Dry eyes are on the rise and everything from screens to makeup to menopause and the Pill can be factors. What can you do for dry eye syndrome? Our eye experts advise
If you can’t seem to get rid of that scratchy, parched feeling in your eyes, you’re far from alone. One survey among 1109 people (admittedly by hydrating eye drop purveyor Rotho). found that one in two Brits may suffer from dry eye syndrome, a condition that makes eyes feel progressively more uncomfortable, dehydrated and sore. Causes can range from something as simple and fixable as not blinking enough, especially from computer use to reacting to your cosmetics. It's also one of the lesser-known symptoms of perimenopause and menopause when just about everything in the body becomes drier.
Eye specialists confirm that cases are rising, particularly among younger people: “I see those in their 30s and even teenagers presenting with them,” says ophthalmologist and Peep Club eye care founder Nicola Cross-Alexander. But is it something you should be worried about, and what can you do to tackle it?
What is dry eye syndrome?
Dry eye syndrome (also called dry eye disease or ‘dry eye’ for short) means you either don’t produce enough tear fluid to properly hydrate your eyes, or the fluid you make is of poor quality. “The latter type is more impacted by lifestyle and diet, and it’s where we’re seeing the biggest increase in cases” says Cross-Alexander. “Most often, it means the tiny ‘meibomian’ glands in the upper and lower eyelids have stopped working properly. They produce the lipid or oily layer of the tear film, and a lack of these oils means eye moisture evaporates too quickly.”
You can also have a dysfunction in the tear (‘lacrimal’) gland, which means you don't produce enough of the watery layer of the tear film. “This is mostly age-related, but lifestyle factors are also involved, and one of them is excessive screen use,” says Cross-Alexander. Pregnancy and Pill use can be causes too.
Our eyes become dry and irritated when the lubricating water-and-oil film that covers your eyeballs is compromised. You might also find yourself over-producing a too-watery fluid that’s not fit for purpose, resulting in gritty eyes and people wondering why you’re ‘crying’.
Dry eye is different from eye strain. Both conditions are part of computer vision syndrome, but eye strain is brought on by intense peering and focusing and exacerbated by glaring overhead lights in offices. It leads to headaches and blurry vision but has no long-term consequences, unlike prolonged dry eye.
What causes dry eye syndrome?
Dry eye can be a result of several things:
- blocked glands
- sensitivity to the environment - wind, air pollution, air conditioning, central heating
- not blinking enough
- Cosmetics - especially eyeliner, lash extensions, lash serums
- certain medications (the Pill, among others)
- some medical conditions (lupus and diabetes, among others, menopause)
- contact lenses
- an overgrowth of ‘demodex’ mites (mites that naturally live in human hair including lashes)
- Ageing - especially form age 50
Despite what many people assume, dry eye is not caused by radiation or blue light from your screens. “It’s a decreased blinking rate that’s the problem,” says ophthalmic and oculoplastic consultant Mr Daniel Ezra. “Like moths to a flame, we seem to be primed to stare into bright lights, suppressing the blink reflex that coats our cornea with moisture and protective oils.” He adds that there is “no evidence” blue light from digital screens damages our eyes or our vision.
How does makeup cause dry eye?
If you use lash serums, have eyelash extensions, or like to apply your eyeliner on the waterline (a makeup trick known as tightlining) and you have dry eyes, read on.
Makeup applied on or too near to the waterline, such as kohl, ‘fine-liner’ or mascara, can spell trouble. “The waterline and eyelash follicles are involved in the production of the oily part of the tear film," says consultant ophthalmologist and oculoplastic surgeon Dr Rachna Murthy. “ So, they help protect the eyeball. "If the lid edge is inflamed or blocked, it can throw off the tear film balance and that can affect the eye surface and develop into dry eye disease.”
Your choice of makeup remover is crucial.“Astringent ones containing alcohol or other irritants will dry out the lash line, while anything with oil too close to the lid margins can travel into the eye, promoting demodex mites and bacteria and disturbing the microbiome, which can again set off dry eye,” says Murthy.
Lash conditioners are a problem for the same reason, while lash growth serums pose their own problems. “Those with prostaglandin analogues [such as Revitalash] can inflame the eye margin when used excessively, while increased lash growth may lead to the plugging of the oil glands and more dry eye disease,” says Murthy.
And “odd as it may sound, very long false lashes or lash extensions can cause a ‘breeze’ that helps evaporate tears,” she says.
Overly dense lashes, meanwhile, can apparently harbour more bacteria than your eye film can manage. Who knew a bit of maquillage could present such issues?
Is dry eye disease dangerous?
Dry eye can be hugely uncomfortable and, despite in most cases not leading to permanent damage, “there are long-term risks,” says oculoplastic surgeon Sabrina Shah-Desai.
Issues that can develop over time are heavy eyelids, permanently sore dry eyes, blurred eyesight and vision fluctuation as issues. If left untreated you may find yourself prone to infection and even eye scarring.
Many people mistake the early symptoms (anything from redness, itching, burning and excessive watering to a gritty feeling) for allergies, or that they simply accept the mild discomfort without seeking treatment, says Cross-Alexander. “But that allows dry eye to potentially turn into a complicated condition to manage with sight-threatening ramifications.”
Does dry eye get worse with age and in menopause?
Traditionally, dry eye has affected mostly older people as it’s to do with tear glands and the quality of the tear film becoming less effective with age (Shah-Desai says the average age for the onset of dry eyes is 50). According to Cross-Alexander, the perimenopause and menopause can also be at play, for reasons of age as well as hormone fluctuations affecting tear film production.
