Dry Eyes – Diagnosis and Treatment
Diagnosis
Eye care professionals rely on a few key methods to figure out what’s behind dry eye symptoms. They usually begin with a thorough eye exam.
During the exam, doctors ask about your health, past eye issues, and current problems—maybe watery eyes, stinging, or blurred vision. They look for dry eye disease and related issues, like trouble with the tear-producing lacrimal gland or fast tear evaporation.
To measure tear production, specialists often use the Schirmer tear test. Here, they gently tuck thin paper strips under your lower eyelids. After five minutes, they check how much of the strip gets wet.
There’s also the phenol red thread test—a dyed thread goes under the eyelid and doctors measure it after a short time.
Doctors use dye drops to stain the eye surface and spot damaged areas or see how quickly tears evaporate. A tear osmolarity test checks how much water and other stuff is in your tears; less water points to dry eye disease.
Sometimes, they collect tear samples to look for chemicals that signal dry eye or inflammation.
Summary of Tests:
| Test Name | What It Checks | How It Works |
|---|---|---|
| Schirmer tear test | Tear amount | Paper strip under eyelid |
| Phenol red thread test | Tear amount | Dyed thread under eyelid |
| Tear staining | Eye surface damage | Dye drops on the eye |
| Tear osmolarity test | Tear composition | Measures water/particles |
| Tear sample lab tests | Inflammation markers | Chemical markers in tears |
These tests help doctors spot if you have low tear production, poor tear quality, or both. They also help rule out other causes, like aging or autoimmune diseases such as Sjögren’s syndrome.
With this info, doctors can build a plan that actually addresses your specific dry eye problems.
Therapy and Management Options
Closing Tear Drainage with Tiny Plugs
Doctors sometimes use tiny plugs to help keep moisture on the eye surface. They place these soft silicone devices in the small eyelid openings where tears usually drain away.
These plugs block the puncta, so natural and artificial tears stick around longer and dryness drops. You’ll find different types—some you can remove, some stay in longer.
If plugs don’t help enough, a doctor might use heat to seal the tear duct for good (thermal cautery). By slowing drainage, the tear film stays put, shielding the cornea and making things more comfortable.
Benefits:
- Tears last longer
- Less dryness and irritation
- Plugs can be adjusted or removed
| Plug Type | Material | Removable | Duration |
|---|---|---|---|
| Temporary | Collagen | Yes | Weeks to months |
| Permanent | Silicone | Yes | Months to years |
| Thermal cautery | N/A | No | Permanent |
Addressing Medical and Lifestyle Triggers
The cause of dry eye isn’t always the same for everyone. Sometimes, other health conditions or medications make things worse.
If a medication like antihistamines or blood pressure drugs dries out your eyes, doctors might switch you to something that’s less likely to cause trouble. Eyelid problems, like inflammation (blepharitis) or meibomian gland dysfunction (MGD), can also dry out your eyes.
To treat these, doctors suggest better eyelid hygiene, manage skin conditions like rosacea, or even fix eyelid position if that’s the problem. People with blocked oil glands can benefit from regular cleaning, warm compresses, and sometimes prescription ointments.
This helps the meibomian glands work better, which keeps the oily layer of your tears stable and stops them from evaporating too fast.
Steps to Address Underlying Issues:
- Change medications if possible
- Treat eyelid inflammation and skin issues
- Fix eyelid position if it’s a problem
- Support meibomian gland health
- Adjust habits—think screen time or home humidity
Prescribed Treatments and Medicines
When store-bought artificial tears just don’t cut it, doctors have more tools.
- Anti-Inflammatory Medicines: Inflammation around your eyelids or on the eye surface can mess up tear production. Doctors might prescribe antibiotics (in pill, ointment, or drop form) to calm things down, especially for blepharitis or MGD.
- Immune-Modulating Eye Drops: These drops target chronic inflammation and encourage your body to make more tears. Doctors sometimes use corticosteroid eye drops for short bursts, but not long-term—side effects are a concern.
- Lipid Layer Support: If MGD thins out the oily tear layer, doctors combine medicines and eyelid treatments to boost oil flow and keep tears stable.
- Eye Inserts that Release Lubricants: For extra, long-lasting relief, hydroxypropyl cellulose inserts go in your lower eyelid each day. They dissolve slowly and keep eyes moist.
- Tear-Stimulating Agents: Oral or topical medicines like pilocarpine or cevimeline can boost tear output, but sometimes cause side effects (sweating, for example).
- Blood Serum Eye Drops: For really tough cases, doctors make drops from your own blood. These drops feed the cornea with nutrients.
- Nasal Sprays: New options like varenicline nasal spray can increase natural tears by stimulating nerves in your nose.
Additional Procedures and Advanced Care
Some people need more than basic treatments to get relief from dry eyes.
- Permanent or Semi-Permanent Duct Closure: If plugs aren’t enough, doctors may use heat (thermal cautery) to close tear drainage channels for good.
- Special Contact Lenses: Scleral or bandage lenses cover the cornea and hold in moisture, protecting eyes from dryness and damage. These are for folks with really severe symptoms.
- Treatments for Meibomian Gland Function: If oil glands are blocked, daily warm compresses or special gadgets that warm and gently massage the eyelids. This “meibomian gland expression” helps unblock oil glands and restore the oily tear layer.
