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Symptoms, Causes, and Treatment for Severe Dry Eye Syndrome

Updated on April 26, 2016
Daughter Of Maat profile image

Melissa Flagg is an ophthalmic technician with over 20 years of experience working with patients in the eye care field.

The eye can become extremely red due to irritation in DES.
The eye can become extremely red due to irritation in DES. | Source

About the Author

Melissa Flagg is an ophthalmic technician and has been examining patients on a daily basis for over 20 years.

She has had rigorous training under the supervision of an ophthalmologist and specialized in the cornea, cataracts, and retina as well as how systemic disease effects the eye. She has been certified by JCAHPO as a Certified Ophthalmic Assistant.

Itching, watering/tearing, burning, redness, blurry or cloudy vision, foreign body sensation (like a lash under the lids) and light sensitivity are all symptoms of a common condition known as Dry Eye Syndrome.

It affects just about everyone at some point in their lives. Many people suffer this syndrome chronically, leading to the inability to perform day to day activities and functions. It can be very uncomfortable and, if left untreated, can lead to scar tissue that causes permanent vision loss.


Chronic dryness is also known by the medical term keratoconjunctivitis sicca. This term can be deceiving to patients since conjunctivitis is also the medical term for pink eye, which is viral conjunctivitis.

Keratoconjunctivitis specifically refers to the cornea. The prefix kerato in Latin means cornea. Keratoconjunctivitis sicca is a Latin term and literally means dry inflammation of the cornea and conjunctiva. Before we get into the chronic version of the disorder, let’s take a look at intermittent dry eyes and its causes.

Intermittent or Evaporative Dry Eyes

The intermittent version of the disorder, also called evaporative dry eyes, can be caused by a number of different things. The most common complaint is irritation when reading or working on a computer. What most people don’t know is that this is completely normal.

When working on a computer, or reading for long periods of time, we don’t blink as much as we would normally. Blinking rehydrates the cornea with a fresh layer of tears. Because we’re concentrating when doing tasks up close, such as reading, we blink less and the tear film on the cornea evaporates more quickly. This can cause irritation such as a foreign body sensation (a sandy feeling), redness, burning, itching, scratching, cloudy vision and even light sensitivity (photophobia).

To prevent the cornea from drying out, artificial tears can be used periodically. These “fake tears” won’t evaporate as quickly as your own tears even if you don’t blink frequently. Taking breaks from reading or computer work at least every 45 minutes to an hour, and focusing on something in the distance or simply walking around for ten or twenty minutes will refresh the tear film.

Chronic Dry Eye Syndrome

Chronic, or severe dryness, is another story entirely. This syndrome, sometimes abbreviated as DES, is usually caused by one of the following:

  • The Aging Process
  • Meibomian Gland Dysfunction and Blepharitis
  • Prolonged Contact Lens Wear (Corneal Desensitization)
  • Autoimmune Disease (Evaporative Dry Eye Syndrome)
  • Surgery
  • Medications

Let’s look at each cause individually.

The Aging Process

As we age, the lipid layer of the tear film becomes depleted. This layer's primary job is to keep the tear film from evaporating rapidly. Normal evaporation time should be over ten seconds; anything lower can be considered a symptom of dry eye.

This rapid evaporation can lead to chronic irritation, burning, itching and over production of tears (called epiphora). Epiphora is the body’s way of compensating for the rapid evaporation and it can cause tears to constantly stream down the face if the dryness is extremely severe.

A Stye

Both blepharitis and meibomian gland dysfunction can lead to styes and hordeolums.
Both blepharitis and meibomian gland dysfunction can lead to styes and hordeolums. | Source

Meibomian Gland Dysfunction (MGD) and Blepharitis

Meibomian glands, or tarsal glands, are oil secreting glands that are located in the tarsal plate of the eyelid.

These glands secrete meibum a substance rich in lipids (fats) and about 90 different proteins in the meibum secreted. It forms the lipid layer of the tear film, which protects the tears from evaporating.

These glands can be afflicted with chronic blockages, or the meibum can become thickened and no longer secreted easily. When the meibomian glands cease to function properly, the tear film evaporates causing the symptoms typically associated with dryness.

