Fact: Dry, irritated eyes can be incredibly uncomfortable (IYKYK). If your eyes sometimes feel parched, inflamed, or otherwise irritated, you're not alone: dry eye and eye irritation in general is super common. The National Eye Institute reports that roughly 16 million Americans deal with dry eye regularly, and that's often behind eye irritation. "If you have dry eye, your eyes may feel itchy, gritty, or have a burning sensation," explains Diane Hilal-Campo, MD, a board-certified ophthalmologist. "They may water or appear red, and it may be uncomfortable to wear contact lenses." Your vision may also be blurry, especially at night, she adds.
But how can you tell what is actually causing your symptoms -- and what you can do to alleviate them? We chatted with top eye doctors to determine the most surprising causes of eye dryness and irritation (um, did you know that birth control can affect your eyes?!) and how to treat it, so you can get your eye health back on track.
Why this happens: "When we focus on a device, such as the TV or computer, our blink rate significantly decreases," says Refresh partner Priya Mathews, MD. "Therefore, our tear layer will easily evaporate, resulting in dry eye symptoms."
How to tell if screen time is to blame: If you notice that your vision becomes progressively blurry and/or starts fluctuating after using screens, it's possible that screen time could be triggering your dry eye symptoms, says Dr. Mathews. "Some people report that their vision becomes blurry or eyes are tired after a few hours at work, which can become worse if untreated," she adds.
How to deal with it: The first step is to reduce or minimize your screen time. Try incorporating frequent breaks into your routine. "Think about the 20/20/20 rule," Dr. Mathews says. "Every 20 minutes, look at an object 20 feet away for 20 seconds."
The second step is to treat your dry eye with either over-the-counter preservative-free artificial tears or prescription eye drops if needed, suggests Dr. Mathews. On your laptop all day for work? Get a desktop humidifier to help keep the air (and your eyes) moist, Dr. Hilal-Campo says. You should also adjust your screen settings to reduce brightness, adds Meenal Agarwal, OD, an optometrist in Ontario and the host of the podcast "Uncover Your Eyes With Dr. Meenal." "When you lower the brightness, it can reduce glare/contrast, decrease blue light exposure, and increase comfort," Dr. Agarwal explains. "This makes it easier for your eyes to focus and blink regularly which helps with dryness."
You're probably well aware that antihistamines and decongestants can give you dry eye (after all, their job is to dry everything up!). But there are a few other medications, like antidepressants, hormonal birth control, blood pressure meds, and Accutane (isotretinoin), that can lead to dry or irritated eye too, Dr. Hilal-Campo says.
Why this happens: "These medications can cause dry eyes because they often reduce tear production, either by affecting tear glands directly or by altering the body's fluid balance," Dr. Agarwal explains. Here's a rundown of how each of these medications can affect your eyes, according to Dr. Hilal-Campo:
How to tell if a medication is to blame: If you've recently started on any of these medications and have noticed increased dryness in your eyes within the first few months, then there's a chance the med could be a contributing factor to your dry eye, Dr. Agarwal says.
How to deal with it: First things first: Don't stop taking your meds, says Dr. Hilal-Campo. Always speak with your eye doctor, who can "collaborate with the healthcare professional who prescribed your medication to determine if it's safe to change the type or reduce the dosage," Dr. Agarwal says.
If switching up the type of medication or the dosage isn't an option, then your eye doctor will proceed with treatment for your dry eyes, Dr. Agarwal says. This may include OTC preservative-free artificial tears and possibly prescription drops as well, Dr. Mathews explains.
The National Eye Institute notes that women are more at risk for developing dry eye, due to the hormonal fluctuations they experience at different points in their lives. A small 2019 study published in The Ocular Surface found that estrogen fluctuations during the menstrual cycle could affect your eyes -- but most notably, this symptom occurs during menopause, says Dr. Hilal-Campo.
Why it happens: "Hormones such as estrogen and progesterone play an important role in maintaining the health of your eye," Dr. Mathews says. "When these levels change or decrease, they can affect tear production and meibomian gland function, which produces lipids that are needed for the tear film."
How to tell if hormonal fluctuations are to blame: Pay attention to how you feel throughout your cycle. "You may notice an increase in your dry eye symptoms during hormonal changes," Dr. Agarwal says. "As other systems in your body are affected by these hormonal shifts, your dryness may also worsen."
How to deal with it: "Talk to your primary care doctor or gynecologist about your other symptoms related to your hormone levels changing to determine if you need any other systemic treatment," Dr. Mathews recommends. For hormonal fluctuations that happen during your menstrual cycle or because of hormonal BC, lifestyle modifications (such as using a humidifier to add moisture to the air and using OTC or Rx eye drops) may help ease your dry eye.
