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Dry Eye Syndrome: Causes and Treatment

Dry eye syndrome is one of the most common reasons for an eye-doctor visit — and one of those conditions whose scale is systematically underestimated, because many people treat burning, tired eyes as an unavoidable side effect of screen work. In reality there are far more causes, from natural aging to autoimmune diseases like Sjögren's syndrome, and treatment success depends heavily on correctly identifying the cause, not just relieving symptoms with artificial tears.

KLdr Katarzyna LewandowskaSeptember 16, 202613 min read
Table of contents

TL;DR — key takeaways

A widespread condition, rarely taken seriously

Dry eye disease (DED) is a chronic disease of the ocular surface resulting from an insufficient amount or improper quality of the tear film, leading to its instability, irritation of the eye's surface, and symptoms such as burning, a gritty feeling under the eyelids, redness, sensitivity to light, and, paradoxically, sometimes even excessive tearing as a defensive reaction to irritation.

The scale of the problem is larger than the number of actual diagnoses in eye clinics might suggest — many people with mild or moderate symptoms never seek help, treating dry eyes as an unavoidable consequence of working at a computer, aging, or simply "tired eyes," rather than as a condition that can and should be diagnosed and treated.

TFOS DEWS II Epidemiology Report

Strong evidence

Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F et al. · The Ocular Surface · 2017

This epidemiology report, prepared by an international expert panel as part of the second Tear Film & Ocular Surface Society Dry Eye Workshop (TFOS DEWS II) report, summarized data from numerous population-based studies worldwide. The prevalence of dry eye disease ranged from 5% to 50% depending on the diagnostic criteria used and the population studied, with the prevalence of both symptoms and objective clinical signs clearly increasing with age, and women showing a higher prevalence than men, especially after menopause.

View study

Why there are more causes than just "not enough tears"

Dry eye disease is traditionally divided into two main, partly overlapping types: aqueous-deficient dry eye, resulting from insufficient tear production by the lacrimal glands, and evaporative dry eye, most often caused by dysfunction of the meibomian glands responsible for producing the lipid layer that, under normal conditions, prevents the tear film from evaporating too quickly. In clinical practice, many patients have elements of both mechanisms.

The most common causes and risk factors for dry eye syndrome

  • Natural aging — tear production and tear-film quality decline with age, and hormonal changes after menopause further intensify this process in women
  • Prolonged use of digital screens — computers, smartphones, tablets — associated with significantly less frequent and incomplete blinking
  • Autoimmune diseases, primarily Sjögren's syndrome, but also rheumatoid arthritis and systemic lupus erythematosus
  • Certain medications — antihistamines, antidepressants, beta-blockers, isotretinoin, some hormonal drugs — which can reduce tear production as a side effect
  • Meibomian gland dysfunction, often associated with chronic inflammation of the eyelid margins
  • Long-term contact-lens wear, especially with improper hygiene or excessively long wearing time
  • Dry, air-conditioned or heated rooms, wind, and tobacco smoke as environmental factors intensifying tear evaporation
  • Corneal eye surgery, including some vision-correction procedures, which can temporarily or permanently disrupt corneal innervation affecting tear production

Screen time — what the research actually shows

The link between time spent in front of screens and dry-eye symptoms is one of the most frequently repeated, but also relatively well-supported, risk factors found in observational research, particularly relevant in the context of remote and office work.

Prevalence of dry eye disease in visual display terminal workers: a systematic review and meta-analysis

Moderate evidence

Courtin R, Pereira B, Naughton G, Chamoux A, Chiambaretta F, Lanhers C, Dutheil F · BMJ Open · 2016

A meta-analysis covering 16 studies and a total of 11,365 people working with display screens found an overall prevalence of dry-eye symptoms of 49.5% (95% CI 47.5-50.6%), with large variation between studies (from 9.5% to 87.5%) mainly due to inconsistent diagnostic criteria used across the primary studies. The authors emphasized that because of this heterogeneity, the single figure (49.5%) should be treated as indicative rather than a precise epidemiological measure.

View study

The mechanism linking screens with dry eyes is mainly associated with reduced blink frequency and incomplete eyelid closure during focused visual work — blinking can decrease several-fold relative to resting values, which shortens the time in which the tear film is renewed on the eye's surface and promotes its faster evaporation.