Blepharitis is a common yet annoying condition. It can be described as dandruff of the lids. The skin around the lashes becomes scaly and starts to flake. If left untreated, the debris can clog the meibomian glands causing MGD and dryness. Blepharitis is typically a chronic disease that needs to be treated daily, but can be easily controlled.

Corneal Desensitization Caused by Prolonged Contact Lens Wear

Contact lenses are a phenomenal invention. They allow many people with difficult prescriptions to be able to see without glasses. However, wearing contact lenses for prolonged periods, even if you take them out nightly, leads to corneal desensitization.

Once the cornea has become desensitized, it can no longer prompt the eye for tears, and allows the eye to dry out. This can cause the contact lens wearer to be unable to continue wearing lenses altogether or drastically reduce the length of time they can wear the lenses comfortably. There is treatment for this, which can allow the patient to keep wearing contacts for years to come.

How to Cure Chronic Dry Eyes

Autoimmune Disease

Inadequate tear production or a depleted lipid layer can be the result of autoimmune diseases such as Sjogren’s syndrome, lupus, rheumatoid arthritis, or Wegener’s granulomatosis. In these diseases, the immune system attacks normal, healthy cells and tissue causing inflammation and damage.

In the case of Sjogren’s syndrome, the exocrine glands that produce tears and saliva are attacked by the immune system and destroyed. This prevents the eye from producing enough tears to keep the eye moist and clean.

The tear film not only hydrates the cornea, with each blink it also flushes out microbes and other debris from the eye. When the tear film is not sufficient to keep the eye moist, it also can’t keep the eye clean, which can lead to chronic infections and eventually permanent vision loss.

Even metabolic diseases can cause dry eye syndrome. Conditions such as diabetes can upset the delicate balance of the tear film. The medications for these diseases also cause dryness. Many, like Glucophage (metformin), can even cause dehydration because of the frequent urination they cause.

Cataract and Refractive Surgeries

Whenever surgery is performed on the eye, whether it is cataract, LASIK or even retinal surgeries like pars plana vitrectomy surgery, the eye will become dryer after the procedure than it was before. This is because most eye surgeries affect the cornea in some way causing it to become desensitized and unable to tell the eye it needs tears.

Normally, this isn’t a major issue for the patient and artificial tears usually remedy the problem. There are certain instances where patients may have more severe complications after surgery that result in severe dry eye syndromes, especially if the patient already had dry eyes prior to surgery. For these patients, more aggressive treatments may be necessary to alleviate symptoms and improve quality of life.

Prescription and Over the Counter Medications

Last, but not least, medications. There are many pharmaceuticals on the market today that can dry out the eyes. Specifically, narcotics pain medications are notorious for drying out the eyes and the mouth as well.

Several narcotic pain and anxiety medications have a reputation for this drying effect including:

  • Vicodin (hydrocodone)
  • Percocet (oxycodone)
  • Valium (diazepam)
  • Xanax (alprazolam)
  • Ultram (tramadol)

Many hypertensive medications and antidepressants also have this effect. Depending on the dosage of the medication, artificial tears should suffice, unless large amounts of painkillers or other narcotics are being taken. These cases may need further therapy to alleviate symptoms.

Treatment Options

There are many treatments available for DES. Artificial tears are the first line of defense for DES, especially for dryness caused by reading and computer or other near work.

I typically recommend that patients use artificial tears about ten minutes before they start reading or working on the computer. This hydrates the cornea, and since artificial tears last longer than our own tears, the eyes stay moist longer.

I also recommend that my patients use artificial tears four times a day minimum if they have any trouble with DES. I suffer the condition myself and in the mornings, upon waking, my eyes feel like sandpaper. I keep a bottle of Refresh tears on my night stand, and as I before I get up I put a couple drops in, and I’m back to normal.

For many people with this syndrome, the symptoms are worse in the morning. This is because most of us don’t close our eyes completely when we sleep, which allows the cornea to dry out.

This is exacerbated by ceiling fans overhead and air conditioning vents pointed at or over your bed. If you absolutely must have a ceiling fan on when you sleep, instilling an ointment prior to retiring for the night will keep the moisture from evaporating. However, in the morning when you awake, your vision will be very cloudy and you’ll need to rinse them to clear the vision. Use artificial tears to rinse the eyes, not water.

