Dry Eyes: Symptoms, Causes, Treatment and Integrative Support

Dry eye, also called dry eye disease or dry eye syndrome, is a long-term condition of the front surface of the eye. The tear film that coats the eye becomes unstable, and the eye's surface becomes irritated and inflamed^1,2. It causes burning, grittiness, redness, watering and blurred vision that comes and goes^2,3. In a 2013 US survey, about 6.8% of adults, roughly 16.4 million people, said a doctor had diagnosed dry eye. It was more common with age and nearly twice as common in women as in men⁴. Dry eye rarely threatens sight², but it can make everyday activities such as reading difficult⁵. Chronic dry eye usually cannot be cured, and treatment is usually long term². Symptoms often improve with treatment. Removing a drying medicine or a dry, drafty environment often leads to marked improvement, and dryness after eye surgery often settles with time².

This page explains what dry eye is and its main types, the symptoms that need prompt care, and the causes and risk factors. It covers how eye doctors diagnose it and what treatment can do today, from self-care and artificial tears to prescription drops and in-office procedures. It answers whether dry eye can be cured, lists the treatments in late-stage trials, and ends with where integrative care can and cannot fit alongside your eye doctor.

Dry eye at a glance

On this page

• What is dry eye?
• Symptoms
• Causes and risk factors
• Diagnosis
• Treatment today
• Can dry eyes be cured permanently?
• New treatments in clinical trials
• Living with dry eye
• Where integrative care fits
• Outlook
• Frequently asked questions
• Sources

What is dry eye?

Each blink spreads a thin film of tears over the front of the eye, keeping its surface moist and smooth⁶. Patient guides describe three layers. The oily outer layer comes from the meibomian glands in the eyelids, the watery layer from the tear (lacrimal) glands, and mucus from the conjunctiva, the thin membrane over the white of the eye⁶. Tear-film researchers now prefer a two-layer model: a very thin oily layer over a watery, mucus-rich gel. They see the three-layer picture as a simplification¹².

In dry eye this system loses its balance. The Tear Film and Ocular Surface Society (TFOS), whose international reports set the definitions eye doctors use, updated its definition in 2025. It describes dry eye as a disease that always causes symptoms¹. Its drivers are an unstable tear film, tears that are too concentrated (too salty), inflammation and damage of the eye's surface, and abnormal nerve signals¹.

There are two main types, and most people have features of both^2,13:

• Evaporative dry eye: tears evaporate too quickly, most often because of meibomian gland dysfunction (MGD), in which the oil glands in the eyelids become blocked or make poor-quality oil⁶. In a study at 10 US and European clinics, 86% of the dry eye patients whose type could be classified had signs of MGD¹⁴.
• Aqueous-deficient dry eye: the tear glands make too little of the watery part of tears. About 1 in 10 people with significant aqueous-deficient dry eye has Sjögren's, an autoimmune disease².

The 2025 TFOS report sorts these drivers into three groups¹. They are shortfalls in the tear film's layers, eyelid problems such as incomplete blinking, and problems of the eye's surface itself, such as nerve dysfunction and inflammation¹. The aim is to match treatment to each driver⁹. Our guide to the two types of dry eye explains the difference in more detail.

Blepharitis, inflammation along the eyelid margins, is closely linked to dry eye². One form is caused by Demodex mites that live in the lash follicles¹⁵. It is commonly linked to stubborn dry eye symptoms, although many people who carry the mites have no symptoms¹⁵. In a review of records of 1,032 people seen for any reason at six US eye clinics, 57.7% had signs of Demodex blepharitis¹⁶. The study was funded by the maker of a Demodex treatment¹⁶.

Some people have strong symptoms but few visible signs on examination. This can be neuropathic eye pain, in which the nerves of the eye's surface become oversensitive. It is often described as burning, stinging or aching, sometimes with light sensitivity^2,17. Our page on corneal neuralgia covers it.

Symptoms of dry eye

Common symptoms are^2,3:

• burning or stinging
• a gritty, sandy or scratchy feeling, as if something is in the eye
• redness
• sensitivity to light
• blurred vision that comes and goes
• watery eyes
• tired eyes, mucus discharge, and contact lenses that become uncomfortable

Watery eyes can seem odd in dry eye, but an irritated eye makes extra reflex tears⁶. Symptoms often vary through the day. Many people find them worse later in the day², while others notice dryness most on waking¹⁷. Dry air, wind, fans or air-conditioning vents, air travel and long spells of reading or screen use tend to bring them on². Our guides explain what dry eyes feel like and why they water, whether dry eyes can cause blurry vision and why some people wake up with dry eyes.

