The Eye Center's staff was welcoming and professional. My first visit with Dr Siv was very thorough and he smiled and put me at ease immediately. I know my husband will feel the same.
— Dorothy Emery
Dry Eye Causes: What Is Behind Your Symptoms and How We Can Help
Medical Conditions That Can Cause Dry Eye
Several systemic health conditions can directly affect your ability to produce healthy tears. In these cases, treating the underlying condition is often as important as treating the eye itself. Our team coordinates with your other physicians when needed to give you the most complete care possible.
Autoimmune conditions cause your immune system to attack your own tissues, including the glands that produce tears. Sjogren syndrome, a condition where the immune system targets moisture-producing glands throughout the body, is one of the most common autoimmune causes of dry eye we diagnose.
- Rheumatoid arthritis can reduce tear production
- Lupus may cause dry eye alongside other systemic symptoms
- Inflammatory conditions often require prescription anti-inflammatory eye drops
- Working with your rheumatologist helps manage both conditions effectively
Thyroid problems can affect your eyes in more than one way. Thyroid eye disease can cause the eyelids to retract or the eye to protrude slightly, which may prevent complete eyelid closure and allow the eye surface to dry out during the day or overnight. Hypothyroidism can also reduce tear production and gland function in some people.
If we suspect a thyroid connection, checking your thyroid levels may be part of our evaluation.
Diabetes can damage the nerves that signal your tear glands to produce tears. High blood sugar levels may also affect the quality of your tears and the overall health of your cornea. People with diabetes are more likely to develop dry eye and may experience more severe symptoms than those without the condition.
Keeping your blood sugar well controlled helps protect your eyes and can reduce the severity of dry eye symptoms over time.
Rosacea, eczema, seborrheic dermatitis, and other skin conditions often extend to the eyelid area and contribute to dry eye. Eyelid rosacea, in particular, causes inflammation that blocks the meibomian glands and limits oil production.
- Seborrheic dermatitis creates flaky buildup along the eyelid margins
- Psoriasis can affect eyelid skin and interfere with gland function
- Treating the skin condition often leads to improvement in dry eye symptoms
- Specialized eyelid hygiene is often a key part of managing these overlapping conditions
Blepharitis, which is inflammation of the eyelid margins, is a closely related condition that commonly causes evaporative dry eye. Demodex mites, tiny organisms that can overgrow on eyelashes and lid margins, can contribute to chronic inflammation and gland blockage in some patients.
The nerves around your eyes detect dryness and trigger your tear glands to respond. Damage to these nerves from injury, surgery, or certain systemic diseases disrupts this feedback loop. LASIK and other corneal surgeries can temporarily reduce corneal sensation and tear production, with most patients recovering normal function within several months. Some people do develop chronic dry eye after eye surgery that requires ongoing management.
Medications and Substances That Trigger Dry Eye
Many common medications have the side effect of reducing tear production or disrupting the tear film. This is one of the most overlooked causes of dry eye, and identifying a medication trigger can lead to meaningful improvement in your symptoms. Always bring a complete list of all your medications and supplements to your appointment.
Many medications used to treat high blood pressure and heart conditions can reduce tear production. Beta blockers and diuretics are among the most common culprits. If you take these medications and develop dry eye, do not stop them without consulting your prescribing doctor first. Our team can recommend treatments to keep you comfortable while you continue your necessary cardiac care.
Allergy medications work by drying up secretions throughout the body, and that includes tears. Both over-the-counter and prescription antihistamines can contribute to dry eye, and decongestants have a similar drying effect on mucous membranes and tear secretion.
- Long-term use of these medications increases dry eye risk
- Newer antihistamine formulations may have a somewhat lesser drying effect
- We can discuss alternative allergy management strategies if these medications are worsening your dry eye
Many psychiatric medications have anticholinergic effects, meaning they reduce gland secretions including tears and saliva. Tricyclic antidepressants and some selective serotonin reuptake inhibitors (SSRIs) are particularly likely to contribute to dry eye.
