Let’s face it: We take our eyes for granted. In fact, when we’re seeing clearly and not feeling any discomfort, we usually don’t give them a second thought.

But there are times when they make their presence known — and your life miserable — particularly if you’ve got a condition known as dry eye. The symptoms, as sufferers can tell you, range from pretty unpleasant to just plain painful: irritation, a gritty or burning feeling, excess watering and blurred vision.

Ideally, our eyes work like a well-oiled machine (literally). Tears are made up of three layers. The layer closest to the cornea is a thin mucus that helps tears adhere to the surface. The middle layer contains the watery portion of the tears. The outer layer is composed of fatty oils. A proper mix helps maintain healthy tears, which coat and lubricate the eyes, nourish cells, wash away dust and other irritants to ward off infection, and keep the surface smooth so you can see clearly.

Simply put, dry eye syndrome happens when your eyes aren’t making adequate tears. “It could be that the lacrimal gland isn’t making enough of the liquid part of the tears, or it could be there’s not a sufficient oil layer to keep tears from evaporating on the surface of the eye — a more common condition known as evaporative dry eye,” says Sarah Dougherty Wood, an optometrist and assistant professor at the Kellogg Eye Center at the University of Michigan. Sometimes you can have both problems.

Also, as we age, we’re more likely to have medical conditions that can impact our tear function, triggering dry eye — among them, systemic autoimmune diseases (such as rheumatoid arthritis and lupus), as well as diabetes, strokes and thyroid problems. Pharmaceutical usage also increases as we age, and some medications can affect tear gland function, contributing to dry eye. They include antihistamines, decongestants, blood pressure medications, antidepressants and anti-anxiety medication, and hormone replacement therapy to relieve symptoms of menopause.

The good news? “In general, dry eye tends to be a chronic and doesn’t go away completely. But it’s usually a manageable condition,” says Sarah Nehls, a Madison, Wisc.-based ophthalmologist and associate professor at the University of Wisconsin School of Medicine and Public Health.

A few ways to treat dry eye

5. Use over-the-counter eyedrops

Mild cases of dry eye can often be managed using artificial tear solutions and lubricating eye drops to supplement natural tear production. But with pharmacy shelves crowded with options, finding the right one for you may not be that easy.

Some OTC drops come in multidose bottles and contain preservatives to keep bacteria from growing once the bottle has been opened. These drops can be used several times a day, as needed, to increase tear volume. “Sometimes people have to use a lot of teardrops, and the preservatives can start to irritate their eyes, which is counterproductive,” Wood says. Preservative-free drops — which come in little vials that can be tossed after each use — contain fewer additives, so they’re less likely to irritate the eyes. If you use artificial tears more than, say, four times a day, this may be the smarter choice.

Artificial tears with low viscosity are light and watery and often provide fast relief. But because that soothing effect is short-lived, you'll probably use them frequently. Artificial tears that have a high viscosity have a more gel-like consistency. They stick around on the surface of the eye longer and provide longer-lasting lubrication. A caveat: “Typically, these drops cause blurring of the vision temporarily after you apply them,” Nehls says. “For this reason, they are recommended for bedtime use, to moisturize your eyes while you sleep.”

How Your Doctor Can Help

If you’re suffering from chronic dry eye, your doctor can offer a wide range of treatments to help keep your eyes healthy and comfortable. 

• They include prescription drops such as Restasis or Xiidra (which can be used instead of OTC artificial tears or gels and ointments, or in addition to them) and tiny punctal plugs that are inserted into the tear duct (puncta) in the inner corners of the eyes to keep natural tears on the surface of the eyes longer.
• Another physician-assisted option for people with moderate to severe symptoms is Lacrisert, in which “little pellets filled with a lubricating agent are placed into the lower pockets of the eye,” Nehls says. “They slowly dissolve over the course of the day, releasing moisture throughout the day onto the eye surface.”
• Or your doctor might suggest softening your meibomian glands — tiny glands located in the eyelids that secrete oils onto the surface of the eyes in order to keep the tears from evaporating too quickly. “The glands are supposed to be like an olive oil consistency coming out, but some patients will get inflammation, which causes the oil to thicken to a toothpaste consistency. So it doesn’t want to come out on its own,” Wood says. “This results in a deficient oil layer."
• If you want to try to soften the oil glands yourself, warm a wet washcloth or compress in the microwave, then place it over your eyelids for about five minutes. If that doesn’t do the trick, your eye doctor may discuss different in-office procedures that squeeze, massage or otherwise treat the glands in order to release the moisture you need.