Most dry eye does not threaten sight². Severe dry eye that is not treated can damage the cornea, the clear front surface of the eye³. In rare cases, usually in people with an underlying inflammatory disease, it can lead to corneal scarring or ulcers and serious vision loss².

Signs that need prompt care

Some symptoms point to something other than ordinary dry eye, or to severe disease, and need an eye examination promptly rather than at your next routine visit^2,17:

• moderate or severe eye pain, rather than discomfort
• vision that drops suddenly, or blur that does not clear when you blink
• symptoms that start suddenly, or that are much worse in one eye than the other
• a red, painful eye while wearing contact lenses: take the lenses out and call your eye doctor right away¹⁸
• a chemical splash: rinse the eye right away with plenty of clean water for 15 minutes and get medical help immediately^19,20,21

Also see an eye doctor if symptoms do not go away, get worse, interfere with daily life, or do not ease with over-the-counter drops⁶.

Dry eye or pink eye?

The two can feel alike, with burning, grittiness and watering in both^2,22. Dry eye is usually long-lasting, affects both eyes¹⁷ and often eases for a while with artificial tears². Pink eye from an infection tends to come on suddenly, often with discharge, and the viral and bacterial forms are very contagious^22,17. Itching points more towards allergy¹⁷.

What causes dry eyes, and who is at risk?

Dry eye usually has several causes at once². The main risk factors are:

• Age. Diagnosed dry eye rises from 2.7% of adults aged 18 to 34 to 18.6% of those aged 75 and older⁴.
• Sex and hormones. Women are about twice as likely as men to be diagnosed⁴. Patient guides link dry eye to menopause^6,23, although the 2017 TFOS report rated the evidence for menopause itself as inconclusive⁸. In the Women's Health Study, hormone replacement therapy was linked to a higher risk of dry eye, more so with estrogen alone than with estrogen plus progestin²⁴.
• Screens. Screen work makes us blink less often and less completely^25,2. Combining 48 studies, screen users were about 1.3 times as likely to have dry eye⁷. Read more in our guide to digital eye strain.
• Contact lenses raise the risk, by about 1.7 to 3 times in different studies^12,7.
• Eye surgery. Dry eye symptoms are common in the first few months after LASIK and cataract surgery and often settle with time². In US studies of LASIK, about 28% of people with no dry eye symptoms before surgery had them three months later²⁶. Overall, though, more people had normal symptom scores after surgery than before²⁶. In a small study of US veterans, 1 in 6 people with no dry eye symptoms before cataract surgery had them six months later²⁷.
• Medicines, including antihistamines, diuretics, beta-blockers, antidepressants and anxiety medicines, isotretinoin for acne, and other drugs with anticholinergic (drying) effects^2,6. Glaucoma drops containing the preservative benzalkonium chloride can also damage the eye's surface^2,28. Do not stop a prescribed medicine on your own; ask your doctor whether an alternative exists.
• Autoimmune and other diseases. Sjögren's, rheumatoid arthritis and other connective tissue diseases, thyroid disease, rosacea and diabetes are all linked to dry eye^8,7,29. In Sjögren's, about 89% of patients have dry eye³⁰.
• Environment: low humidity, wind, smoke, air conditioning and heating^2,31,23.
• Other links: smoking^32,33, poor sleep and sleep apnea^33,7, and depression and anxiety³⁴.

Our guide to what causes dry eyes all of a sudden goes through screens, medicines and environment in detail. Sjögren's and autoimmune dry eye explains when drops alone are not enough, and our page on Sjögren's syndrome covers the condition itself.

How dry eye is diagnosed

Dry eye is diagnosed by an optometrist or ophthalmologist from your symptoms together with an eye examination; no single test confirms it^2,35. Under the 2025 TFOS criteria, a diagnosis needs both symptoms and at least one sign that the tear film or eye surface has lost its balance^17,1. Tests usually run from the least to the most invasive¹⁷:

• A symptom questionnaire, such as the Ocular Surface Disease Index (OSDI) or the 5-item Dry Eye Questionnaire (DEQ-5), which scores how often symptoms occur and how they affect daily life. TFOS recommends a six-question version of the OSDI for screening^1,36,37.
• A microscope (slit lamp) examination of the eyelids, glands, tear film and eye surface^2,38.
• Tear break-up time: how long the tear film stays intact after a blink³⁸. TFOS prefers a dye-free version, where under 10 seconds suggests dry eye^1,17. With a dye, its 2025 cut-off is under 5 seconds; the AAO's 2023 guideline uses 10 seconds^17,2.
• Staining: dyes show damaged spots on the cornea, the conjunctiva and the lid margins^1,2.
• Tear osmolarity: a quick test of how concentrated the tears are^1,39. Results can sometimes be hard to interpret².
• Schirmer test: a small strip of paper rests on the edge of the eyelid for five minutes to measure tear production^38,2.
• Meibomian gland checks: gentle pressure on the lid to see the quality of the oil, and imaging (meibography) to show gland loss^17,2.
• An inflammation marker test (MMP-9) on a tear sample. It cannot tell dry eye apart from other inflammatory eye conditions², and in 1,515 patients it was much less accurate than in the maker-linked study that supported it^40,41.
• Blood tests for Sjögren's when it is suspected².

Symptoms and test results often do not match, especially in mild dry eye². Dry eye is most common in women after menopause, so in younger people and in men doctors look harder for an underlying cause². Guidelines advise seeing an ophthalmologist for moderate or severe pain, no response to treatment, corneal ulcers, scarring of the conjunctiva or vision loss². The same applies when a systemic disease such as Sjögren's is suspected². Our guide to blocked eyelid glands explains the gland tests and home care.

Dry eye treatment today

Treatment aims to relieve symptoms and protect the eye's surface by tackling each cause⁹. Guidelines start with simple, low-risk measures and add stronger ones if symptoms continue, though any option can be used at any stage². Many people need a combination⁴². Artificial tears on their own often fail if other causes, such as blocked glands or a drying medicine, are not dealt with at the same time². Our guide to dry eye treatments beyond drops covers the procedures in more depth.

Self-care and your surroundings

• Warm compresses and eyelid cleaning are the usual first step for blocked glands and blepharitis^2,9. They may ease symptoms, but there is no strong evidence that any lid treatment cures chronic blepharitis⁴³.
• Humidify dry air and avoid drafts from fans, vents and car heaters². In a small trial of computer users, a desktop humidifier kept the tear film stable for longer and more people felt comfortable over an hour⁴⁴.
• Change screen habits: put the screen below eye level, take regular breaks and blink fully². In a small two-week study, reminders to follow the 20-20-20 rule (every 20 minutes, look 20 feet away for 20 seconds) eased symptoms⁴⁵. The benefit faded a week after stopping, and the eye surface did not change⁴⁵.
• Blinking exercises (close, squeeze, open, 15 times, three times a day) reduced symptoms and incomplete blinks in one study, but the effects mostly wore off two weeks after people stopped⁴⁶.
• Protect your eyes outdoors with wrap-around glasses; moisture-chamber glasses are another option^6,2.
• Review your medicines with your doctor², and stop smoking and avoid second-hand smoke².
• Water: drinking extra water is often advised, but in a study of 51,551 adults, people who drank more were not less likely to have dry eye⁴⁷.

Artificial tears

Over-the-counter artificial tears may be safe and effective, and most brands may work about equally well⁴⁸. The trials are of low quality, so this is uncertain⁴⁸. Thicker gels and ointments last longer but blur vision, so many people use them at bedtime^2,6. If you use drops more than about four times a day, choose preservative-free ones². If blocked glands are part of the problem, drops that contain oil (lipid) may suit better².

Use only sterile, regulated eye drops. In 2022 and 2023, a drug-resistant bacterium spread through recalled preservative-free artificial tears, mainly EzriCare^49,50. CDC counted 81 patients in 18 states. Fourteen lost vision, 4 had an eye removed and 4 died within 30 days of a positive test⁵⁰. The FDA later warned against 27 over-the-counter eye drops, sold under several store brands, because of insanitary manufacturing conditions⁵¹. It also warned against MSM eye drops sold online, which it found contaminated and illegally marketed⁵². Buy FDA-regulated products from known manufacturers, check for recalls, and never put homemade or non-sterile products in your eyes. Stop and call your eye doctor if a drop causes pain, redness or a change in vision. Our article on MSM eye drops explains the FDA warnings.

Prescription treatment

When self-care and artificial tears are not enough, an eye doctor can prescribe drops that calm inflammation or increase tear production^2,42. None has been shown to work better than another in head-to-head trials². The results below come from each drug's FDA label and main trials. They are group results: a drug that helps one person may not help another.

*A "large rise in tear production" means at least 10 mm more wetting on the Schirmer strip, the measure most of these labels report. Cochrane reviews bring together all the trials on a question. A 2026 Cochrane review of 58 trials found that cyclosporine drops may improve symptoms and some signs⁶⁹. The results were inconsistent and the evidence low certainty, meaning the true effect could be quite different⁶⁹. People on cyclosporine 0.05% were more likely to stop because of side effects⁶⁹.