Your mental health is a priority, and you should never discontinue these medications on your own. Our team can help you manage dry eye symptoms while you continue the treatment your mental health provider has prescribed.
Isotretinoin and other systemic retinoids are well-established causes of dry eye. These medications reduce the activity of the meibomian glands and lower the oil content of your tear film, which leads to faster evaporation and significant discomfort for many patients.
- Symptoms can develop within weeks of starting treatment
- Symptoms often improve after the medication is stopped
- Preservative-free lubricating drops are important during treatment
- Your prescribing dermatologist should monitor for eye-related side effects
Hormone replacement therapy, birth control pills, certain pain medications, chemotherapy drugs, and immunosuppressants can all affect tear production. Some commonly overlooked triggers include sleep aids, cold medications, anticholinergic medications for overactive bladder, and certain preserved eye drops including some glaucoma medications.
Dehydration, including from alcohol use, can also temporarily worsen dry eye symptoms. Sharing your full medication list with our team helps us identify possible connections and avoid recommending treatments that might interact with what you already take.
Lifestyle, Environmental, and Age-Related Causes
Many daily habits and environmental factors play a significant role in dry eye, and modifying them is often one of the most effective steps you can take. These factors frequently combine with underlying medical causes to make symptoms worse than they would be on their own.
When you focus on a screen, your blink rate can drop significantly compared to normal. Blinking is what spreads tears across your eye and stimulates oil gland function, so reduced blinking leads to faster evaporation and an unstable tear film.
- Position your screen slightly below eye level to reduce the area of eye surface exposed
- Follow the 20-20-20 rule: every 20 minutes, look 20 feet away for 20 seconds
- Use preservative-free artificial tears proactively during long work sessions
- Anti-reflective lens coatings can reduce glare-related squinting and discomfort
Contact lenses can disrupt the tear film through mechanical friction, increased evaporation, and low-grade inflammatory effects on the eye surface. Some long-term wearers experience changes in corneal sensitivity over time, which can affect tear production signaling.
If dry eye develops during contact lens wear, we may recommend daily disposable lenses, reduced wearing time, or specialty lenses designed for dry eyes. Pain, marked light sensitivity, or worsening redness with contact lens wear should prompt you to remove your lenses and seek same-day evaluation to rule out a corneal abrasion or infection.
Low-humidity environments, air conditioning, heating systems, airplane cabins, and ceiling fans all accelerate tear evaporation. Wind blowing directly across your eyes has the same effect. Airflow during sleep from a fan or an improperly fitting CPAP mask can cause overnight dryness and leave your eyes feeling rough and irritated in the morning.
Smoke from any source irritates the eye surface and disrupts the tear film. Using a humidifier at home and avoiding direct airflow can make a meaningful difference in how your eyes feel throughout the day.
Tear production naturally decreases with age, and the meibomian glands become less active over time. Eyelid tissue can also lose muscle tone, which affects how completely the eyelids close and spread tears during blinking. These changes make dry eye considerably more common in people over 50.
- Hormonal shifts during menopause strongly affect tear quantity and composition
- Women are more likely than men to develop dry eye overall
- Estrogen changes alter the inflammatory balance of the eye surface
- Regular eye exams help catch early signs of dry eye before significant symptoms develop
Eyelid surgery, brow lifts, and facelifts can change how completely your eyelids close. Incomplete closure during sleep exposes the cornea and allows tears to evaporate overnight, which can lead to significant morning dryness and surface damage over time.
Botulinum toxin injections near the eyes may also affect blinking mechanics and tear distribution. If you are planning a cosmetic procedure, discussing your dry eye history with your cosmetic surgeon and with our team in advance helps you make a fully informed decision.
How We Diagnose the Root Cause of Your Dry Eye
Pinpointing what is causing your dry eye often requires more than a standard eye exam. Our team uses a combination of targeted questions, clinical observation, and specialized testing to understand your unique situation and guide treatment in the right direction.
