Dry Eyes: A Cry for Attention

by Robert Abel, Jr. M.D.

Many people experience the discomfort of dry eyes or an inadequate tear film over their eyes at some time in their lives. However, there are more than 10 million Americans who suffer with a significant dry eye condition that may be related to other symptoms.

The classic Sjogren's-associated dry eye condition, generally experienced in an airplane, overheated room, or a dusty workplace, affects up to two percent of the population. Its triad of symptoms includes dry eyes, dry mouth, and arthritis. Dry eyes may also be caused by medication, dehydration, inflammation of the eyelids and/or skin, previous eye surgery, systemic diseases such as rheumatoid arthritis, thyroid disease, lupus, sarcoidosis, and even poor blinking habits (i.e., staring at a computer).

It's important to understand that tears are more than water.


Mucous–from the goblet cells deep inside the eyelid

Watery or aqueous tears–from the lachrymal and accessory lachrymal glands located in the conjunctiva of the eyelids

Oil–from the Meibomian oil glands in the eyelids

The innermost layer of tears in direct contact with the eye is the mucin, a mucous layer which coats the surface of the cornea. The middle or aqueous tears layer, which sticks to the mucin, keeps the eye moist. The outer tear layer is the oil from the Meibomian glands and acts like an oil slick on the outside of the watery tears to slow their evaporation from the surface of the eye. Every time you blink, you sweep the tears across the cornea and into the drainage ducts called puncta.

The tear film can be evaluated by numerous tests; however, your symptoms will often be your best guide. They can include irritation, burning, redness, mucous accumulation, itching, and light sensitivity. Mild eye muscle problems or inadequate reading glasses may aggravate symptoms. A routine eye examination will exclude conjunctivitis, or faulty glasses or contact lens as possible causes of irritation. Any low-grade, chronic irritation may actually be a medical problem and an indicator to seek help.


Use artificial tears: Cyclosporine A, a prescription, is a new anti-inflammatory drop. For those looking for a natural option, Similasan is a homeopathic eye drop. Researchers are looking at estrogen and essential fatty acids as other ways to fortify the tear film. Ointments at bedtime are often helpful in reducing morning symptoms. See the "Dry Eye" chapter in my book, The Eye Care Revolution, for more details.

Punctal plugs: Every time you blink, tears are lost through the puncta at the inner corner of your eyelids. By plugging the exit, any tears, man-made or supplied, remain longer.

Environment: Are your home and workplace too dry or lack humidity? Are there plants? If you suffer from dry eye symptoms, especially in the winter, placing a humidifier in your bedroom is a simple solution.


Drink at least 6 to 8 glasses of water a day; limit sodas, caffeine, and alcohol.

Include fish, soy, and other legumes and seeds, such as flax, in your diet. These provide essential fatty acids to protect cells and stabilize the tear film.

Add green leafy vegetables and small amounts of meat. They supply B vitamins.

Supplements that benefit those with arthritis appear to build other membranes, such as conjunctiva, mouth, nose, and ears.

Omega-3 and -6 fatty acids from plants (flaxseed, evening primrose, and borage) or from cold water fish (salmon, mackerel, sardines, halibut, and cod) are loaded with good fats. A good supplement is approximately 500 mg of DHA (fish oil) or flaxseed oil twice daily with meals.

Glucosamine sulfate, chondroitin sulfate, and gelatin have also reportedly helped to promote eye health and benefit those with arthritis.

Increasing water intake, exercising, and further supplementation with probiotics and digestive enzymes promote digestion and improve your body's absorption of nutrients.


Medications: Common pharmaceutical drugs for intestinal problems, depression, allergies, and colds may dehydrate sensitive tissues in your body. If you must take prescription drugs, you may have to compensate for this dehydration by drinking more water. Ask your pharmacist or doctor if any of your current medications may cause dry eyes.

Remember to blink: Many of us tend to get lost in work and stare at our computers, simply forgetting to blink. Other people have weak lower lids, which prevents them from completing a blink. Fortunately, with a forced or voluntary blink, you can close your eye. Inadequate eye closure while sleeping may also contribute to dry eye symptoms.

Treat associated problems: Conjunctivitis or blepharitis (inflammation of the eye lid) can contribute to symptoms, which can be alleviated with a program of short-term antibiotic therapy. Also, many may experience headaches, neckaches, and other general complaints, yet not recognize these as symptoms associated with dry eyes.

Dry eye syndrome is a frustrating condition, which may involve more than your eyes. The good news is you have many options. Monitor your symptoms. Be aware of the time of day you experience them, whether they are aggravated by reading or other activities, and non-eye symptoms that may not seem to be related. By working with your eye doctor, you can address dry eye problems ahead of time, and perhaps avoid surgery or more drastic remedies.