- Light Therapy and Eyelid Massage: Intense pulsed light therapy, followed by gentle eyelid massage, can sometimes help the meibomian glands work better and ease dryness.
Common Advanced Treatments Table
| Procedure | Purpose | Typical Candidate |
|---|---|---|
| Thermal cautery | Permanently closes tear ducts | Severe dry eye |
| Scleral contact lenses | Shields and hydrates the cornea | Severe, persistent dryness |
| Meibomian expression | Unblocks meibomian glands | MGD, oily tear deficiency |
| Intense pulsed light | Improves oil gland function | Severe MGD, rosacea-linked |
Doctors pick these treatments based on what’s really causing your dry eye, how you’ve responded before, and your overall eye health.
Self care
Choosing Over-the-Counter Solutions for Dry Eyes
People with dry eyes can often get relief from nonprescription products. You’ll find artificial tears, gels, and ointments—each made to ease irritation, stinging, redness, or tired eyes.
Think about what you need before picking something:
| Type | Best For | Key Notes |
|---|---|---|
| Artificial Tears | Mild symptoms, frequent use | Use several times a day; helps prevent dryness and irritation |
| Ointments | Nighttime use | Thicker; can blur vision, so best before bed |
| Gels | Moderate dryness | Last longer than drops, but can feel thicker |
Eye drops come in two main types—preservative and preservative-free. Preservative drops work if you use them no more than four times daily. If you need drops more often, go preservative-free to avoid irritation.
Skip redness-reducing drops as a daily fix; long-term use can actually make eyes more sensitive.
Tips for Using Nonprescription Eye Products:
- Stick to the label’s instructions for how often to use them.
- If you wear contacts, wait at least 15 minutes after drops before putting lenses in—unless the drops are made for contacts.
- If symptoms stick around or get worse, talk with an eye care professional.
Keeping Eyelids Clean to Ease Swelling
Keeping eyelids clean every day can lower swelling and help with blocked oil glands. This routine helps if you get stinging, burning, irritation, or swelling from dry eyes or lots of screen time.
Step-by-Step Eyelid Care:
- Warm Compress: Hold a clean, warm, damp washcloth over closed eyes for about five minutes. This softens oils and unclogs glands.
- Gentle Lid Scrub: Clean the eyelid edges and lash base with your fingertips using a mild soap, like baby shampoo. Rinse well after.
Regular eyelid care—sometimes called lid scrubs—can also help with eye fatigue and lower the chance of blocked glands, especially in dry or windy weather.
Complementary Approaches
Some people find alternative therapies help with dry eye symptoms. Omega-3 fatty acids—from foods like flaxseed and fish, or as supplements—may support eye moisture.
Castor oil eye drops can slow tear evaporation and keep eyes comfy. A few people even feel better after trying acupuncture.
| Alternative Method | Potential Benefit |
|---|---|
| Omega-3 fatty acids | Supports eye moisture |
| Castor oil eye drops | Reduces tear evaporation |
| Acupuncture | May ease symptoms for some people |
Before starting anything new, talk with an eye care specialist about what’s safe and what could actually help.
Getting Ready for Your Visit
Steps You Can Take Beforehand
A little prep before your eye appointment can go a long way. It helps to:
Jot down any eye problems—even the small stuff, like itching, burning, or that gritty feeling.
Note big life changes—stress, new illnesses, or sleep changes.
Make a list of everything you take: meds, vitamins, supplements—bring it along for your doctor to review.
- Prepare questions. This way, you won’t forget something important. Here are a few to get you started:
Example Questions for Your Eye Doctor- What could be causing my dry eyes?
- Will I need any special eye tests?
- Can my eyes get better without treatment?
- What treatments are available and what risks do they have?
- How can I manage my dry eyes if I also have other health problems?
- Are there generic (cheaper) medicine options for what you recommend?
- Is another visit needed?
A notebook comes in handy for jotting down answers and new questions.
Questions and Information Your Eye Specialist May Discuss
At your visit, the doctor will want to know what’s really going on. Expect questions like:
- What symptoms have you noticed, and how long have they lasted?
- Do symptoms happen every day, or do they come and go?
- Any family history of dry eyes or similar issues?
- Have you tried over-the-counter drops? Did they help?
- Are symptoms worse at certain times—morning, night?
- Do you take any medicines regularly?
- Ever had treatments like radiation near your head or neck?
The doctor might also ask about your environment—how much you use screens, if your home is dry, things like that. Be as honest as you can, since it helps them find the right tests and treatments.
Simple Actions Until Your Visit
While you wait for your appointment, you can take a few steps to feel better:
- Try nonprescription lubricating eye drops (artificial tears). They’re easy to find and can help a lot.
- Skip redness-reducing drops—they can make things worse in the long run.
- Rest your eyes often, especially if you’re staring at screens. The 20-20-20 rule helps: every 20 minutes, look at something 20 feet away for 20 seconds.
- Stay out of smoky or windy places if you can—they’ll dry your eyes out even more.
- Drink enough water and use a humidifier if your home feels dry.
- Wear sunglasses outside to block wind and sunlight.
If your eyes start to hurt or your vision changes suddenly, contact your eye care professional right away—even before your appointment.
Doing these things can make your eyes feel better and help you get more out of your visit. Go in prepared, and take care of your eyes at home until you see the doctor.