Your evaluation begins with a detailed conversation about your symptoms, medical history, and medications. We ask about your work environment, daily screen time, and activities that might be contributing to dryness. This background gives us important clues before the exam even starts.
The exam itself includes careful observation of your blink pattern, the condition of your eyelid margins, and the overall appearance of your tear film. We look for signs of inflammation, redness, lid margin disease, and other indicators of the underlying cause.
We may perform a Schirmer test, which uses a small paper strip placed under your lower eyelid to measure how much tear fluid your eyes produce over five minutes. This simple, painless test helps determine whether you are making enough tears.
- Tear break-up time measures how quickly the tear film becomes unstable between blinks
- Osmolarity testing measures the salt concentration in your tears, with higher levels indicating more severe dry eye
- Inflammatory marker testing may be used in select cases to guide anti-inflammatory treatment decisions
- Results from these tests are combined to give us a complete picture
Specialized cameras allow us to photograph the meibomian glands inside your eyelids. This imaging shows gland structure, identifies blockages, and reveals gland dropout, which is the permanent loss of gland tissue. Seeing the glands directly helps us understand how much damage has occurred.
Gland expression, where gentle pressure is applied to the eyelid margins, lets us examine the quality of the oil being produced. Thick, cloudy, or reduced oil output is a clear sign of meibomian gland dysfunction that needs treatment.
We use special dyes and a slit lamp microscope to check for damage to your cornea and the conjunctiva, which is the clear tissue covering the white of your eye. Fluorescein dye highlights areas where surface cells have been damaged by dryness, and lissamine green stain reveals dead or unhealthy cells.
The pattern and location of staining help us determine which type of dry eye you have and how severe the surface damage is. This information is essential for building an effective, personalized treatment plan.
When an underlying medical condition is suspected, we may order blood tests to check for autoimmune antibodies or thyroid function. Allergy testing can identify environmental triggers that are contributing to inflammation. Corneal topography, a map of the corneal surface shape, may be used in specific cases where surface irregularity is a concern.
In some situations, we may refer you to a specialist to help manage a condition that is driving your dry eye, such as a rheumatologist for autoimmune disease or an endocrinologist for thyroid problems.
Treatment Options Based on the Underlying Cause
Effective dry eye treatment depends entirely on what is causing your symptoms. Our team tailors your treatment plan to your specific triggers and the severity of your condition, and we adjust that plan over time as your eyes respond to care.
Warm compresses applied for about 10 minutes once or twice daily help melt blocked oil in the meibomian glands and improve oil flow. Eyelid scrubs remove debris and reduce the bacterial load along the eyelid margin, which reduces inflammation and improves gland function.
For moderate to severe gland dysfunction, in-office treatments such as thermal pulsation therapy or intense pulsed light may be recommended. These procedures can improve gland function and provide longer-lasting relief than home care alone in many patients.
Prescription anti-inflammatory eye drops reduce the cycle of inflammation that damages the eye surface and tear-producing glands. Cyclosporine and lifitegrast are two commonly used options that work differently from traditional lubricants and address an underlying inflammatory driver of dry eye.
- Short-term steroid drops can help during flare-ups but require careful supervision because of risks including increased eye pressure and cataract formation
- Omega-3 fatty acid supplements may support healthy tear production and reduce inflammation in some individuals, though benefits vary and dosing should be discussed with your doctor
- Treating any underlying autoimmune disease in coordination with your rheumatologist is essential for long-term improvement
When a medication is identified as a contributing cause, our team works with your prescribing physician to explore alternatives when it is safe and appropriate to do so. Sometimes switching to a different drug in the same medication class reduces dry eye symptoms significantly.
When continuing the medication is necessary, we focus on managing your symptoms effectively with preservative-free artificial tears, overnight lubricating ointments, and prescription treatments as needed to keep you comfortable.
Changes to your daily environment can provide meaningful relief alongside other treatments. Using a humidifier adds moisture to dry indoor air, and repositioning fans and air vents so they do not blow directly toward your face reduces tear evaporation throughout the day.