Where Do Punctal Plugs Go?

Punctal plugs fit inside the puncta and prevent tears from escaping the eye too quickly.
Punctal plugs fit inside the puncta and prevent tears from escaping the eye too quickly. | Source

Punctal Plugs

The next most common treatment for DES is punctal plugs. These tiny plugs are inserted into the puncta (the opening into which the tears drain) to keep the tears in the eye longer. Plugs are a great option for those who have moderate to severe dry eyes.

There can be problems with punctal plugs, however. Some patients can be allergic to the materials in the plugs, which is usually collagen or silicone. Allergies can be managed with antihistamine drops such as Zaditor or Pataday, or the plugs can be removed.

Infections can also occur, which typically resolve with antibiotics. In the case of chronic infections the punctal plugs should be removed.

The puncta can also be cauterized (burned) shut. Punctal plugs can be removed, but once the puncta is cauterized, it’s permanent. This is usually the last resort for dry eyes that don’t respond to drops, or plugs since it is a bit drastic. It works quite well however, and can be an option for those who had allergic reactions or infections from typical punctal plugs.

Lid Scrubs

Ocusoft makes an excellent medicated pad for scrubbing the lids. They're easy to use as well, just wet and scrub!
Ocusoft makes an excellent medicated pad for scrubbing the lids. They're easy to use as well, just wet and scrub! | Source

Treatments for MGD and Blepharitis

For meibomian gland dysfunction, or MGD, a warm compress is placed on the eyes for about 15 to 20 minutes twice a day and artificial tears are used for comfort.

Lid scrubs and topical ointments (such as Maxitrol) are given in cases of chronic inflammation and blockages. On occasion, when nothing else works, doctors will prescribe oral antibiotic treatment along with the other treatments listed previously.

Blepharitis is treated easily with lid scrubs twice a day. Scrubbing the lids with a commercially available medicated pad found at any drugstore can keep symptoms under control.

A washcloth and baby shampoo can also be used to scrub the lids and alleviate symptoms. Warm compresses can help keep MGD from causing styes to form on the eyelid.

Some cases of blepharitis don’t respond to the lid scrubs in which case antibiotic ointments applied to the lids twice a day is usually the preferred treatment. Maxitrol ointment is a common treatment for blepharitis and is usually given in combination with lid scrubs and warm compresses.

Restasis is an ophthalmic emulsion drop that suppresses the immune system.
Restasis is an ophthalmic emulsion drop that suppresses the immune system. | Source

Autoimmune Disease and Immunosuppresants

In cases of autoimmune disease and DES that results from medications, only one treatment has proven effective for patients who have tried everything else.

Restasis, or cyclosporine, is an ophthalmic emulsion drop that suppresses the immune system and prevents further destruction of the tear film. In the majority of patients, Restasis is given with Lotemax or Alrex for the first month due to the stinging sensation initially felt when the drop is instilled.

After about six months to a year of continual use twice a day, most patients notice a dramatic decrease in their symptoms. For those whose symptoms are caused by the medications they take, Restasis is an excellent option if the medication cannot be discontinued.

How to Prevent Dry Eye Syndrome

I get this question quite a bit. Unfortunately, there isn’t a whole lot you can do to prevent severe dry eye syndrome, especially if it is caused by an underlying autoimmune disease that has yet to manifest.

Taking vitamins fortified with Omega 3-6-9 compounds, or drinking fluids fortified with these compounds (like hemp protein in almond milk) can help keep the tear film in good health.

Scrubbing the lids with either lid scrubs or baby shampoo and a wash cloth can help prevent MGD and blepharitis.

Managing environmental elements like ceiling fans and air conditioners can help prevent symptoms. When driving with the air conditioner on, point the vents down toward the floor, not directly at you or up at the windshield.

Pointing the vents directly toward you is self-explanatory; the air goes directly toward the face. When the vents are pointed up toward the windshield, the air bounces of the windshield and right into your eyes.

Taking breaks when working on a computer or reading is essential in preventing dry eye symptoms. I typically recommend breaks every 45 minutes to my patients who use a computer for long periods of time or who are voracious readers for at least 10 minutes to rest the eyes. Keeping rewetting drops nearby is also a good idea.