Other prescription options include short courses of other steroid drops, oral doxycycline or azithromycin for blocked glands and blepharitis, and, for Sjögren's, tablets (pilocarpine or cevimeline) that stimulate tear production^2,42. The evidence for oral antibiotics in chronic blepharitis is very low certainty, and they can cause side effects⁷⁰.

In-office procedures

• Heat-and-express gland treatments (thermal pulsation devices such as LipiFlow, iLux and TearCare) apply heat and pressure to the eyelids to clear the glands. The FDA authorised LipiFlow in 2011 and cleared iLux in 2017 and TearCare in 2021³⁹. A 2024 Cochrane review found that LipiFlow worked about as well as other common treatments, with no difference from warm compresses in gland function or tear stability⁷¹. The evidence was low or very low certainty, and no trial reported a sight-threatening harm⁷¹.
• Intense pulsed light (IPL) applies flashes of light to the skin near the lower eyelids. The FDA authorised an IPL device for dry eye due to MGD in 2021³⁹. Trials show better tear stability. Results for symptoms compared with sham (fake) treatment are mixed, and a Cochrane review called the effect uncertain^72,73.
• Punctal plugs are tiny plugs placed in the tear drainage openings to keep tears on the eye. A Cochrane review found the benefit inconclusive; plugs can cause watering and, less often, inflammation of the tear sac⁷⁴. The AAO guideline says they are best used once the tear film is back in balance².
• Eyelid margin cleaning (microblepharoexfoliation) and gland probing each rest on very limited evidence^75,76,77.

Severe dry eye

• Eye drops made from blood (your own serum, or platelet-rich plasma) may ease symptoms in the short term^78,79,2. The trials are small and the evidence is low or very low certainty⁷⁸.
• Scleral contact lenses, large rigid lenses, have been used successfully for years in severe dry eye, although fitting, cost and handling can be barriers².
• Amniotic membrane, a thin biological tissue placed on the eye, can be considered when other treatment fails, but its effect is short term².
• Surgery, such as permanently closing the tear ducts or partly closing the eyelids, is kept for the most severe cases².

Can dry eyes be cured permanently?

Usually not. Chronic dry eye is a long-term condition, and the American Academy of Ophthalmology's guideline says treatments are rarely curative and long-term treatment is typically needed². Symptoms do often improve with treatment².

Some dryness has a trigger you can change, such as a drying medicine or a dry, drafty room. Removing it often leads to marked improvement². Dryness after eye surgery often settles over the following months².

Long-term data are limited. In a study of 784 US health professionals who had had dry eye for about ten years on average, 44% said their eye-surface symptoms had improved since diagnosis⁸⁰. About a third said they were unchanged and a quarter said they were worse⁸⁰.

Be wary of products sold as a permanent cure. In trials, people given a placebo (a dummy treatment) often improve a lot too. In the largest fish-oil trial, symptom scores improved by about 13 points on a 100-point scale in both the fish-oil and the placebo groups⁸¹. That is why before-and-after stories cannot show that a product works. Our guide to natural remedies for dry eyes looks at the home measures people ask about.

Our article Can dry eyes be cured permanently? goes through which causes can be fixed for good and which need long-term control.

New treatments for dry eye in clinical trials

Several new drugs are in late-stage trials or under FDA review. Phase 3 trials are the large, final trials usually needed for approval. None of these drugs is approved. Status is as of 19 October 2026¹¹.

The newest approved option is Tryptyr (acoltremon), approved in May 2025¹⁰. Treat online claims that any of the drugs above is available with caution.

Living with dry eye

• Keep going with treatment even when you feel better; most dry eye needs ongoing care².
• Choose preservative-free drops if you use them more than about four times a day².
• Make your space eye-friendly: a humidifier, seats away from vents, the screen below eye level, and regular breaks².
• Look after your eyelids with warm compresses and lid cleaning if your eye doctor finds blocked glands or blepharitis².
• Plan ahead for eye surgery: dry eye that is not under control is a reason not to have LASIK, so tell your surgeon about it².
• Tell your eye doctor if contact lenses become uncomfortable; severe dry eye raises the risk of lens problems².
• Look after your mood: depression and anxiety are much more common in people with dry eye³⁴. Which comes first is unclear, and counselling may help some people cope².

