Dry Eye: Symptoms, Treatment, Prevention

BY AMY CAMPBELL, MS, RD, LDN, CDCES | DECEMBER 29, 2022

Diabetes is a condition that can affect the eyes. Some eye problems, such as diabetic retinopathy and macular edema, are well-known complications of diabetes. Dry eye is another eye condition that is common in people who have diabetes, although it’s not always discussed. The American Diabetes Association (ADA) shares that, based on research, 54% of people with diabetes have dry eye. Could you have dry eye? Read on to learn what it is, what the symptoms are, and what you can do to get relief.

What is dry eye?

Dry eye is a condition that affects millions of people in the United States every year. It’s also known as dry eye syndrome (DES), dry eye disease, or keratoconjunctivitis sicca. According to the National Eye Institute (NEI), “Dry eye happens when your eyes don’t make enough tears to stay wet, or when your tears don’t work correctly.” It can also involve tears not having the right consistency or evaporating too quickly. Tears are necessary to help maintain moisture on the surface of the eye and for clear vision.

With many cases of dry eye, the surface of the eye becomes inflamed; if not treated, pain, ulcers, scars, and possibly loss of some vision can occur. Fortunately, dry eye is treatable and there are a lot of things that you can do to stay comfortable. Advertisement

What are symptoms of dry eye?

Any of the following symptoms could be a sign that you have dry eye:

Stinging or burning sensation in the eye
Feeling like you have something gritty in your eye
Stringy mucus in or around your eyes
Pain in the eyes
Eye redness
Eye fatigue
Sensitivity to light
Blurry vision
Heavy eyelids
Excess tears following periods of very dry eyes
Inability to wear contact lenses

You might notice that the above symptoms occur in certain situations. For example, staring at a computer screen, sitting on an airplane, being in an air-conditioned room, or being outside on a windy day can trigger dry eye symptoms. Of course, these symptoms can be linked with other eye conditions, too. That’s why it’s important to see an eye care specialist for a proper diagnosis.

What causes dry eye?

The NEI states that normally, the glands in your eyes make tears that keep your eyes wet. Dry eye can happen when:

Your eyes don’t make enough tears
Your tears dry up too fast
Your tears don’t work well enough to keep your eyes wet

Tears are made up of three layers: fatty oils, aqueous fluid, and mucus. Certain factors can lead to problems with any one of these layers. These may include:

Age: The older we get, the drier the eyes can get. Most people over the age of 65 have some degree of dry eye.
Gender: Women are more likely to have dry eye than men due to hormonal changes.
Medications: Blood pressure medications, birth control pills, antihistamines, decongestants, and antidepressants can reduce tear production.
Medical conditions: Having diabetes, rheumatoid arthritis, lupus, and thyroid problems, along with certain eye problems, raise the risk of dry eye. Research shows that dry eye in people with diabetes is typically linked with a type of neuropathy called autonomic neuropathy; this neuropathy can affect the nerves that control tear production.
Environment: Dry, windy, or smoky climates increase dry eye risk. Staring at a computer screen all day also increases the likelihood.
Refractive surgery: Procedures such as LASIK, LASEK, and PRK can decrease tear production and lead to dry eye.

People who wear contact lenses may be prone to having dry eyes, although contact lenses don’t cause the condition.

Why are people with diabetes at risk for dry eye?

Constant high blood glucose (sugar) levels raise the risk of a number of eye problems, such as retinopathy, macular edema, glaucoma, cataracts, and dry eye. According to the ADA, diabetes affects the lacrimal glands (these glands make tears watery) as well as the oil glands (called meibomian glands) in the eyelids that prevent tears from evaporating too quickly. These problems can result from:

Not enough insulin in the body. Insulin plays a role in the function of the lacrimal glands.
High blood sugar levels that can damage nerves in the lacrimal gland and nerves in the cornea that help tears to stay on the surface of the eyes.
Inflammation that impacts the function of the lacrimal glands and impairs the flow of oils from eyelid glands that keep tears from evaporating.

How is dry eye diagnosed?

Dry eye may be diagnosed as part of a regular comprehensive eye exam. In addition, there are several kinds of tests that your eye doctor might use. One test is the Schirmer test in which strips of paper are placed under your lower eyelids; after five minutes, the amount of tears absorbed by the paper is measured.

Another test, called the tear break up time (TBUT) test may be used. This test involves the use of special dyes in eyedrops to determine how long it takes your tears to evaporate. And a tear osmolarity test can measure the composition of particles and water in your eyes.

How is dry eye treated?

Dry eye can be treated in a number of ways, although it can’t be cured. You may need to try one or more types of treatment to find relief. It’s important to realize that dry eye can be an ongoing condition. And the type of treatment that’s prescribed will depend on the severity of your symptoms, as well as the cause. Treatment options may include:

Prescription eye drops

These medicines help your eyes make more tears.

Cyclosporine (brand name Restasis)
Lifitegrast (Xiidra)

Over-the-counter eye drops

These eyedrops help make your eyes feel better. A few examples are:

Olopatadine (Pataday)
Ketotifen (Alaway, Zatidor)
Naphazoline/glycerin (Clear Eyes)

You can also use eye moisturizing gels and ointments for relief.

Procedures

Punctal plugs: Your eye doctor may recommend plugging the drainage holes at the inner corners of your eyelids with punctal plugs. These are made of materials such as silicone or collagen and may be temporary or permanent.
Punctal cautery: This is a surgical procedure that permanently closes the drainage holes.
LipiFlow: LipiFow is a technology that applies heat and pressure on the eyelids to unclog blocked glands.

Self-care

You can help your eyes feel better by trying the following:

Applying warm compresses on the eyes
Cleaning the eyelids to remove debris and oil and to help the glands in your eyelids function properly
Massaging the eyelids
Blinking regularly when at the computer and when reading
Wearing sunglasses when outdoors
Using a humidifier at home and at work
Limiting time spent in the wind, in air-conditioning, and in smoky rooms
Limiting screen time and taking breaks from staring at your screens for too long
Keeping your blood sugars in your target range as often as possible

Nutrition

Omega-3 fatty acids: Some studies show that increasing your intake of omega-3 fatty acids can help with dry eye management. The best sources of omega-3s are fatty fish (salmon, tuna, mackerel, herring). Or speak with your doctor or dietitian about taking an omega-3 fatty acid supplement in the form of fish oil or flaxseed oil.
Fluids: To prevent dehydration, drink plenty (roughly 8 to 10 glasses each day) of noncaloric fluids during the day, such as water, seltzer water, or unsweetened ice tea.
Eat a nutritious diet: While more research is needed, there may be some basis for increasing your intake of potassium, vitamin A, zinc, and B vitamins to help with eye health. Do this by eating a variety of fruits, vegetables, whole grains, nuts, and seeds.

You might also consider getting acupuncture to help with dry eye but discuss this with your eye doctor first.

Dry eye is an uncomfortable, chronic condition that can affect the quality of your life if it’s not treated. However, there are treatments available. Be patient and work with your eye care specialist to find the approach that works best for you.