Symptoms of Chronic Dry Eye
Dry eye can range from mildly annoying to debilitating. Common symptoms include:
A gritty or sandy sensation, as if something is in the eye
Burning, stinging, or general discomfort
Redness and irritation
Blurred or fluctuating vision
Sensitivity to light
Itching
Mucous discharge
Paradoxically, chronic dry eye can also cause excessive tearing. When the eye becomes too dry, it signals the brain to flood the surface with reflex tears — but these tears are mostly water, lacking the oil and mucus needed to properly coat the eye and evaporate quickly.
Why Tears Matter
Tears are essential to healthy vision. Every time you blink, a thin film of tears coats the surface of your eye, providing the moisture, lubrication, and protection your eyes need to function comfortably.
A healthy tear film is more complex than it looks. It's a carefully balanced mixture of water, mucus, oils, antibodies, and proteins — each layer playing a specific role in keeping the eye clear, comfortable, and defending against infection. When the glands around your eyes can't produce tears properly, or the composition of those tears is off-balance, the result is chronic dry eye.
What Causes Dry Eye?
Dry eye is classified into 2 broad categories: aqueous tear deficiency (ATD) and evaporative dry eye.
ATD occurs when there is a blockage to the tear-producing glands or if the eye does not produce enough tears. It is commonly associated with Sjögren's syndrome, aging, hormonal changes, and certain medications (such as antihistamines, β-blockers, antispasmodics, diuretics, and some psychotropic drugs).
Evaporative Dry Eye accounts for the majority of dry eye. It occurs when tears evaporate too quickly and can be caused by intrinsic factors such as meibomian gland dysfunction (MGD), eyelid malposition, slow blink rate, or extrinsic factors such as vitamin A deficiency, contact lens wear, or topical drug preservatives.
Many patients have elements of both aqueous deficiency and evaporative dry eye, which is why a thorough evaluation is so important before recommending treatment.
Treatment Options
There's no single fix for dry eye — effective treatment usually combines several approaches tailored to the underlying cause.
Artificial Tears. For mild cases, lubricating drops and ointments are the first line of defense. The most effective artificial tear formulation varies from person to person, and finding the right drop often takes some trial and error.
Prescription Medications. When drops alone aren't enough, prescription medication can reduce inflammation and help your eyes produce more of their own tears. Short courses of steroid drops may be used to calm acute flare-ups, though they aren't suitable for long-term use.
Punctal Plugs. These tiny, biocompatible plugs are inserted into the tear drainage ducts to keep your natural tears on the eye surface longer. They can be temporary (dissolvable) or long-lasting, depending on your needs.
Nutrition. Omega-3 fatty acids — found in fish oil, flaxseed, and certain leafy greens — can support healthy tear production.
Lifestyle Adjustments. Simple changes often make a meaningful difference. Take regular breaks from screens (the 20-20-20 rule — every 20 minutes, look 20 feet away for 20 seconds). Use a humidifier in dry environments. Stay well-hydrated and wear wraparound sunglasses outdoors to protect against wind.
Advanced In-Office Treatments. For moderate-to-severe cases, we may recommend therapies such as meibomian gland expression and TearCare to address the oil gland dysfunction that underlies many chronic dry eye cases. We may also give you amniotic membrane to help heal the ocular surface.