Dry Eye Syndrome: Symptoms, Causes & Treatment (2026)

Written by Dr. Kathryn Kline, MD, Board-Certified Family Medicine Physician | Medically reviewed by Dr. Casey Dean, DO | Trinity Family Medicine

Last medically reviewed: November 2026

About the author: Dr. Kline is a board-certified family medicine physician (ABFM) at Trinity Family Medicine who evaluates eye irritation, skin conditions, and women's hormonal health for patients across Texas through primary care and telehealth.

If your eyes burn by mid-afternoon, feel gritty like there's sand under your lids, or blur after an hour on a screen, you may have dry eye syndrome, also called dry eye disease. A 2017 study in the American Journal of Ophthalmology estimated that about 16.4 million U.S. adults (6.8%) have diagnosed dry eye disease. Women are affected nearly twice as often as men (8.8% vs. 4.5%). The right treatment plan starts with figuring out why your eyes are dry.

Quick Summary: Key Facts at a Glance

Classic Symptoms: Burning, stinging, grittiness, redness, and blurry vision that clears when you blink, often worse late in the day or after screen use.

Main Causes: Aging, female sex and menopause, screen time (which reduces blinking), contact lenses, dry or windy air, autoimmune disease, and medications such as antihistamines, antidepressants, and isotretinoin.

First-Line Treatment: Artificial tears, warm compresses and eyelid hygiene, screen breaks, and a review of medications that may be drying your eyes.

Frequent-Use Tip: The American Academy of Ophthalmology (AAO) generally recommends preservative-free tears if you use drops often and long-term (for example, more than four times a day).

When to See a Doctor: If over-the-counter drops don't help within a few weeks, a clinician can look for an underlying cause and discuss prescription options. Many first steps can start through telehealth.

Emergency Red Flags: Sudden vision loss, severe eye pain, strong light sensitivity, or a painful red eye in a contact lens wearer need same-day, in-person eye care.

Key takeaway: Dry eye is usually a chronic, manageable condition, and treatment works best when it targets the cause, whether that's fast tear evaporation, low tear production, eyelid inflammation, or a medication side effect.

Emergency warning: Sudden vision loss, severe eye pain, or a painful red eye with light sensitivity, especially if you wear contact lenses, can signal an infection or ulcer of the cornea (the clear front of the eye). Get seen in person the same day.

What Is Dry Eye Syndrome (Dry Eye Disease)?

Dry eye syndrome is a chronic condition in which your tears don't keep the surface of your eye properly lubricated, either because you make too few tears or because your tears evaporate too quickly. Doctors may also call it keratoconjunctivitis sicca. A problem with any of the tear film's three layers (oil, water, mucus) can leave the eye surface irritated and inflamed.

Doctors describe two main types, and many people have both:

Evaporative dry eye: The oil glands along your eyelid edges (meibomian glands) don't release enough healthy oil, so tears evaporate too fast. This is meibomian gland dysfunction (MGD). The AAO's 2023 Dry Eye Syndrome Preferred Practice Pattern (PPP) notes this type is far more common in clinics than pure low tear production.

Aqueous-deficient dry eye: The tear glands don't make enough of the watery layer. According to the AAO PPP, about 10% of people with clinically significant aqueous-deficient dry eye have Sjögren's syndrome, an autoimmune disease that also causes dry mouth.

What this means in plain English: "Dry eye" is several problems with one name, and your treatment should match your type.

What Are the Symptoms of Dry Eye?

The most common dry eye symptoms are burning, stinging, a gritty "something in my eye" feeling, redness, tired eyes, and blurry vision that clears when you blink. Symptoms often worsen late in the day, with screens, in wind or air conditioning, or with contact lenses. Surprisingly, constantly watery eyes can also be dry eye: an irritated surface triggers "reflex" tears that are mostly water and don't lubricate well.

What Causes Dry Eyes?

Dry eyes usually come from a mix of factors: older age, female sex and hormone changes, screen use, contact lenses, dry environments, eyelid gland problems, autoimmune disease, and certain medications. According to the AAO PPP, older age and female sex are the two major risk factors. Others include:

Screens. The AAO PPP states that more screen time may reduce your blink rate and worsen dry eye.

Menopause and hormones. Dry eye becomes more common after menopause. In the Women's Health Study, hormone therapy, especially estrogen alone, was linked to a higher risk of dry eye.

Contact lenses, LASIK, and eyelid conditions such as blepharitis (eyelid inflammation), Demodex mites on the lashes, and ocular rosacea.

