Do I have dry eye?
This page is meant for you if:
- You are experiencing dry eye symptoms but have not been to a doctor yet
- You are at risk for dry eye and wondering what preventive steps you can take
What is dry eye like?
Dry eye has a lot of different possible symptoms, and each person may experience it a little differently. For some people the main symptom is watery eyes. For others, tired eyes and blurry vision but without needing a prescription change. For others, grittiness or feeling like they have something in their eye. Some people become very sensitive to light. Some have a feeling of burning, others a sort of exposed feeling that could be called a menthol sensation. Some people experience dry eye as the inability to wear contacts. Some feel like their lids always feel heavy. Some people experience dry eye only at certain times of the day or only at night.
Dry eye symptoms overlap with other things, such as ocular allergies. And many people have both dry eye and ocular allergies. Further complicating this picture, eye drops to treat ocular allergies are drying. Bit of a catch-22.
Who gets dry eye?
It's a pretty long list. The majority are older women, though many younger people are getting dry eye now too. Asians get dry eye more than Caucasians. Contact lens wearers and computer users are high on the list too, as well as people with environmental stressors like low humidity, high pollution or "sick building syndrome". Then there are people with auto-immune diseases and connective tissue disorders. There is an almost incredibly long list of drugs that can cause or exacerbate dry eye, as well as surgeries and medical procedures, including many elective ones such as LASIK, cosmetic lid surgeries and even Botox (which, confusingly, is also occasionally used to treat some kinds of dry eye).
How can I find out if I have dry eye?
You can't simply answer a few questions online and get an accurate answer, because there are many other things with overlapping symptoms. You need to be examined by a qualified eye doctor. Even then, you stand a strong chance of simply being lumped into a category and handed some cookie cutter treatments. (This, despite the fact that dry eye symptoms are the most common reason people visit an eye doctor.) We strongly advise learning more about dry eye even before your first doctor appointment. But the internet is no substitute for an actual examination.
What kind of eye doctor should I see?
You can see an optometrist or ophthalmologist. In many situations, the optometrist can manage your care long term. In some situations, they will need to refer you to an ophthalmologist (preferably a corneal specialist, because that is the subspecialty that gets the most training in corneal diseases, which is what dry eye is).
My eyes are always dripping, but my doctor says I have dry eye. How can that be?
It's because there are two types of tears: constant tears, and reflex tears. If you don't have enough constant tears or they are poor quality, your eyes will feel irritated, and that irritation triggers reflex ("emergency") tears in exactly the same way that getting grit in your eye triggers tearing. It seems counterintuitive that drippy eyes can be dry, but it's true. There are, of course, other possible reasons for drippy eyes, like blocked tear drains, so again, a thorough examination is important.
What kind of eye drops can I use?
If you are purchasing over-the-counter eye drops without a doctor's guidance, it's important to know that there are, unfortunately, MANY drops on the shelves that can make dry eyes worse. Don't expect them to be labeled in such a way that you could easily figure that out just by reading: they aren't!
AVOID these over-the-counter drops:
- Decongestants ("redness reliever" drops with vasoconstrictors), even if they also contain lubricants. If you use them, use them sparingly, on special occasions. Daily use of these drops will harm your eyes. They have a well known "rebound redness" effect, where your eyes get even more red with continued use. In addition, most of them contain a highly toxic preservative known to cause dry eye.
- Any drops containing benzalkonium chloride (look for this in the Inactive Ingredients list). It is a highly toxic preservative known to cause dry eye. Most allergy (antihistamine) and decongestant drops contain this preservative.
- Any drops in a bottle, because the vast majority of bottled drops contain preservatives. If you purchase them for convenience or cost reasons, don't use them frequently if you can help it.
Choose instead these drops:
- Preservative free lubricant eye drops. How will you know? The vast majority are in little single-use vials, not bottles. All preservative-free drops say "preservative-free" on the label.
What if I don't want to use drops?
If you have mild dry eye symptoms and want to avoid using drops, you may be able to minimize the need for them by strategies such as these:
- Wear wraparound sunglasses as much as possible (to reduce irritation from wind and increase moisture around the eyes)
- Pay attention to relative humidity, and use a humidifier indoors if possible
- Use a sleep mask at night
- Exercise good eyelid maintenance case (daily gentle cleaning and a 5 minute warm compress)
If you are avoiding going to the eye doctor because you figure they will want to prescribe something that you will not want to use, fair enough, but... go anyway. If there's something wrong, you need to know what it is. There's a wide range of treatment options, and many are natural. Educate yourself and speak up for yourself about your treatment preferences.
Can I still wear contact lenses if I have dry eye?
Many people do. Be mindful though of the following:
- Long term contact lens wear is associated with dry eye.
- A dry eye is a vulnerable eye. Dry eye needs to be addressed, whether or not you choose to continue contact lens wear.
- For some people, dry eye means they can't tolerate contacts, but for some others, their contacts actually seem to insulate them from the sensations of dry eye - that is, they're happier and more comfortable with their contacts in. If that describes you, you really ought to get a full dry eye workup, so that you're not inadvertently making your eyes worse with something that makes them temporarily feel better.
- Not all contact lenses are equal. Seek out dry eye friendly contacts. If you've maxed out your tolerance of soft lenses, talk to your lens provider about scleral lenses. Sclerals are extra large gas permeable lenses that don't touch the cornea (sensitive part of the eye) but instead hold fluid over the cornea, keeping it wet all day.
Is there anything I can do to prevent dry eye?
Yes! There are lots of things you can do to lower your risk and maintain good "tear system" health:
- Make sure you're getting plenty of Omega 3s.
- Follow a simple, brief eyelid care regimen consisting of cleansing the lids with a gentle cleanser (not soap, and not baby shampoo), followed by a 5 minute warm compress.
- Avoid eye drops that can cause or worsen dry eye. Don't use over-the-counter drops in bottles, period, if you can help it, as they almost all have toxic preservatives.
- Be mindful of drugs that can cause or worsen dry eye.
- Avoid elective procedures associated with dry eye.
- Get specialist care quickly if you suspect you have dry eye, so that you can get on an appropriate treatment sooner rather than later. Many people with dry eye look back and see that their initial diagnosis and treatment wasn't quite right.
How can I learn more about dry eye?
- If you're really serious about wanting to know more, try Dry Eye 101.
- If you just want to quickly skim the surface, try Dry Eye FAQ.