- Wraparound glasses and sunglasses block wind and help retain moisture around the eye
- Moisture chamber goggles can help in severe cases where exposure is a significant factor
- Adjusting screen position and following the 20-20-20 rule reduces screen-related symptoms
- Avoiding smoke exposure and irritants protects the tear film and slows surface damage
For more persistent dry eye, punctal plugs are small devices placed in the tiny drainage openings of the eyelids to reduce how quickly tears drain away. We typically address significant eyelid or surface inflammation before placing plugs, since blocking drainage when tears are already inflammatory can worsen symptoms in some patients.
Advanced options such as amniotic membrane placement, autologous serum tears made from your own blood serum, or specialty scleral contact lenses that vault over the cornea may be considered for severe dry eye that has not responded to more conservative approaches. These are reserved for patients with significant surface damage or persistent symptoms despite other treatments.
Dry eye is most often a chronic condition that benefits from regular monitoring rather than a single course of treatment. Our team schedules follow-up visits to evaluate how your treatment is working and make adjustments based on how your eyes are responding.
Your plan may evolve over time as your condition improves, as new triggers appear, or as new treatment options become available. Consistent monitoring helps us catch complications such as corneal surface damage early and protect your long-term vision.
Frequently Asked Questions
These answers address common questions our patients have about dry eye causes, diagnosis, and what to expect from treatment.
Yes, and this is actually very common. It is possible to have meibomian gland dysfunction alongside a medication side effect, or age-related changes combined with environmental triggers. When multiple factors are at work, addressing all of them together leads to better outcomes than focusing on just one. This is why our evaluation looks at the full picture of your health, habits, and history rather than searching for a single explanation.
Many people do see improvement within weeks to a few months after stopping a contributing medication, but recovery is not always complete or guaranteed. How much you improve depends on how long you were on the medication, whether your glands have sustained lasting damage, and whether other contributing factors are present. Never stop a prescribed medication on your own. The decision to change or discontinue a medication should always be made with the doctor who prescribed it, and we are happy to communicate with your other providers if needed.
Some of the conditions that cause dry eye, particularly autoimmune diseases like Sjogren syndrome, do have genetic components. Having a close relative with one of these conditions increases your risk of developing it yourself. That said, most dry eye results from a combination of genetic tendency and environmental or lifestyle factors, and having a family history does not mean you will definitely develop chronic dry eye. Sharing your family medical history with our team helps us screen for underlying causes more thoroughly.
In mild to moderate cases, dry eye is uncomfortable but rarely causes lasting harm when managed appropriately. In severe or longstanding cases, particularly when the corneal surface repeatedly breaks down, scarring or vision changes are possible. The risk is higher when there is significant exposure of the eye surface or when surface inflammation is left unchecked for a long time. This is one of the reasons we recommend early evaluation rather than waiting to see whether symptoms resolve on their own.
It is possible to have significant dry eye discomfort with relatively few visible signs on examination. This can occur with a condition called neuropathic ocular pain, where changes in nerve signaling cause discomfort even when tears and the eye surface appear reasonably healthy. It can also reflect early-stage disease that standard tests do not fully capture. When symptoms and findings do not match, we may use additional specialized testing or adjust our treatment approach to focus on nerve-related comfort alongside standard dry eye care.
Many straightforward cases are diagnosed during the initial evaluation visit. When the picture is more complex, with multiple possible causes or an unclear response to initial treatment, it may take several appointments and additional testing to identify all the contributing factors. We are upfront with you about the diagnostic process and keep you informed at each step. Most patients have a working diagnosis and an initial treatment plan in place within a few weeks of their first visit.
See Our Team at The Eye Center
Finding what is truly driving your dry eye symptoms is the most important step toward lasting relief, and our team at The Eye Center is experienced in doing exactly that. We provide comprehensive dry eye evaluations and personalized treatment plans for patients throughout Northern Virginia, using both in-office diagnostic tools and a full range of treatment options tailored to your specific situation. If dry eye is affecting your comfort or your vision, we encourage you to schedule an appointment so we can help you find the relief you deserve.