Mayo Clinic Q&A: How to treat dry eye disease

DEAR MAYO CLINIC: As I have gotten older, I notice that my eyes are almost constantly dry. I use over-the-counter eye drops to keep them moist, but I also have some itching and redness. What causes dry eyes? Are there any other treatments available to alleviate the condition?

ANSWER: Dry eye disease is a common condition that can cause an array of uncomfortable side effects. Symptoms of dry eyes often include blurry vision; eye redness; sensitivity to light; and a burning, gritty or scratchy feeling in your eyes. Dry eyes happen because the eyes do not produce enough tears or if the tears are not adequate quality to keep the eyes properly lubricated.

To keep your vision clear and your eyes comfortable, you need a smooth layer of tears consistently covering the surface of your eyes. The tear film has three basic components: oil, water and mucus. Problems with any of these can cause dry eyes.

Many people may experience episodes of dry eyes during their lifetime. Aging, environment, hormones, air travel, the outdoors — there are a lot of factors that contribute to the lubrication of the surface of the eye. Medications, age, eyelid problems and excessive eye strain all can result in dry eyes. Certain medical conditions also may increase risk for dry eyes, including rheumatoid arthritis, lupus, scleroderma, sarcoidosis, thyroid disorders and others.

While having dry eyes may be nothing more than an irritation, it can affect vision, so it is important to be evaluated, especially if you have redness, itching or pain.

For some people with chronic dry eyes, the problem stems from glands in the eyelids, called the meibomian glands. Normally, these glands make oil that slows the evaporation of tears. If the glands become blocked, tears do not contain enough oil. Then the tears evaporate too quickly, and eyes become dry. This type of dry eye condition is known as evaporative dry eye. Inflammation of the eyelid skin — a disorder called ocular rosacea — often can result in blocked meibomian glands.

The first line of treatment for dry eyes is to try over-the-counter lubricating eye drops. Many brands contain preservatives which help minimize the risk of contamination and infection. However, over time, the preservative can become toxic to the surface of the eye. For chronic dry eye sufferers — those people who are using lubricating eye drops more than four times a day — preservative-free eye drops are best. Consider single-use vials since they can be discarded after use, minimizing the risk of contamination. Use caution not to touch the surface of the eye when using drops, which could lead to contamination and infection.

If you have symptoms of dry eyes that do not respond to eye drops or other standard therapies, speak to an eye specialist, as there are prescription treatments available that could help if the problem is blocked tear ducts, including anti-inflammatory medications, neurostimulators that can trigger or increase tear production, and, sometimes, steroids to reduce inflammatory conditions.

If you experience dry eyes, pay attention to situations that are most likely to increase your symptoms. For instance:

Speak to your health care professional about how often you need to obtain eye exams. There are several factors that can determine how frequently you need an eye exam, including your age, history of eye problems and risk of developing other vision issues. — Dave Patel, M.D., Ophthalmology, Mayo Clinic, Scottsdale, Arizona

(Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.)