Body-wide diseases. Sjögren's syndrome, rheumatoid arthritis, diabetes, and thyroid eye disease can all cause dry eye. Gritty eyes can be an early clue in Graves' disease and other overactive thyroid conditions.

Environment and smoking. Low humidity, heating, fans, vents, and smoke speed up evaporation.

Texas note: In winter, indoor heating and dry fronts lower humidity just as cedar fever season sends many people to oral antihistamines, which can dry the eyes further.

Which Medications Can Cause Dry Eyes?

Many common medications can cause or worsen dry eye, including oral antihistamines, antidepressants and anti-anxiety medications, diuretics, beta-blockers, oral isotretinoin, and some hormone therapies. The AAO PPP also lists heart-rhythm drugs, chemotherapy, and dupilumab. Mayo Clinic adds decongestants. Preservatives in eye drops can also irritate the eye with frequent use.

A family physician, such as Dr. Kline at Trinity Family Medicine, can review your full medication list and, when it's safe, discuss a dose adjustment or an alternative. If you take isotretinoin, see our guide to adult acne treatment options, including isotretinoin. Never stop a prescribed medication on your own.

How Can You Tell Dry Eye From Allergies or Pink Eye?

The main symptom is often the best clue: itching points to allergies, sudden discharge points to pink eye, and burning or grittiness that worsens late in the day points to dry eye. No single symptom proves the diagnosis. Allergic conjunctivitis, viral or bacterial pink eye, blepharitis, ocular rosacea, eye strain from an outdated glasses prescription, and nerve-related eye pain can all mimic dry eye or occur alongside it.

Feature	Dry eye	Allergic eye	Infectious pink eye
Main sensation	Burning, gritty, tired eyes	Itching is the hallmark	Irritation, crusting
Discharge	Watery or none; sometimes stringy mucus	Watery	Watery (viral) or thick (bacterial)
Pattern	Chronic; worse late in day, with screens or wind	Seasonal or after exposure	Sudden onset; often spreads to the other eye
Typical first step	Artificial tears, lid care, medication review	Antihistamine eye drops	Usually supportive care; see a clinician

See our guides to pink eye symptoms and when you need antibiotic drops and rosacea and ocular rosacea.

How Is Dry Eye Diagnosed?

Dry eye is usually diagnosed from your symptoms and history, and an eye exam confirms it; if symptoms are mild with no red flags, you usually don't need testing before trying artificial tears. The AAO supports a trial of artificial tears once other causes of irritation are ruled out.

Get checked further if:

Your symptoms persist despite steady treatment.

One eye is much worse than the other.

You also have dry mouth, joint pain, or rash, which can point to Sjögren's or another autoimmune disease.

You have thyroid symptoms, or you're considering LASIK.

An eye doctor can measure tear production (the Schirmer test) and check for surface damage with dye and a slit lamp (an eye microscope). If an autoimmune cause is suspected, a physician may order SSA/SSB antibody blood tests for Sjögren's.

How Is Dry Eye Treated?

The best dry eye treatment depends on the cause: most people start with artificial tears, eyelid care, environment changes, and a medication review, then add prescription therapy if those aren't enough. The AAO 2023 PPP describes a stepwise approach based on severity. The 2025 TFOS DEWS III report, from an international expert panel, instead recommends identifying the specific drivers of each person's dry eye and choosing matched treatments, often in combination. Either way, the goal is to control symptoms and protect the eye surface rather than "cure" a condition that is often chronic.

Step 1: Dry Eye Treatments You Can Start at Home

You can start easing dry eye at home with artificial tears, warm compresses, and better screen habits.

Artificial tears. A systematic review cited by the AAO found artificial tears safe and effective, with most brands performing similarly. Thicker gels blur vision, so use them at bedtime.

Preservative-free when you use drops often. According to the AAO 2023 PPP, preserved tears may be enough for mild dry eye. When you use tears frequently and long-term (for example, more than four times a day), preservative-free tears are generally recommended.

Warm compresses and lid hygiene. These help loosen thickened oil in the meibomian glands.

Screen habits. Take regular breaks, blink fully on purpose, and set your monitor slightly below eye level. In a small 2022 study, the "20-20-20" habit (every 20 minutes, look 20 feet away for 20 seconds) reduced symptoms over two weeks, though the benefit faded after people stopped.

Your environment. Use a humidifier, aim vents away from your face, and wear wraparound glasses outdoors.

Clinical pearl: If you're reaching for artificial tears more than four times a day, treat it as a signal, not just a habit. Switch to preservative-free drops and get evaluated, because frequent use can be a sign of an underlying cause worth finding.