Leafy green veggies are jam packed with antioxidants and vitamins that protect the eyes.
Leafy green veggies are jam packed with antioxidants and vitamins that protect the eyes. | Source

One of the most important things a person can do to keep the eyes healthy is to wear sunglasses anytime you are outside.

Even if it’s a cloudy day, there are still dangerous UV rays that can damage the delicate tissues in the eye. ALWAYS wear sunglasses even if you think you don’t need to due to rain or cloudy weather.

Last but not least, eat a diet rich in leafy green vegetables, fruits, nuts and omega fatty acids. A healthy diet will prevent free radicals from causing permanent damage and keep your eyes healthy long into old age.

© Copyright 2012 - 2015 by Melissa Flagg (aka: Daughter of Maat) ALL RIGHTS RESERVED


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    • ytsenoh profile image

      Cathy 5 years ago from Louisiana, Idaho, Kauai, Nebraska, South Dakota, Missouri

      Hello Daughter of Maat. First, thumbs up. This was an excellent hub providing a generous amount of information that's really meaningful. Since I'm at a computer a lot, I have to use eyedrops. And I also wear glasses. Well written and organized hub. Thanks much.

    • phoenix2327 profile image

      Zulma Burgos-Dudgeon 5 years ago from United Kingdom

      Another outstanding hub. Voted up, useful, awesome and interesting. Well done.

    • Daughter Of Maat profile image

      Melissa Flagg 4 years ago from Rural Central Florida

      Oh that sounds really cool! I could definitely ue that little program since the majority of my day is spent on the computer! I'll have to look into it. It's a brilliant idea, too bad we didn't think of it! :D

    • rahul0324 profile image

      Jessee R 4 years ago from Gurgaon, India

      Very useful read... I suffer temporarily from dry eyes and itching and I found this write very helping

      Up! and shared :)

    • Daughter Of Maat profile image

      Melissa Flagg 4 years ago from Rural Central Florida

      How old are you rahul? I'm going on the fact that you look young in your profile pick, so... even temporary dry eyes can signal an autoimmune disease. If you're in your 20's, even staring at a computer for 8 hours shouldn't cause dry eyes. Mild symptoms maybe, but it depends on how mild they are. I only say this because many patients with lupus, or Sjogren's syndrome (as examples) or other autoimmune disease aren't typically diagnosed until their late 30's early 40's and by then damage has already been done. Keep an eye on it (no pun intended) and notice if the symptoms have a pattern. I had dry eyes in my 20's and it was chalked up to being a contact lens wearer, but it was caused by osteoarthritis. Just a thought. Thanks again for your comments and thanks for sharing! Always appreciated.

    • Shyron E Shenko profile image

      Shyron E Shenko 4 years ago

      Daughter of Maat, I read your comment on diogenes hub and, as I have had cataracts in both eyes, you sounded interesting and I was right.

      I have the multifocal intracular lenses (i.e. ReSTOR lens implant) they are awesome, I do have a problem with dry eye, but my doctor is adressing the problem.

      I do hope you go back to school ASAP.

    • Daughter Of Maat profile image

      Melissa Flagg 4 years ago from Rural Central Florida

      Thanks Shyron! I'm working on it. Trying to fit it in my already hectic schedule is now my main issue.

      I'm glad your happy with your ReSTOR lens. Do you have any problems with glare at night? I know quite a few patients complained of glare, and I was wondering if they had upgraded the lens to fix the problem.

      Thanks for reading and commenting!! :D

    • profile image

      MattP1986 2 years ago

      Interesting article! I'm in my late twenties and have been a lot more eye conscious ever since my first (and so far, 'only') flare up of Iritis a few months ago in my left eye. But I noticed that even when the Iritis was clearing up, I would still get these very mild pains in either eye (but mostly my left one).

      Two eye doctors couldn't see anything wrong with them, and I was later cleared from the Iritis.

      I saw an optician the other week and he said I have healthy eyes too (but prescribed glasses for astigmatism) but I didn't mention anything about any pains as I'd not had any for a while. I'd used dry eye drops a week or so prior to this, so perhaps that's why.

      But lately I've been getting these really mild pains every now and then and have been told (online) that it may be due to dry eyes.

