well as vision focusing problems in people who work on computer screens (xv).
You can get astaxanthin in your diet by eating foods such as salmon, lobster, shrimp, crawfish and crab, but it’s unlikely that you’d be able to eat enough to get the amount needed to see any vision benefits. Taking a high-quality supplement, however, would provide a more beneficial dose of astaxanthin – plus it’s a great option for anyone who doesn’t like eating fish or seafood.
Read more about astaxanthin and its benefits for eye health here.
Meanwhile curcumin, an antioxidant compound found in the curry spice turmeric, may also be useful for dry eye symptoms, say researchers who tested a curcumin and soy lecithin supplement on people with an autoimmune eye disease called chronic anterior uveitis (xvi).
Also known as riboflavin, vitamin B2 may be beneficial for eye health as it’s a co-factor for antioxidants that support the eye (that is, it helps with the biological function of certain antioxidants). This may explain why it’s commonly used as a remedy for eye fatigue.
Meanwhile if your eyes are dry as a result of having Sjögren’s syndrome, there’s evidence that a flaxseed oil supplement may help. A small-scale study suggests taking one or two grams of flaxseed a day may help reduce inflammation on the surface of the eye and relieve the symptoms of dry eye in people with Sjögren’s (xvii).
Having dry eyes can be a nuisance, but this guide shows there’s lots you can do to make your eyes more comfortable. To discover more helpful articles on a range of other health conditions, visit our health library.
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.