Practical ways to reduce screen-related symptoms

  • The 20-20-20 rule: every 20 minutes of screen work, look at an object at least 20 feet (about 6 meters) away for 20 seconds
  • Conscious, full blinking at regular intervals during longer computer work
  • Positioning the monitor slightly below eye level, which reduces the eyelid opening width and the tear-film surface exposed to evaporation
  • Humidifying the air in the room, especially with air conditioning or heating
  • Regular breaks from close-up visual work, not only for the eyes but also for general work hygiene

Sjögren's syndrome — when dry eye is a symptom of autoimmune disease

In some patients, chronic dry eyes aren't an isolated ophthalmological problem but one of the symptoms of Sjögren's syndrome — a chronic autoimmune disease in which the immune system attacks the exocrine glands, primarily the lacrimal and salivary glands, leading to dryness of the eyes and mouth as the main symptoms (so-called sicca syndrome).

Sjögren's Syndrome: More Than Just Dry Eye

Moderate evidence

Akpek EK, Bunya VY, Saldanha IJ · Cornea · 2019

This narrative review indicates that about 1 in 10 patients with clinically significant, aqueous-deficient dry eye is found, upon further workup, to have Sjögren's syndrome. The authors emphasize that the disease remains substantially underdiagnosed — on average, many years pass between the first symptoms and a correct diagnosis — and unrecognized Sjögren's syndrome can lead to more serious eye complications, including corneal damage, as well as systemic complications such as lymphoma.

View study

When to suspect Sjögren's syndrome rather than just "regular" dry eye

It's worth considering further workup for Sjögren's syndrome if dry eyes are accompanied by chronic dry mouth (difficulty swallowing dry foods, needing to drink liquids with meals), swollen salivary glands, chronic fatigue, and joint pain, especially in middle-aged women, in whom the disease occurs much more often than in men. Diagnosis usually requires collaboration between an ophthalmologist and a rheumatologist, along with appropriate serological tests (anti-Ro/SSA, anti-La/SSB antibodies) and sometimes a minor salivary gland biopsy.

Artificial tears — the foundation of treatment, but not always enough

Artificial-tear preparations (lubricating drops) remain the first-line treatment for mild and moderate cases of dry eye syndrome, regardless of the exact cause — they relieve symptoms by supplementing and stabilizing the tear film. Preservative-free formulations are generally preferred for frequent use (more than 4-6 times a day), since preservatives in drops can themselves further irritate the eye's surface over time.

Myth

Artificial tears are an effective treatment for dry eye syndrome for every patient — you just need to find the right formulation and use it regularly.

Fact

In patients with moderate to severe disease, especially when chronic inflammation of the eye's surface plays a significant role (typical, for example, in Sjögren's syndrome), artificial tears alone often merely mask the symptoms without addressing the underlying inflammatory mechanism. In such cases, anti-inflammatory medications like topical cyclosporine may be needed, and the decision to start such treatment is best made by an ophthalmologist after assessing the severity and type of disease.

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Cyclosporine — what the registration trials showed

Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease

Strong evidence

Sall K, Stevenson OD, Mundorf TK, Reis BL (CsA Phase 3 Study Group) · Ophthalmology · 2000

Two multicenter, randomized, double-blind, vehicle-controlled trials enrolled a total of 877 patients with moderate to severe dry eye disease, comparing cyclosporine A ophthalmic emulsion (0.05% and 0.1%) with vehicle alone over 6 months. Groups treated with cyclosporine showed statistically significant improvement in objective ophthalmological parameters (including corneal fluorescein staining and Schirmer test) compared with the control group, leading to the drug's approval for treating chronic dry eye disease associated with inflammation-related suppression of tear production.

View study

Cyclosporine works differently from artificial tears

Strong evidence

Unlike artificial tears, which only supplement missing fluid, topical cyclosporine acts as an anti-inflammatory, suppressing the local immune response that contributes to damage of the lacrimal glands and eye surface. The clinical effect usually appears gradually, often only after several weeks to a few months of regular use — worth discussing with the patient before starting therapy, to avoid premature discontinuation due to lack of immediate improvement.

Other treatment options when response is insufficient

Additional treatment methods for moderate and severe cases

  • Punctal plugs — temporary or permanent closure of the tear ducts, extending the time tears remain on the eye's surface
  • Warm compresses and eyelid-margin hygiene for coexisting meibomian gland dysfunction
  • Topical autologous serum drops for patients with severe disease resistant to standard treatment
  • Moisture-chamber glasses or inserts for people with strong exposure to wind or dry air
  • Treating the underlying disease (e.g., appropriate rheumatological therapy for confirmed Sjögren's syndrome), which can also indirectly ease ocular symptoms

A separate category worth mentioning is omega-3 fatty acid supplementation, whose effectiveness in treating dry eye was the subject of a separate, large randomized trial — we cover it in more depth in our article on omega-3 and dry eye syndrome, where we discuss, among other things, the DREAM trial and its surprisingly null result. It's worth treating as a supplement to this text if you're specifically interested in the supplementation question rather than the general clinical picture of the disease.