      I use a computer a lot for work, and have recently started wearing my new glasses. I've bought some eye drops for dry eyes which I think help my symptoms a bit, which I now use 3 times daily.

      I only really notice it when I've been using the computer a lot. My eyes sometimes feel irritated / itchy. Occasionally I have a foreign body sensation, and I sometimes get a mild pain or subtle 'pulling' feeling. As well as occasional mild headaches.

      Sometimes I may notice it a little in the morning when I wake up, which seems strange as I wouldn't have been on the computer for a good 10-12 hours.

      Does this sound normal? This has been going on for a couple months so hopefully it's nothing to worry about

    • Daughter Of Maat profile image

      Melissa Flagg 2 years ago from Rural Central Florida

      The pains you are describing do sound a lot like dry eyes, especially if you are waking up with it in the morning. Most of us actually sleep with our eyes slightly open, which means air can easily get in and dry out the cornea. This is exacerbated by a fan in the room or air conditioning vent over the bed. But since you've also had a bout with iritis, I would suggest having your doctor order blood tests to look for an autoimmune disease such as Sjogren's or rheumatoid arthritis, possibly even lupus. Iritis is typically the result of an autoimmune disorder. I would also recommend taking vitamin C 1,000mg four times a day, this can help reset your immune system if there is an autoimmune disorder. The subtle pulling sensation and mild headaches are usually the result of an inadequate prescription, so you may also want to have that double checked. Hope that helps, and so sorry for the delay in responding, I had a family emergency to deal with.

    • profile image

      MattP1986 2 years ago

      thanks for the response and no worries about the delay! I went back to the hospital shortly after posting that and thankfully it just turned out to be dry eyes after all.

      I got prescribed some eye lubricants for a month and they seemed to do the trick, no more pains ever since.

      I had my bloods tested not long after I was diagnosed with Iritis and they came back normal, although I did test positive for HLA-B27.

      Apparently Spondylitis cannot be picked up with a bloodtest though? I don't have any lower back problems (yet) but my auntie does have Spondylitis

    • Reema Saini profile image

      Reema Saini 2 years ago from India

      Very interesting article indeed. gud work

    • RandaHandler profile image

      Randa Awn Handler 13 months ago from USA

      Thanks for all the research that went into this article. Good to remember to take breaks from staring at the computer! I was worried about using the artificial tears drops but glad to see you recommend them.

    • profile image

      Liz 6 months ago

      I had my puncta cauterized two weeks ago. I was allergic to the plugs my eyes itched constantly and had plugs removed. Now that tear ducts are closed by cauterization my eyes have watered constantly. The tears flow onto my face for they have no drainage. This is driving me crazy/. I have very little vision and cant read clearly. I have Dr.visit in a week so I hope this stops. My eyes are soo sore from tearing all day long. I am lucky I was off from work-could not work in this condition which Dr did not mention.

    • profile image

      Sebastian 6 months ago

      Great article Melissa! I'm only 29 but have recently (over the past year) been suffering from eye allergies and dryness and find this very useful.

      My optometrist has done all kinds of tests and says I have healthy eyes but he recommended I get my family physician to look into testing for auto-immune diseases such as Sjorgen's! I've done my bloodwork and am now just waiting on those results! I hope it's just dry eyes and not an auto-immune condition because it sounds like that one is a lot more difficult to deal with and of course has implications beyond just eyes.

    • profile image

      Gloria 4 months ago

      I have suffered with dry eyes when waking up from sleeping for 20 years! I use miro 128 ointment. For the last year I cannot open my eyes in the morning without rubbing my eye lids until my lids can open! If I open my lids without rubbing them I suffer severe pain for about 10 minutes, I have to,d my eye doctor this & my medical doctor! They don't seem to have any answers to my problem! I also suffer from dry mouth & dry lips! I have had blood work done for sorejans (sp) & the doctor said it was negative! Does anyone else have these problems?

    • lambservant profile image

      Lori Colbo 8 days ago from Pacific Northwest

      I really appreciate the information here. Many mornings I literally can't open one or both of my lids and I have to pry them open with my fingers. As a writer I used my computer a lot so it was good to find out it can be a problem. I have tried to gel drops and I find them somewhat helpful but not consistently. My primary care doctor has a severe case herself and is pretty knowledgable but I learned a few things here. Thanks.

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