Step 2: Prescription Dry Eye Treatments

When over-the-counter care isn't enough, several FDA-approved prescription options work in different ways. The AAO PPP notes that no FDA-approved dry eye drug has proven more effective than another in head-to-head trials. The choice depends on your dry eye type, preferences, and cost. (Tryptyr postdates the guideline, and Xdemvy is approved for Demodex blepharitis rather than dry eye itself.)

Your situation	Options commonly considered	Main trade-offs
Fast tear evaporation (oil-gland/MGD dry eye)	Perfluorohexyloctane (Miebo), FDA-approved May 2023; warm compresses; in-office gland treatments	Blurred vision or redness in about 1–3%; remove contacts first and wait 30 minutes
Ongoing inflammation, moderate dry eye	Cyclosporine (Restasis, Cequa); lifitegrast (Xiidra), FDA-approved 2016	Burning or stinging (17% with Restasis, 22% with Cequa in trials); Xiidra can alter taste; benefit builds over weeks to months
Low tear production, or trouble using drops	Varenicline nasal spray (Tyrvaya), FDA-approved 2021; acoltremon drops (Tryptyr), FDA-approved May 2025	Tyrvaya: sneezing is the most common side effect. Tryptyr: burning or stinging in about half of trial patients
Crusty "dandruff" at the base of the lashes (Demodex blepharitis)	Lotilaner (Xdemvy), FDA-approved July 2023	Stinging or burning in about 10%
Short-term flare	Loteprednol 0.25% (Eysuvis), FDA-approved for up to 2 weeks	Raises eye pressure and cataract risk; renewal requires an in-person eye exam

How much do these help? In two phase 3 trials of acoltremon summarized in its FDA labeling, 42.6% and 53.2% of users had a meaningful rise in tear production at day 14. On placebo, the figures were 8.2% and 14.4%. With cyclosporine 0.05%, the AAO reports a meaningful rise in tear production in 15% of treated patients vs. 5% on placebo at 6 months.

What this means in plain English: Prescription drops can help, but none works for everyone. Expect a trial period, and have your clinician review side effects first.

Step 3: Procedures for Persistent or Severe Dry Eye

If your dry eye remains moderate to severe despite treatment, an ophthalmologist (eye physician) or optometrist can offer in-office options. These include punctal plugs to keep tears on the eye longer, heat treatment of the oil glands, and serum eye drops made from your own blood. The AAO recommends timely referral when moderate to severe dry eye doesn't respond or a body-wide disease is suspected.

Do Omega-3 or Fish Oil Supplements Help Dry Eye?

The evidence on omega-3 supplements for dry eye is mixed, and the largest U.S. trial found no benefit. In the NIH-funded DREAM trial (New England Journal of Medicine, 2018), 535 people with moderate to severe dry eye took 3 grams of omega-3s or an olive-oil placebo daily for a year, and both groups improved about equally. The 2025 TFOS DEWS III review rated the overall evidence more favorably, but the best dose and source remain unclear. Supplements are not a substitute for proven therapy.

Can You Treat Dry Eye During Pregnancy or Breastfeeding?

Dry eye can usually be treated safely during pregnancy and breastfeeding, starting with preservative-free artificial tears. Evidence and risk differ from drug to drug, and FDA labeling for the newer prescription drops reports limited or no human pregnancy data. If you are pregnant, trying to conceive, or breastfeeding, review any prescription eye drop or nasal spray with your clinician first.

When Should You See a Doctor for Dry Eyes?

See a clinician if your dry eye symptoms last more than a few weeks despite artificial tears, interfere with reading, driving, or work, or come with dry mouth, joint pain, or thyroid symptoms. A physician can look for underlying causes and medication triggers, rule out look-alike conditions, and coordinate referral to an eye specialist when needed.

Get same-day, in-person eye care for sudden vision loss, severe eye pain, strong light sensitivity, a painful red eye in a contact lens wearer, or an eye injury or chemical splash.

At Trinity Family Medicine, a telehealth visit can assess whether your symptoms are consistent with dry eye, review contributing medications, and start a stepwise plan, with referral if you need a slit-lamp exam or procedure. Visits across Texas start at $49.99, no insurance required.

Book online or call 817-932-4022.

Frequently Asked Questions About Dry Eye

How can I tell if I have dry eyes or allergies?

Usually by the main symptom. Itching is the hallmark of eye allergies, while dry eye more often causes burning, grittiness, and tired eyes that worsen late in the day or with screens. The two can overlap, and oral allergy pills can worsen dry eye.

Can dry eye cause watery eyes?

Yes. An irritated eye surface can trigger bursts of reflex tears that are mostly water and don't lubricate well. So your eyes can feel dry and watery at once. Constantly watery eyes with burning or grittiness are a common, often overlooked sign of dry eye syndrome.