When to see an eye doctor

Signals requiring an eye-doctor consultation

It's worth scheduling an eye-doctor visit if dry-eye symptoms persist despite regular use of over-the-counter artificial tears for several weeks, if they're accompanied by pain (not just discomfort), a significant decline in visual acuity, strong light sensitivity, or redness that doesn't improve with rest. Urgent consultation is needed for symptoms suggesting corneal damage (severe pain, a foreign-body sensation, sudden vision loss) as well as coexisting chronic dry mouth, swollen salivary glands, or joint pain, which may point to an autoimmune disease requiring broader workup.

QuestionShort answer
How common is dry eye syndrome?Very — from 5% to 50% depending on criteria and population, according to the TFOS DEWS II report
Do screens really matter?Yes — a meta-analysis found roughly 49.5% symptom prevalence among screen workers
Is it always a mild condition?Not always — in some patients it's a symptom of Sjögren's syndrome or another autoimmune disease
Are artificial tears always enough?Not in moderate and severe cases with an inflammatory component — cyclosporine can help there
When should I see a doctor?When symptoms don't improve after several weeks of self-treatment, or are accompanied by pain, strong redness, or dry mouth

Dry eye syndrome at a glance

Our editorial recommendation

Dry eye syndrome is a good example of a condition that's both widely minimized and genuinely underdiagnosed — many people accept chronic discomfort as an unavoidable cost of computer work, instead of considering whether the cause might lie elsewhere, including in a systemic disease requiring entirely different treatment than eye drops.

A stepwise approach — from modifying screen and environmental habits, through artificial tears, to anti-inflammatory medication in persistent cases — remains a reasonable path, as long as it's accompanied by vigilance for symptoms suggesting something more than ordinary eye fatigue, such as dry mouth or joint pain.

Dry eye is rarely a problem of the eyes alone — more often it's a signal the body is sending, and the doctor's role is to recognize when that signal calls for just drops, and when it calls for much broader diagnostic workup.

dr Katarzyna Lewandowska, VitMode editorial team

Frequently asked questions

It depends on the cause — dryness related to reversible environmental factors (e.g., excessive screen time) often responds well to habit modification, while chronic forms related to age or autoimmune disease usually require long-term symptom-control treatment rather than a one-time cure.

Not necessarily, but with pronounced symptoms it's worth consulting an eye doctor about switching to a different type of lens (e.g., with higher oxygen permeability or a different material), shortening wear time, or a temporary break from lenses during more intensive treatment.

In registration trials, significant improvement in objective parameters was visible after several weeks to a few months of regular use — the effect isn't immediate, which is important information for patients starting therapy, so they don't stop it prematurely because of a lack of quick improvement.

No — most dry-eye cases aren't related to Sjögren's syndrome. Available data suggest this applies to about 1 in 10 patients with clinically significant, aqueous-deficient dry eye, though it's worth considering this possibility when there's coexisting dry mouth, joint pain, or chronic fatigue.

With occasional use they're usually not a problem, but with frequent use (more than a few times a day) preservatives, especially benzalkonium chloride, can further irritate the eye's surface over time. If frequent use is necessary, it's worth choosing preservative-free formulations.

This is a topic we cover in more depth in a separate article on omega-3 and dry eye syndrome — in short, results from the large DREAM trial were surprisingly negative relative to placebo, which shows that even a well-reasoned mechanistic hypothesis doesn't always hold up in a rigorous clinical trial.

Yes, though prevalence clearly rises with age. In younger people, the most common cause is intensive use of digital screens and the associated less frequent, incomplete blinking, rather than the chronic diseases typical of older patients.

Sources

KL

dr Katarzyna Lewandowska

Specialist physician in cardiology, cardiovascular-prevention consultant

Katarzyna works as a cardiologist at a Warsaw teaching hospital and has spent years focused on cardiovascular prevention — trying, as she puts it, to convince people to change their habits before they end up on her ward, not after. She joined VitMode after a series of conversations with Anna at a lifestyle-medicine conference, where the two discovered they shared the same frustration: an internet full of contradictory claims about cholesterol, aspirin and heart supplements, with no clear signal of what's actually backed by research. She reviews content on cardiovascular health, lipid panels and pharmacological prevention, consistently distinguishing what helps a statistical population from what makes sense for a specific person. Off duty, she road-cycles — not for performance, but because, in her words, it's hard to write credibly about prevention without practicing it yourself.

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Comments (2)

  • KW

    Kasia W. 2 weeks ago

    Very clearly explained, especially the interactions section — I hadn't seen it laid out this well anywhere else.

  • MT

    Marek T. a month ago

    Are you planning to update this with the newest study from this year? I saw an interesting meta-analysis.