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Dry Eye Syndrome: Symptoms, Causes, Diagnosis and Treatment
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Dry eye syndrome (also dry eye disease, dry eyes; medical name keratoconjunctivitis sicca): a common, usually long-term condition in which the eyes do not make enough tears, or the tears are the wrong quality or dry out too quickly. The surface of the eye is then not kept properly wet, which causes burning, grittiness, redness and blurred vision. Dry eye is usually controlled rather than cured, with lubricating drops, eyelid care and, in more severe cases, prescription treatment from an eye specialist.
Dry eye syndrome: key facts
- What it is
- A multifactorial disease of the eye surface in which the tear film loses its balance (the 2017 TFOS DEWS II definition)
- Main types
- Aqueous-deficient (too few watery tears) and evaporative (tears evaporate too fast, often from oil-gland problems in the eyelids); the two overlap as a continuum
- How common
- Estimates range from about 7% to 34% of people, depending on how dry eye is defined
- Who is at higher risk
- People aged 50 and over, women, contact lens wearers, heavy screen users, and people with autoimmune disease such as Sjögren's syndrome
- Typical symptoms
- Stinging, burning, gritty feeling, redness, light sensitivity, blurred vision, sometimes watery eyes
- Usual outcome
- Long-term, with treatment that is typically needed over the long term; most people can control it
- Specialist
- Ophthalmologist; at Laser Istanbul Clinic, Doç. Dr. Muhammet Derda Özer (cornea), with Prof. Dr. Ahmet Satıcı and Op. Dr. Aysan Bayram for pre-laser and cataract assessment
What are tears made of, and what goes wrong in dry eye?
Tears are not just water. The tear film has three layers, and dry eye can start in any of them:
| Layer | Made by | What it does | What goes wrong |
|---|---|---|---|
| Oily (outer) layer | Meibomian glands in the eyelid edges | Slows evaporation of the tear film | Blocked or poorly working glands (meibomian gland dysfunction) let tears evaporate too fast |
| Watery (middle) layer | Lacrimal glands above the eyes | Wets and nourishes the surface | Too little watery tear is made (aqueous-deficient dry eye) |
| Mucus (inner) layer | The conjunctiva | Helps the tear stick to and spread over the cornea | Poor spreading leaves dry patches |
The US National Eye Institute describes three routes to dry eye: not enough tears made, tears evaporating too quickly, and tears of poor quality that do not keep the eye wet. In practice many people have a mix. The TFOS DEWS II international report also lists tear film instability, increased tear salt concentration (hyperosmolarity) and inflammation of the eye surface as part of the disease.
Dry eye symptoms: what do dry eyes feel like?
The most common dry eye symptoms, according to the American Academy of Ophthalmology (AAO), the NHS and the NEI, are:
- stinging or burning
- a gritty or scratchy feeling, as if something is in the eye
- red, sore or itchy eyes
- strings of mucus in or around the eyes
- sensitivity to light
- blurred vision, particularly when reading
- discomfort when wearing contact lenses
- watery eyes (the NHS lists excessive tearing as a symptom, which surprises many people: a dry, irritated eye can react by producing a flood of tears)
Symptoms usually affect both eyes and tend to be worse in wind, smoke, dry or air-conditioned air, and after long periods of reading or screen use.
Dry eye is not the same as an allergy. Eye allergy also causes red, itchy, watery eyes, and the two can occur together. If itching is your main symptom, read our guide to Glossary: Eye allergy →.
Dry eye causes and risk factors: why are my eyes dry?
Dry eye has many causes, and several often add up. The AAO, NHS and NEI list these main ones:
| Cause or risk factor | How it contributes |
|---|---|
| Age and sex | People make fewer tears as they age; risk is higher from age 50, and in women, especially after the menopause (AAO, NEI) |
| Screen use | The AAO notes that we blink only about 5 to 7 times a minute at a computer, against roughly 15 a minute normally, so the tear film dries between blinks |
| Environment | Smoke, wind, dry climates and air conditioning |
| Contact lenses | Long wear time can dry the eye surface and cause discomfort |
| Eyelid disease | Blepharitis and blocked meibomian glands reduce the oily layer; eyelids that turn in (entropion) or out (ectropion) are also listed by the AAO as causes |
| Autoimmune and general disease | Sjögren's syndrome, rheumatoid arthritis, lupus and thyroid disease. The AAO's 2023 guideline notes that about 10% of people with aqueous tear deficiency have underlying Sjögren's syndrome |
| Medicines | The AAO lists diuretics, beta-blockers, antihistamines, sleeping pills, antidepressants and some heartburn medicines |
| Eye surgery | LASIK and other laser procedures can cause dry eye (see the laser section below) |
| Diet | The NEI lists too little vitamin A or omega-3 fatty acids as a risk factor (see the omega-3 question in the FAQ) |
Eyelid position matters because the lids spread each tear across the eye. If your lids droop, turn in or turn out, the problem can be mechanical as well as a tear problem. Our eyelid and oculoplastic surgeon, Prof. Dr. Ahmet Satıcı, treats eyelid conditions.