What are the best eye drops for dry eyes?

It depends on your type of dry eye. For most people, artificial tears come first, and most brands work similarly. The AAO generally recommends preservative-free tears if you use drops often and long-term, such as more than four times a day. If drops alone aren't enough, prescription options target evaporation, inflammation, or tear production.

Is dry eye syndrome permanent?

Sometimes. Dry eye caused by a medication, a dry environment, or another short-term trigger often improves once that factor is addressed. Dry eye related to aging, menopause, or autoimmune disease tends to be chronic, with symptoms that come and go.

Can a family doctor diagnose and treat dry eye?

Usually, yes, for most first steps. A family physician can evaluate your symptoms, look for medications or medical conditions that may be drying your eyes, recommend first-line care, and prescribe some treatments when appropriate. Specialized tear testing, slit-lamp exams, and procedures such as punctal plugs require an ophthalmologist or optometrist.

Can I get a dry eye evaluation through telehealth in Texas?

Yes. Trinity Family Medicine offers telehealth visits across Texas, starting at $49.99 with no insurance required. A board-certified family physician reviews your symptoms and medications, checks for red flags, and recommends treatment or in-person referral when needed. Sudden vision loss, severe eye pain, or a painful red eye needs same-day in-person care instead.

Conclusion

Dry eye syndrome is common and often chronic, but very manageable once you know what's driving it. If you use drops often, switch to preservative-free tears and get evaluated. Key takeaway: The most effective dry eye treatment targets the cause, and a medication review plus a stepwise plan can substantially reduce symptoms for many people.

References

Amescua G, et al.; American Academy of Ophthalmology Cornea/External Disease PPP Panel. "Dry Eye Syndrome Preferred Practice Pattern®" (approved September 22, 2023). Ophthalmology, 2024;131(4):P1–P49 aao.org/Assets/07558f65-8d1a-4b35-8350-3126f0d0fd01/638434228319570000/dry-eye-syndrome-ppp-pdf

Jones L, et al. "TFOS DEWS III: Management and Therapy Report." American Journal of Ophthalmology, 2025;279:289–386. doi:10.1016/j.ajo.2025.05.039 publications.aston.ac.uk/id/eprint/47669

Dry Eye Assessment and Management (DREAM) Study Research Group. "n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease." New England Journal of Medicine, 2018;378(18):1681–1690 pubmed.ncbi.nlm.nih.gov/29652551/

Farrand KF, et al. "Prevalence of Diagnosed Dry Eye Disease in the United States Among Adults Aged 18 Years and Older." American Journal of Ophthalmology, 2017;182:90–98 pubmed.ncbi.nlm.nih.gov/28705660

Pattar GR, et al.; COMET-2 and COMET-3 Study Groups. Acoltremon phase 3 trials. Ophthalmology, 2026;133(5):563–574 pubmed.ncbi.nlm.nih.gov/41038456/

Drugs.com. "FDA Approves Tryptyr (acoltremon) Eye Drops for Dry Eye Disease," 2025 drugs.com/news/fda-approves-tryptyr-eye-drops-dry-eye-125213.html

Drugs.com. "Xdemvy FDA Approval History," 2023 drugs.com/history/xdemvy.html

Ophthalmology Times. "Bausch + Lomb, Novaliq Announce FDA Approval of Perfluorohexyloctane Ophthalmic Solution," 2023 ophthalmologytimes.com/view/bausch-lomb-novaliq-announce-fda-approval-of-perfluorohexyloctane-ophthalmic-solution-for-treatment-of-dry-eye-disease

Talens-Estarelles C, et al. "The effects of breaks on digital eye strain, dry eye and binocular vision: Testing the 20-20-20 rule." Contact Lens and Anterior Eye, 2023;46(2):101744 pubmed.ncbi.nlm.nih.gov/35963776/

National Eye Institute. "Causes of Dry Eye." nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/dry-eye/causes-dry-eye

Mayo Clinic. "Dry Eyes: Symptoms and Causes." mayoclinic.org/diseases-conditions/dry-eyes/symptoms-causes/syc-20371863

This article is for educational purposes only and does not replace individualized medical advice, diagnosis, or treatment. Consult a qualified clinician about eye symptoms and before starting or changing any medication. Seek same-day in-person care for sudden vision loss, severe eye pain, or a painful red eye.

Medical Review Date: November 2026, by Dr. Casey Dean, DO, Texas Medical Board License T3065

Dry Eye Syndrome: Symptoms, Causes, and the Treatments That Actually Help