Sometimes generalizing is dicey, but everyone wants to avoid dry, itchy eyes. Right? (If you don’t for some reason, let’s chat.) Unfortunately, you can’t always get what you want, and sometimes a dry, irritated sensation in your eyes just comes as part of inhabiting a body. But is that completely different from actually having chronic dry eye as a health condition?
Yes, it is. “There are situations where your eyes can become dry [under certain circumstances], for example with exposure to wind and dust, but there are others where it can become chronic,” Mina Massaro-Giordano, M.D., co-director of the Penn Dry Eye & Ocular Surface Center and a professor of clinical ophthalmology at the University of Pennsylvania, tells SELF. Here’s how to tell the difference.
Dry eye happens when your eyes can’t wet themselves well enough, according to the National Eye Institute (NEI). That usually comes down to one of two things: Either the amount of your tears or the quality of them can’t keep your eyes as lubricated as they should.
We don’t mean the big, fat tears you shed from happiness at your best friend’s wedding. You actually have a tear film that covers your eyes at all times to keep your eyeballs wet. When you blink, the film spreads across your eyes, Dr. Massaro-Giordano says, and in doing so plays a critical role in maintaining your eyes’ comfort.
This tear film is made up of three layers, the NEI explains:
- There’s a lower mucous-based layer that binds with water in your tears to make sure your eyes stay wet.
- There’s also a middle layer of water and water-soluble proteins, made by the lacrimal glands under your eyebrows, to nourish your corneas (the clear, dome-shaped surfaces of your eyes) and conjunctiva (the mucus membranes that cover the front of your eyes).
- The last layer is an oily outer one, which keeps your tears from evaporating too quickly. Your Meibomian glands, which are located under your eyelids, produce this layer.
If anything with any of these tear layers goes awry, or if your eyes aren’t producing enough tears to begin with, you can end up with dry eye. Fun! Except not really.
Dryness is obviously a major dry eye symptom, but this health condition often doesn’t stop there. Here are all the symptoms you might experience with dry eye:
- Dryness
- Excessive tearing in response to that dryness
- Itchiness
- Scratchiness
- Stinging
- Burning
- Redness
- Pain
- Feeling like something is in your eyes when nothing actually is
- Stringy eye discharge that looks like mucus
- Sensitivity to light
- Discomfort when wearing contact lenses
- Difficulty driving at night
- Blurry vision
- Eye fatigue (feeling like your eyes are exhausted)
Experiencing these symptoms every so often based on your surroundings or habits is totally normal. If, for example, you ride in a convertible for an hour, your eyes might feel dry as a result. This is what some doctors call “situational dry eye,” Christopher J. Rapuano, M.D., chief of the cornea service at Wills Eye Hospital in Philadelphia, tells SELF, meaning when you get dry eye symptoms in certain scenarios, but they go away pretty easily.
But if these symptoms persist no matter the situation—or if you’re basically always in a situation that brings them on—chances are you’re dealing with chronic dry eye.
So, quick disclaimer: Chronic dry eye isn’t an actual medical diagnosis, Jennifer Fogt, O.D., an associate professor in the College of Optometry at The Ohio State University, tells SELF. Given that, there’s no set diagnostic timeline for when you definitely have it, Caroline A. Blackie, O.D., Ph.D., medical director of dry eye at Johnson & Johnson Vision, tells SELF. But if your dry eye symptoms are persistent instead of only happening when you’re in certain situations when they'd logically come about, like riding in a convertible—or if they arise frequently in situations you can't avoid, like using your computer for hours—it essentially means you have a chronic case of dry eye.
Relentless dry eye symptoms can happen for many reasons, including different health issues. Dr. Fogt points to Meibomian gland dysfunction as one example. This condition causes lowered production of the meibum (oily layer) of your tears. “If there is insufficient meibum in our tears, the watery tears will evaporate, resulting in dry eye,” Dr. Fogt explains. A variety of things can cause this, like mascara gunking up these important glands, Dr. Fogt says.
Dry eye can also happen due to blepharitis, which is eyelid inflammation that can lead to a host of unpleasant symptoms similar to dry eye’s, along with bonuses like red, swollen, or greasy eyelids.
Or you could be dealing with dry eye linked with medications you’re taking. Drugs including some antidepressants, antihistamines, and decongestants can reduce your tear output, according to the American Optometric Association. Then there are environmental factors, like exposure to wind, smoke, or dry air, and situational ones, like blinking less often because you’ve spent hours driving or reading.
“Regardless of how long you have had dry eye, the treatment process is the same: You need to improve the ability of the tears and the eyelids to protect the surface of the eye from drying,” Dr. Blackie says.
It’s totally possible that the fix for your chronic dry eye is as simple as using artificial tears when you’re dealing with symptoms (and when your eyes feel fine, since it can help keep them that way), using contact lenses designed to combat against dry eye, or taking some other relatively easy measure.
It’s also possible that your treatment may need to be a little more intensive. Options like prescription eye drops to battle inflammation or boost tear production are out there, as are punctal plugs (inserts that can help block your tear ducts to keep your tears from draining away too quickly), the Mayo Clinic notes. If your dry eye is due to an underlying health issue, your doctor will likely want to explore ways to target that as well, Dr. Fogt says.
No matter what you suspect is causing your dry eye, Dr. Fogt cautions against writing it off. Depending on the cause, dry eye can really be easy to treat, she says. Wouldn’t it be nice to stop screaming internally about how aggravated your eyes are? Seeing a doctor to get confirmation that you’re dealing with dry eye—and figure out how to treat it—will help you get there.
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