For age-related hormonal shifts that occur leading up to and during menopause, Dr. Hilal-Campo says using OTC preservative-free tears four times a day can help. "Additionally, there are over-the-counter thick gel-like drops that can be used before bed that mimic the effect of the meibum layer or a Vaseline-like nighttime lubricating ointment that can help provide comfort and relief," she says.
Many autoimmune diseases, including rheumatoid arthritis, lupus, thyroid disorders, and Sjogren's syndrome, can leave you with a case of dry eye or eye irritation, says Dr. Hilal-Campo. Other chronic conditions, such as diabetes, can also contribute to symptoms, Dr. Mathews adds.
Why it happens: "Autoimmune diseases cause inflammation throughout the entire body, which can affect your body's ability to produce tears or expel meibum," Dr. Hilal-Campo explains. "Diabetes also causes inflammation that can inhibit tear or meibum output, as well as cause nerve damage to the vessels that help produce tears."
How to tell if a chronic condition is to blame: For starters, you should always work with your primary care provider and eye doctor to get a proper diagnosis, Dr. Hilal-Campo says. You may notice that your dry eye gets worse whenever you experience a flare-up of your autoimmune disease -- this could be a sign your dry eye is being caused by your condition, Dr. Agarwal says.
How to deal with it: Talk to the doctor treating the disease (if you have an autoimmune disease, that'd be a rheumatologist) and your eye doctor to come up with the proper treatment plan, Dr. Mathews says. Ultimately, you need to treat the primary disease to get symptoms such as dry eye to improve, she says.
"Additionally, your eye doctor may recommend topical eye drops for localized treatment, including preservative free artificial tears or prescription eye drops," Dr. Mathews adds. Staying hydrated and placing a humidifier on your desk or next to your bedside may also help alleviate dry eyes, says Dr. Hilal-Campo.
Research shows one of the most common nutritional deficiences in the US, vitamin D, may be associated with dry eye. Many Americans also don't get enough omega-3 -- and the National Institutes of Health (NIH) says this can contribute to dry eyes too. Vitamin A deficiency is also correlated to dry eye -- however, it's now extremely uncommon in the developed world, reports the World Health Organization.
Why it happens: Nutrients such as vitamin D and omega-3 help support many functions in your body, including your eye health. Vitamin A, meanwhile, helps protect your cornea and helps your eyes produce tears that keep your eyes moist, says Dr. Hilal-Campo. On the flip side of this, "Nutritional deficiencies can cause inflammation and reduce tear production and quality," Dr. Agarwal explains.
How to tell if a nutritional deficiency is to blame: Your medical doctor can measure vitamin and nutrient levels in your blood with a blood test, Dr. Hilal-Campo says. "If you're experiencing dry eyes along with other symptoms like fatigue, weakness, poor appetite, hair loss, or changes in night vision, it could indicate a nutritional deficiency," adds Dr. Agarwal. "It's also helpful to assess your diet to ensure you're consuming enough nutrients."
How to deal with it: Your eye doctor will collaborate with your primary care provider to recommend dietary changes, supplements, and appropriate treatments for dry eye, Dr. Agarwal says. The plan that works best for you will depend on your unique nutrient deficiencies.
Per the NIH, dietary sources of vitamin D include fatty fish skin, egg yolk, and foods that are fortified with this vitamin, including milk and some breakfast cereals. Foods high in omega-3 fatty acids include chia seeds, flaxseeds, salmon, and walnuts.
And while vitamin A deficiency is super rare, eating foods high in this nutrient can still help support your overall eye health. According to the NIH, vitamin A-rich foods include sweet potato, spinach, egg, salmon, and, of course, carrots.
According to Harvard Medical School, over time, chronic stress can raise your blood pressure, make it harder to sleep, and contribute to mental health conditions like anxiety and depression. Something else stress can do? Cause dry eye, Dr. Agarwal says.
Why it happens: When you're stressed, your body releases the hormones cortisol and adrenaline as part of its "fight-or-flight" response -- and this can impact your eyes in myriad ways, according to the American Academy of Ophthalmology. For example, stress can lead to decreased tear production and increased inflammation due to the increased cortisol and adrenaline, Dr. Agarwal says.
How to tell if stress is to blame: Per the American Academy of Ophthalmology, you may experience a variety of eye-related symptoms due to stress. So, if in addition to dry eye you notice eye twitching, blurry vision, or eye strain, it's possible that stress could be the culprit. In most cases, Dr. Agarwal says dry eye caused by stress is temporary and should resolve once you alleviate your stress.
How to deal with it: "Your best course of action is visiting your eye doctor to ensure your dry eye signs and symptoms are treated appropriately," Dr. Agarwal says. The American Academy of Ophthalmology suggests trying OTC preservative-free artificial tears or asking your eye doc for prescription drops, using a warm compress on the eyes, and massaging your eyelids. "It's also important to manage your stress levels by acknowledging your triggers and finding ways to cope," Dr. Agarwal adds. She says exercise, meditation, and/or seeking help from a mental health professional may be solutions.