How is dry eye diagnosed?
The AAO's 2023 clinical guideline says clinical examination is the gold standard for diagnosing dry eye, and that no single test is enough: the doctor puts the findings of several tests together. An eye specialist typically:
- Asks about your symptoms, medicines, general health and daily habits
(screens, contact lenses, workplace air).
- Examines the eyelids, how you blink and the surface of the eye
under a slit-lamp microscope.
- Measures tear quality and stability
Tear break-up time (TBUT) checks how many seconds the tear film stays intact after a blink; EyeWiki gives under 10 seconds as abnormal.
- Measures tear production
The Schirmer test uses a thin paper strip in the lower lid; EyeWiki says it is most useful for detecting severe aqueous deficiency and has limited sensitivity in mild cases.
- Checks tear concentration (osmolarity)
in some clinics. EyeWiki gives a tear osmolarity above 308 mOsm/L as indicating at least mild dry eye.
- Looks at the eyelids and oil glands
to see whether meibomian gland dysfunction or blepharitis is involved.
- Arranges blood tests when needed
, for example when Sjögren's syndrome or another autoimmune disease is suspected.
Why this matters before laser or cataract surgery: the AAO recommends evaluating and managing dry eye in all cataract and refractive surgery candidates before the operation.
Dry eye treatment: what helps?
Dry eye is usually managed step by step, starting simple. The AAO stresses that most treatments improve symptoms and signs but rarely cure the condition, so long-term treatment is typically necessary.
| Step | Treatment | What it does |
|---|---|---|
| 1. Self-care | Take regular screen breaks and look at something in the distance; position the screen below eye level; use a humidifier in dry rooms; wear wrap-around glasses in wind; avoid smoke and hair dryers; wear glasses instead of contact lenses for a while | Reduces evaporation and daily triggers (NHS, AAO) |
| 2. Eyelid care | A clean, warm washcloth over closed eyes for at least a minute, then gentle lid massage and cleaning of the lash line | Loosens blocked oil and crusts; used for blepharitis and oil-gland problems (AAO, NHS) |
| 3. Artificial tears | Over-the-counter drops, gels and ointments; the AAO advises preservative-free drops if you use them more than six times a day, and an ointment at bedtime for morning dryness | Adds moisture to the eye surface |
| 4. Prescription drops | The AAO's 2023 guideline lists FDA-approved options including cyclosporine, lifitegrast, loteprednol, varenicline nasal spray and perfluorohexyloctane. Which are available varies by country | Reduces surface inflammation or stimulates natural tear production |
| 5. Saving tears | Silicone or gel punctal plugs block the small tear drainage openings; permanent closure by surgery is also possible (AAO) | Keeps your own tears on the eye longer |
| 6. Further care | Treating the underlying eyelid disease or eyelid malposition; for resistant cases EyeWiki lists autologous serum tears, LipiFlow, TearCare and intense pulsed light therapy | For cases that do not respond to the earlier steps |
Treat the cause as well as the dryness. If medicines, blepharitis, an eyelid problem or Sjögren's syndrome is behind the dry eye, that needs dealing with too. The NHS advises not stopping prescribed medicines without medical advice, and avoiding smoking and excess alcohol.
Dry eye and laser eye surgery
Does laser eye surgery cause dry eye? Yes, for most people it does at least temporarily. The AAO says almost everyone who has LASIK will have dry eyes and changing vision during the day afterwards, and that this usually fades within a month, though for some people it lasts longer. The AAO's 2023 guideline adds that dry eye symptoms continuing beyond the normal 3-month postoperative period are seen in about one third of people.
Can you have laser surgery if you have dry eyes? It depends on how severe they are. The AAO lists severe dry eye among the conditions that rule people out of LASIK, and notes that existing dry eyes may be worse after LASIK. At Laser Istanbul Clinic, laser surgery is led by Prof. Dr. Ahmet Satıcı and Op. Dr. Aysan Bayram. If you already have dry eyes, tell them at your first consultation so it can be taken into account when choosing a method.
Cataract surgery too. The AAO recommends evaluating and managing dry eye before cataract surgery as well as before refractive surgery.
