Dry eyes happen when your tears can’t adequately lubricate the surface of your eyes, either because you’re not producing enough tears or because your tears evaporate too quickly. It’s one of the most common eye conditions worldwide, affecting roughly 1 in 11 people. Symptoms range from mild irritation to persistent discomfort that interferes with reading, driving, and screen use.
How Your Tear Film Works
Your tears aren’t just saltwater. They form a three-layered film across the surface of your eye, and each layer plays a distinct role. The innermost layer is a mucus coating produced by cells in the clear tissue covering your eye. This mucus anchors the watery layer above it to the eye’s surface, creating a smooth, even spread of moisture. Without it, tears would bead up and slide off.
The middle layer is the thickest. It’s a watery solution packed with proteins, salts, glucose, and oxygen that nourishes the eye’s surface, flushes debris, and fights off infection. On top of that sits a thin oily layer produced by tiny glands along the edge of your eyelids called meibomian glands. This oil slows evaporation, keeping the watery layer intact between blinks. When any of these three layers breaks down, dry eye symptoms follow.
The Two Types of Dry Eye
Dry eye falls into two main categories, and knowing which type you have matters because the treatments differ.
Evaporative dry eye is by far the more common form, responsible for over 85% of cases. It happens when the oily layer is deficient, usually because the meibomian glands along your eyelid margins become clogged or dysfunctional. Without enough oil on the tear surface, your tears evaporate faster than they should.
Aqueous-deficient dry eye accounts for only about 10% of cases. Here, the lacrimal glands above each eye simply don’t produce enough of the watery layer. This type is sometimes linked to autoimmune conditions like Sjögren’s syndrome, where the immune system attacks moisture-producing glands throughout the body. It can also occur without any underlying autoimmune cause.
What Dry Eyes Feel Like
The name is a bit misleading. Dry eyes don’t always feel “dry.” Common symptoms include a gritty or sandy sensation, stinging or burning, redness, blurred vision that clears temporarily when you blink, and a feeling like something is stuck in your eye. Paradoxically, some people with dry eye experience excessive tearing. This happens because the irritated eye surface triggers a reflex flood of watery tears that lack the proper oil and mucus balance to stay put.
Symptoms tend to worsen in certain environments: air-conditioned rooms, airplane cabins, windy days, or after long stretches of focused visual work like reading or using a computer.
Who Gets Dry Eyes
Global estimates put the symptomatic prevalence at about 9%, with women affected more often than men (roughly 9.5% vs. 6.8%). Hormonal shifts during menopause are a major driver of that gap. Prevalence is lowest around age 40 to 50, then climbs roughly linearly with each decade after that. But dry eye is increasingly showing up in younger people too, largely driven by screen habits.
Common Causes and Risk Factors
Screen use is one of the biggest modern contributors. Your normal blink rate is around 18 to 22 times per minute, but during focused computer or phone use, that can drop to as few as 3 to 7 blinks per minute. Each blink refreshes your tear film, so fewer blinks means faster evaporation and more surface exposure.
Several categories of medication can cause or worsen dry eyes. Antihistamines, antidepressants, and blood pressure medications are among the most common culprits. Isotretinoin, a strong acne medication, can shrink oil-producing glands throughout the body, including the meibomian glands in the eyelids. Certain cancer treatments, particularly chemotherapy drugs in the taxane family, can trigger meibomian gland dysfunction. Aromatase inhibitors used in breast cancer treatment cause eye irritation in up to 29% of patients. If your dry eye symptoms started around the same time as a new medication, that connection is worth exploring with your prescriber.
Other risk factors include contact lens wear, previous eye surgery (especially LASIK, which temporarily disrupts the corneal nerves that signal tear production), low indoor humidity, and autoimmune conditions.
Over-the-Counter Artificial Tears
For mild dry eye, artificial tears are the first line of relief. They come in two main formats: multi-dose bottles with preservatives and preservative-free single-use vials. If you use drops more than a few times a day, preservative-free versions are worth the extra cost. The preservatives in multi-dose bottles can irritate already-sensitive eyes with frequent use, potentially making symptoms worse over time.
Thicker gel drops and ointments last longer on the eye surface but can blur your vision temporarily, so they’re best used at bedtime. Thinner drops are better for daytime use. You may need to try a few brands to find what feels best, since formulations vary in how well they address the oily versus watery components of the tear film.
Prescription Treatments
When over-the-counter drops aren’t enough, prescription options target the underlying inflammation that drives chronic dry eye. The two most widely prescribed treatments both work by calming the immune activity on the eye’s surface, but through different pathways.
One approach blocks the activation of immune cells that sustain inflammation on the eye surface. The other inhibits the release of inflammatory signaling molecules from those same cells. Both are used as twice-daily eye drops, and both typically take several weeks to show their full effect. Burning or stinging on application is common early on and usually improves with continued use.
Procedures for Persistent Dry Eye
For dry eye that doesn’t respond well to drops alone, two in-office procedures are commonly used.
Punctal plugs are tiny devices inserted into the tear drainage openings at the inner corners of your eyelids. By blocking the channels that normally drain tears into the nose, they keep more of your natural tears on the eye surface longer. They also help any lubricating drops you use last longer. The insertion takes seconds and is generally painless. Plugs can be temporary (dissolving over weeks to months) or semi-permanent (silicone, removable if needed).
Intense pulsed light therapy targets the root cause of evaporative dry eye. The light energy heats the eyelids gently, helping to unclog blocked meibomian glands and restore normal oil flow. It also reduces inflammation by closing off small abnormal blood vessels along the eyelid margins and lowering the bacterial and mite load on the lids. A typical course involves three to four sessions spaced a few weeks apart.
Everyday Habits That Help
Keeping indoor humidity at 45% or higher reduces tear evaporation noticeably, especially during winter when heating systems dry the air. A simple hygrometer can tell you where you stand, and a humidifier in your bedroom or workspace can close the gap.
During screen work, the 20-20-20 rule helps compensate for reduced blinking: every 20 minutes, look at something 20 feet away for 20 seconds. Consciously blinking fully (not the partial blinks that tend to happen during concentration) also makes a difference. Positioning your monitor slightly below eye level so you’re looking slightly downward reduces the exposed surface area of your eye, slowing evaporation compared to looking straight ahead or upward at a screen.
Wraparound sunglasses or moisture-chamber glasses block wind and reduce evaporation outdoors. Omega-3 fatty acids from fish, flaxseed, or supplements may support meibomian gland function, though the evidence is mixed. Warm compresses held against closed eyelids for 5 to 10 minutes soften hardened oils in the meibomian glands, making them easier to express with gentle lid massage afterward. This is especially helpful if your dry eye is the evaporative type.