Where integrative care fits

Netra Eye Institute is an acupuncture and Oriental medicine practice. Nothing we offer replaces artificial tears, prescription treatment, eyelid care or procedures from your eye doctor. Our role is adjunctive: care that sits alongside your eye doctor's treatment, with the evidence explained before you start. A summary of the 2025 TFOS report says acupuncture may relieve symptoms for some patients⁴². It adds that such approaches should be combined with standard treatment, not used alone⁴². Here is what the research shows for the approaches people ask about most.

What working with Netra looks like. We ask first that an optometrist or ophthalmologist has examined your eyes, made the diagnosis and set a treatment plan. If you have eye pain, a sudden change in vision, or a red, painful eye with contact lenses, see them first; that comes before anything we do. Then we review your diagnosis, treatment and medicines, and look at the factors around dry eye that matter for overall health: screen habits, sleep, stress and your environment. We offer acupuncture and, where appropriate, Chinese herbal medicine within Netra Restoration Therapy (NRT), and we check every herb and supplement against your medicines. NRT is adjunctive. It does not replace drops, eyelid care or procedures. We do not claim that it cures dry eye or changes its course. Only a controlled trial could show that, and no controlled trial of NRT has been done. Our article on dry eye beyond MGD explains the Chinese medicine view. For the Ayurvedic perspective, see Ayurveda and dry eyes and Netra Tarpana: evidence and risks.

Outlook

Dry eye is usually long term, with symptoms that rise and fall and can slowly worsen over the years². It rarely threatens sight². It can still weigh heavily on daily life. In a small US study of 56 patients, people with severe dry eye valued their health about as low as people with severe angina did in earlier studies¹¹². In an online survey, employed people with severe dry eye said they were about 35% less productive at work¹¹³. Both studies were run by staff of a dry eye drug maker^112,113. Over-the-counter drops are often not enough on their own. In one study at US eye clinics, people rated their symptom relief from these drops much lower than their satisfaction with them¹¹⁴. Symptoms often improve when the causes are treated together^2,42.

Frequently asked questions

Can dry eyes cause blurry vision?

Yes. Blurred vision that comes and goes is a typical symptom². Blur that comes on suddenly or does not clear when you blink needs prompt examination¹⁷. Read more in can dry eyes cause blurry vision?

Can dry eyes cause blindness?

Rarely. Most dry eye does not threaten sight². Severe dry eye, usually in people with an underlying inflammatory disease, can scar or ulcerate the cornea and cause serious vision loss^2,3.

Why do my eyes water if they are dry?

An irritated eye makes extra reflex tears, so watery eyes are a common sign of dry eye⁶. Read more in what dry eyes feel like and why they water.

What are the best eye drops for dry eyes?

No single brand stands out: trials suggest most over-the-counter artificial tears work about equally well⁴⁸. Choose preservative-free drops if you use them more than about four times a day, and ask about a drop that contains oil if your eyelid glands are blocked². Buy only sterile, FDA-regulated products⁵¹. If drops are not enough, ask your eye doctor about prescription treatment.

How long does dry eye last, and can it go away on its own?

Dryness after eye surgery often settles over the following months, and removing a drying medicine or a dry environment often leads to marked improvement². Chronic dry eye usually lasts for years and needs ongoing care². In one long-term study, more people said their symptoms had improved over about ten years than said they had worsened⁸⁰.

Does drinking more water help dry eyes?

Studies have not found that it does. In 51,551 adults, people who drank more water were not less likely to have dry eye⁴⁷. Drinking enough is good for general health, but it is not a treatment for dry eye.

Is dry eye an autoimmune disease?

Not in itself, but autoimmune diseases can cause it. About 1 in 10 people with significant aqueous-deficient dry eye has Sjögren's². Tell your doctor if you also have a dry mouth or swollen salivary glands¹⁷. Read more in Sjögren's and autoimmune dry eye.

What causes dry eyes all of a sudden?

A new medicine, dry or windy air, long screen sessions or recent eye surgery can bring on dryness^2,23. True sudden onset, especially with pain or in one eye, can mean an infection or injury, so get it checked¹⁷. Read more in what causes dry eyes all of a sudden?

Why are my eyes so dry when I wake up?

Some people's dryness is worst on waking¹⁷. Eyelids that do not close fully and a poorly fitted sleep apnea mask are recognised contributors², and an ointment at bedtime can help⁶. Read more in waking up with dry eyes.

Can acupuncture help dry eye?

It may ease symptoms for some people as an addition to standard treatment, but the evidence is limited and trials against sham acupuncture are mixed^92,94,95,96. It does not replace drops, eyelid care or your eye doctor's plan. Netra offers acupuncture as adjunctive care, with the evidence explained.

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