Eye health doesn’t begin and end with crystal clear vision. There are plenty of issues that can affect your eyes and make you miserable—even when they don’t ultimately steal your sight.
In fact, there’s one staggeringly common condition that often gets overlooked. Which is why I want to devote some time and attention to it today.
I’m talking about chronic dry eye disease. And despite the fact that you don’t hear much about it, there’s plenty you can do to combat this uncomfortable—and at times, debilitating—condition.
A clinical picture of chronic dry eye
Chronic dry eye is an incredibly complex condition that can dramatically affect your quality of life. In fact, research has shown it’s on par with dialysis when it comes to self-reported impact on quality of life.
And it’s important to note that when we use the term “dry eye,” we’re talking about more than a physical lack of tears. In fact, the disease has more to do with the quality of your tears than the quantity. And the central factor here is something called “hyperosmolarity.”
In plain terms, hyperosmolarity means that your tears are too salty. This could be caused by increased tear evaporation or decreased tear secretion. But either way, the result isn’t always a feeling of “dryness.”
For many patients, it feels more like you have something stuck in your eye, even when you don’t. But other common symptoms include itching, burning, redness, or a little bit of discharge (though this is more typical of conjunctivitis). And surprisingly, another frequent complaint is watery eyes.
That’s because there are two types of tear production—basic and reflexive. The former refers to basal tear production, which is when lubricating, oily tears are secreted and continuously spread by the eyes. The latter refers to tears produced due to outside stimulus. These tears tend to be watery and less lubricating. And if you’re not producing enough of the first kind, you could find yourself with reflexive tears literally pouring out of your eyes in response.
This inflammatory tailspin causes damage to your eye’s cornea and tear film, both of which play important roles in eyesight. Which is why impaired vision that clears with blinking is another key feature of dry eye disease.
As you can imagine, these symptoms aren’t easy to live with. And while dry eye disease may not leave you blind, you can bet that it will affect your vision.
Dry eyes can strike at any age
You may have noticed that a lot of the above symptoms sound like allergies. That’s one of the main reasons why dry eye disease can be so hard to pin down. (Your eyes only have so many ways to “cry for help” after all—so it’s very easy to mistake one problem for another.)
But the real challenge with dry eye is that there’s no definitive diagnostic test. And even if you check all of the clinical boxes for the condition, you might not experience any symptoms… while someone without any of the key clinical features may experience plenty.
So let’s look at what we know.
Rates of dry eye increase by about 10 percent with each decade of life, which obviously makes older people more vulnerable.
But dry eye disease is also common among younger patients—and there are a handful of factors that put them at higher risk. Like contact lenses, which can disrupt the tear film and aggravate symptoms.
Refractive surgery (like LASIK) is another culprit behind chronic dry eye, despite its deceptively risk-free reputation. (And dry eye caused by refractive surgery is particularly tough to treat, due to the involvement of corneal nerves.)
Too much time spent on digital devices, like your smartphone or computer, is another common cause. As are lash extensions, eye makeup, or eyelid tattooing.
So at the end of the day, dry eye is really a syndrome that can affect anyone, at any age. The question is, what can you do about it?
The best solution is the most obvious one
There’s no “one-size-fits-all” treatment for dry eye. And sadly, no single approach is universally effective. In fact, many don’t work at all—even when they cost you a fortune.
Yes, there are prescription medications available. But I’ve never seen those treatments work particularly well.
You’re better off starting with more practical strategies. Like limiting your time in front of electronic screens, laying off the eye makeup, and switching from contact lenses to glasses. You can also do what I do, and squirt some lubricating drops into your eyes several times throughout the day.
But, the most basic—and effective—thing you can do to combat dry eye is to stay properly hydrated.
The common culprit behind chronic dry eye
Now, you may think you already drink plenty of water. But in reality, most Americans are chronically dehydrated. And if you have dry eyes, dehydration could be one very simple reason why.
So how much water do you actually need? I’m sure you’ve heard the “eight glasses a day” advice before. But the truth of the matter is, that may or may not be enough.
To set the record straight, you should be drinking half your body weight in ounces of water each day. So a 150-pound woman would need 75 ounces of water daily, as a rule of thumb.
And if you exercise, you need to drink more. For every 30 minutes you spend exercising, you should add another eight ounces to your daily intake.
I realize that may sound like a lot—but it doesn’t take long to make a habit of it. Drink a full glass first thing in the morning, before each meal, and before bed. That habit alone will make a big dent in your daily requirement.
You should also keep water with you at all times (or as much as you possibly can). And take a big sip every couple of minutes. By making these simple adjustments to your current routine, you’ll easily meet your daily quota.
Mother Nature to the rescue again
A very recent meta-analysis also found that fish oil might offer relief from dry eyes.
This study included 17 trials, featuring both men and women with dry eye disease caused by a range of issues.
A pooled analysis of all participants showed that omega-3 fatty acid supplementation delivered a significant reduction in dry eye symptoms—as well as clinical markers, like corneal abrasion, tear film integrity, and tear production—compared to placebo.1
And this isn’t the first research to suggest as much, either. Previous research has shown that women with the highest levels of dietary omega-3 intake cut their risk of dry eye by 20 percent. (It’s also worth noting that this study also found high intakes of omega-6 fatty acids—a key characteristic of the Standard American Diet—more than doubled the risk of chronic dry eye.)
I always recommend fish oil (3,000 mg of EPA/DHA)—along with 800 IU of vitamin E daily—to my patients with dry eyes. And incorporating more wild-caught, cold-water fish into your diet doesn’t hurt, either.
And one more thing: Don’t forget your vitamin D. Research suggests deficiency in this critical nutrient could also impair tear production and pave the way to dry eye.3
As always, I recommend at least 2,000 to 5,000 IU of vitamin D3 every single day. You may even need more. (I take as much as 10,000 IU daily, during the winter months in particular.)
The only way to be sure is to get your vitamin D levels tested regularly (at least twice a year). I like my patients to shoot for optimal levels around 80 nanograms per milliliter (ng/mL). And that’s what you should aim for, too—dry eyes or not.
- Giannaccare G, et al. “Efficacy of Omega-3 Fatty Acid Supplementation for Treatment of Dry Eye Disease: A Meta-Analysis of Randomized Clinical Trials.” Cornea. 2019 May;38(5):565-573.
- Schepens Eye Research Institute. “Dietary Fat Intake Linked To Dry Eye Syndrome In Women.” Science Daily, 10.24/2005. (www.sciencedaily.com/releases/2005/10/051024081947.htm)
- Yildirim P, et al. “Dry eye in vitamin D deficiency: more than an incidental association.” Int J Rheum Dis. 2016 Jan;19(1):49-54.