Can you treat dry eye yourself?
Happily, there are plenty of things you can do to alleviate dry eye syndrome.
- Don't stare and blink more often
Research has shown that gamers blink twice a minute compared to an average blink rate of 12 times a minute, proving the power of our ‘stare reflex’. “Lowering the light intensity on your screens will help you blink more – just make sure it’s not so low that you start peering and cause eye strain,” advises Ezra. - Take omega 3 supplements and eat more oily fish
“I recommend an omega oil-rich diet or omega 3 supplements to my patients,” says Shah-Desai. “Omega-3 fatty acids, especially in the shape of fatty fish, may help protect adult eyes from macular degeneration or dry eye syndrome.” Fish-free sources of omega-3 fatty acids are eggs, flaxseed oil, walnuts, dark leafy greens and tofu. - Try eye warmers
Ezra is a fan of warm eye compresses. “Not only do they relax the area, the warmth helps re-liquefy the oils in the natural tear film.”
Try Spacemasks, £16.50, or go hi-tech with the Peep Club Heated Eye Wand Pro – Nickel Free, £75. The chunky pen has a smooth metal tip - this latest one is nickel-free to service those allergic to nickel – that heats up to a comfortable warmth while also emitting healing red light and pleasantly buzzy micro-vibrations. It’s an eye spa in a stick, and a real lifesaver for dry eye sufferers.
- Do some eye yoga
Take a break well away from your screen every hour. Look at a distant object 20 feet away, for 20 seconds every 20 minutes (the 20-20-20 rule) for a quick dose of eye rest says In addition, says Shah-Desai.
Eye yoga is very effective. GTG’s editorial director and yoga teacher Victoria Woodhall demonstrates it on Instagram @victoriawoodhall. "It's a traditional practice that exercises the eye muscles by moving your gaze in all directions as you follow your thumb. I use it all the time as a screen break," she says.
The best dry eye drops for dry eye
Of course, hydrating eye drops area great help but they have to be the right sort: “You must make sure they are preservative-free, so look for products that mention this specifically,” says Cross-Alexander. Preservatives, if used regularly, can make damage the eye surface and make dry eye worse. “This is well-known among experts, yet many drops still contain them.”
'Whitening’ drops are another no-no, as they will irritate already-sore eyes. We love:
The eye doctor drops for all concerns MTHK Eye Drops, £15.99
MTHK is a leading eye doctor-led brand dedicated to alleviating sore eyes; the co-founder Prof Marcus Fruttiger is a professor of ophthalmology working at UCL and Moorfields Eye Hospital in London. The brand also makes eye vitamins and a brilliantly soothing eye spray, that our Editorial Director Victoria Woodhall uses nightly for menopausal dry eye. Preservative-free and contact lens-friendly, this hyaluronic acid and electrolytes in a comfortingly viscous formula. MTHK incidentally stands for Making Technology Human Kind.
The spray that's also an eye serum Peep Club Instant Relief Eye Spray, £15
This mist loved by Trinny Woodall (she uses it on transatlantic flights) has hyaluronic acid to add moisture with a lipid (sea buckthorn oil) to lock the water in – just like the natural tear film. It can be sprayed on closed eyes (it’ll seep under the lids) and is a great moisturiser for the skin around your eyes. and it’s preservative-free.
Antimicrobial for lids and lashes: Purifeyes Professional Spray, £11.95 for 100ml
Not strictly an eye drop but a great relief for sore, dry eyes nonetheless, this antimicrobial, pH-balanced hypochlorous mist serves as a cleanser, hydrator and microbiome-restorer for the eyeballs and well as eye skin. It’s the equivalent of Clinisoothe Skin Purifier, £14.95, but formulated specifically for the eyes.
Can you cure dry eyes permanently?
Being scrupulous about the above eye health strategies should relieve dry eye considerably, but you’d have to keep at it or the syndrome will come back. There are some professional treatment options that should further help keep dry eye at bay at make it less problematic, but you can’t quite cure dry eye permanently so the right lifestyle strategies remain essential.
- Eye plugs
‘Punctual plugs’, are literally tiny plugs used to temporarily block the opening of the tear ducts (which drain eye fluid) to allow tears to be retained on the eye surface. Shah-Desai performs the procedure but “they are routine on the NHS as well.” - Eye acupuncture
Dry eye has been clinically proven to be alleviated by acupuncture sessions. “The condition has a lot to do with inflammation,” says Laura Lewis, practitioner at London acupuncture clinic Pricc , which collaborated with Peep Club last year to offer a special treatment focused on dry eye. - “Research shows acupuncture stimulates our vagus nerve to trigger the adrenal glands to release dopamine, taming the activity of inflammatory molecules.” It means a course of treatment could liberate you from a dependence on eye drops. The Peep Club collaboration is currently not available, but regular acupuncture sessions are equally effective and cost from £45.
- Eye laser
OptiLight by Lumenis, £1600 for a course of 3, is an IPL device that delivers “precise pulsed light of high intensity to the closed eyelids to improve eye, lid and lash health, and is the first and only IPL system that’s FDA-approved for dry eye management,” says Murthy.
Three (painless) treatments are required for eyes, taking about 10 minutes each and spaced two to three weeks apart, with one annual session for maintenance. “It destroys the overgrowth of the mites that promote inflammation and re-sets the eye microbiome, so reducing the symptoms of dry eye disease,” she explains. “The heat from the light also liquefies the lipids in the tear film so they flow more easily.” Excitingly, the treatment is proven to promote regeneration of the lipid-excreting Meibomian glands, so this could indeed free you from dry eye disease long-term.