Not sure whether your dryness affects your options? Send us your prescription and scans, with a few lines about your symptoms: Free online consultation (upload prescription & scans) →
When to see a doctor about dry eyes
Same-day or emergency care (eye emergency service; in the UK, NHS 111 or A&E) if you have:
- a painful red eye, or a red eye if you wear contact lenses (take the lenses out)
- a sudden change in vision
- light sensitivity that causes pain
- severe redness with headache or nausea
- an eye injury, a chemical splash or something in the eye
Book an eye appointment if:
- symptoms last more than a few weeks despite lubricating drops and self-care (NHS)
- the drops stop working, or you need them more and more often
- dry eyes are affecting reading, work, driving or sleep
- your eyelids are changing shape, or turning in or out (NHS)
- you also have a dry mouth, joint pain or other signs of an autoimmune condition such as Sjögren's syndrome
- you are planning laser eye surgery, lens replacement or cataract surgery
Frequently asked questions
Dry eye syndrome is a long-term condition in which the eyes do not make enough tears, or the tears evaporate too quickly or are of poor quality. The eye surface is then not kept properly wet, causing burning, grittiness, redness and blurred vision.
The most common dry eye symptoms are stinging or burning, a gritty feeling, redness, light sensitivity, blurred vision, strings of mucus and discomfort with contact lenses. Watery eyes can also be a sign of dry eyes.
Common causes are ageing, long screen use, dry or windy environments, contact lenses, eyelid disease such as blepharitis, autoimmune conditions such as Sjögren's syndrome, some medicines and eye surgery. Often several causes combine.
A dry, irritated eye surface can trigger excessive tearing, which is why the NHS lists watery eyes among the symptoms of dry eyes. The eye can feel dry and sore even though tears are running down your face. An eye specialist can find out why the tear film is not working.
Usually it is controlled rather than cured. The AAO says treatments improve symptoms and signs but are rarely curative, so long-term treatment is typically necessary. Dryness caused by a temporary trigger, such as a long spell of screen work, a smoky room or dry air, may ease when the trigger is removed; persistent dry eye needs an ongoing routine and sometimes prescription treatment.
There is no single best treatment. Most people start with screen breaks, a humidifier, warm compresses and artificial tears, then move on to prescription drops, punctal plugs or other care if that is not enough. If you use drops more than six times a day, the AAO advises preservative-free ones. An eye specialist can work out which type of dry eye you have and choose treatment accordingly.
Not in the best trial so far. In the DREAM trial, published in the New England Journal of Medicine in 2018, 535 people with moderate to severe dry eye were assigned to 3,000 mg of fish-derived omega-3 daily or a placebo for 12 months; the supplement group did no better than the placebo group on symptoms, tear break-up time, corneal staining or the Schirmer test. Speak to your doctor before relying on supplements.
Yes. Blurred vision, particularly when reading, is a recognised dry eye symptom. If blurred vision comes on suddenly or does not improve, get it checked. Double vision is a different problem and needs its own assessment: see Glossary: Diplopia (double vision) →.
It depends on the severity. The AAO lists severe dry eye as a reason not to have LASIK, and warns that existing dry eyes may be worse afterwards. Dry eye symptoms are very common after laser surgery and usually settle within weeks to months. Send your scans and symptoms for review before you travel.
See a doctor if symptoms last more than a few weeks despite drops and self-care, or if they affect daily life. Seek urgent care for a painful red eye, a red eye if you wear contact lenses, a sudden change in vision, or an eye injury.
Sources for the facts on this page
- American Academy of Ophthalmology. What Is Dry Eye? https://www.aao.org/eye-health/diseases/what-is-dry-eye
- American Academy of Ophthalmology. Dry Eye Treatment. https://www.aao.org/eye-health/diseases/dry-eye-treatment
- American Academy of Ophthalmology. Dry Eye Syndrome Preferred Practice Pattern (2023). https://www.aao.org/education/preferred-practice-pattern/dry-eye-syndrome-ppp-2023
- American Academy of Ophthalmology. LASIK: Laser Eye Surgery. https://www.aao.org/eye-health/treatments/lasik
- American Academy of Ophthalmology. What Is Blepharitis? https://www.aao.org/eye-health/diseases/what-is-blepharitis
- American Academy of Ophthalmology. Computer Usage and Eye Health. https://www.aao.org/eye-health/tips-prevention/computer-usage
- NHS. Dry eyes. https://www.nhs.uk/conditions/dry-eye-syndrome/
- National Eye Institute (NIH). Dry Eye. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/dry-eye
- EyeWiki (AAO). Dry Eye Syndrome. https://eyewiki.org/Dry_Eye_Syndrome
- Craig JP et al. TFOS DEWS II Definition and Classification Report. Ocular Surface 2017. PubMed: https://pubmed.ncbi.nlm.nih.gov/28736335/
- Asbell PA et al. (DREAM Study Research Group). n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. N Engl J Med 2018. https://www.nejm.org/doi/full/10.1056/NEJMoa1709691 (PMID 29652551)
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