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What are Dry Eyes?
Dry eyes are more than just a temporary discomfort in your eyes. It’s where your tears can’t provide enough lubrication for your eyes.
There are 3 main reasons why you have dry eyes:
- Your tear glands are not producing enough tears
- Your tears glands are not producing tears of good quality
- There is excessive evaporation of tears from your eye surface
You might experience dry eyes on an airplane, in an air-conditioned room, or even after a long day of looking at your computer screen, among other situations.
So find out about the causes of dry eyes and its treatments below!
What are the symptoms of Dry Eyes?
You may be confused. What do dry eyes feel like? As the name suggests, you’ll feel that your eyes are dry and experience some discomfort. Some signs of dry eyes  include:
- Stinging / burning sensation in your eyes
- Mucus in or around your eyes
- Light sensitivity
- Blurry vision
- Difficulty wearing contact lenses
These signs will appear in both eyes and are an indication that you may be suffering from dry eyes.
One other symptom of dry eyes which you may find fascinating is that you may experience watery eyes at some point in time. What? How can my eyes be watery and dry at the same time? This ironic symptom is known as reflex tearing. It occurs when the lack of moisture irritates your eyes and triggers your body to respond with more moisture.
But the content of the tears released is mostly water, so it does not function like normal tears do. It does not double as a lubricant that coats the surface of your eyes and is only effective in helping to remove dust or irritants from your eyes.
Why do dry eyes occur?
There are many causes of dry eyes and while some may be due to uncontrollable circumstances, other causes can be prevented. Sometimes, you may only experience the symptoms of dry eyes during different parts of the day. Other times, existing medical conditions are linked to the development of your dry eyes condition.
Regardless, knowing the actual cause of your dry eyes is important so that your doctor can properly recommend a treatment to you. I recommend a comprehensive eye exam.
Some causes of dry eyes include:
Ageing. Dry eyes is considered a geriatric condition, where it becomes more common as you age. As you grow older, your eyes experience many changes. One such change is the deterioration of our tear production abilities.
Medication. Oil + water + mucus = tears. Certain medications, like isotretinoin, can reduce any one of these components. Some other drugs include antidepressants, diuretics, and beta-blockers used to treat hypertension.
For instance, antihistamines used to relieve nasal congestion can reduce mucus production in your body. Therefore, this affects tear production and plays a part in the development of chronic dry eyes.
- Screen time. In this day and age, more and more people are spending time on screens, especially people working on laptops or desktops.
This may surprise you, but people who work on computer monitors tend to blink less as compared to when they are reading print material. A decrease in blink rate by 30% to 50% tends to dry your eyes out .
- Exposure to smoke. Smoke can make your eyes dry out so it is best if you avoid smoky environments or take precautions if you can't avoid them.
If you smoke, ask your doctor how you can stop smoking. Alternatively, you can take up nicotine replacement therapy or take prescription medication.
- Eye operations. LASIK operations and cataracts surgery, if not done properly, can cause some cut cornea nerves, reducing corneal sensitivity.
As such, your eye might not sense the need for lubrication, and your eyes wouldn’t get the signal to release tears, causing inadequate lubrication in your eyes.
What are the causes of Dry eyes in the morning and at night?
As mentioned before, some patients may experience dry eyes or the worsening of the condition at different times of the day. This worsening is not random and there could be an underlying medical condition to explain this situation that you are facing.
1. Dry eyes in the morning
Have you ever wondered why you only experience dry eyes in the morning? Here is a reason why your dry eyes condition worsens when you wake up:
- Nocturnal Lagophthalmos. Simply put, your eyelids were not fully or tightly closed when you were sleeping, resulting in dry eyes when you wake up the next morning. About 20% of people have this benign condition.
The other causes of nocturnal lagophthalmos are primarily facial nerve weakness. The seventh cranial nerve is known as the facial nerve, and facial nerve weakness means your eyelids will not fully close when you are sleeping.
Facial nerve weakness can be caused by skull trauma, jaw trauma, injury to the cerebellar artery or Bell’s palsy. Bell’s palsy is a sudden but temporary facial muscle weakness which could in turn weaken the facial nerve.
While there are a few other reasons as to why dry eyes would occur in the morning, Nocturnal Lagophthalmos is usually the culprit. Causes such as the quality of tears and the amount of tears being produced are general reasons why you could be experiencing dry eyes.
2. Dry eyes at night
On the flip side, you may only experience dry eyes at night. So what could be a specific cause for this?
One reason why your eyes may dry out at night is due to your metabolism slowing down with your blood circulation at night . When your metabolism slows down, tear volume produced also decreases , resulting in dry eyes at night.
What medical conditions can lead to dry eyes?
As mentioned before, existing medical conditions that you have could be the reason for your dry eyes developing. Some of these may really shock you.
Menopause. Although it seems unrelated, menopause can lead to the development of dry eyes. This is due to the imbalance in the hormones that stimulate tear production.
Unfortunately, hormone replacement therapy has not been proven to improve dry eyes. Hence, other treatments would be needed to deal with dry eyes if the cause is due to the imbalance in hormones.
Vitamin A deficiency. Most of us know that vitamin A promotes healthy eyes, but can forget that the reverse is also true. A lack of vitamin A can lead to dry eyes and other eye conditions.
Vitamin D deficiency. Some new research shows that vitamin D deficiency can also lead to dry eyes.
Sjogren’s syndrome. Sjogren’s syndrome is an immune system disorder that also affects the mucous membranes and moisture-secreting glands of your eyes .
This condition leads to the reduction of tear production. Other autoimmune disorders like diabetes may also result in poor or insufficient tear production.
- Blepharitis. Blepharitis refers to eyelid inflammation due to bacterial growth . There is no complete cure for this condition but there are ways in which you can treat it. You may ask your doctor for antibiotic eye drops to deal with the bacterial infection.
Other than that, applying warm compresses over your closed eyes and maintaining good hygiene is key to reducing the inflammation.
Does wearing contact lenses lead to dry eyes?
Wearing contact lenses for long periods of time each time is a risk factor that can lead to chronic dry eyes.
If you feel that your eyes are always drying out when you wear contacts, switch back to spectacles first. Your contact lenses may be restricting the amount of oxygen to your cornea.
However, there are options for lenses that can help your eyes retain moisture. The contacts are specifically recommended to people with dry eyes and you should consider asking your eye doctor about them.
In the event you are a contact lens wearer that experiences significant dryness, you may want to take extra precaution. Significant dryness can expose the eyes to an increased risk of infection, which can be potentially sight-threatening.
What should I do if I am experiencing Dry Eyes after Lasik / Cataracts surgery?
It is not uncommon for you to experience dry eyes after laser surgery for the eyes. Procedures like Lasik and laser cataracts surgery will cause some nerves in the cornea to be cut, reducing the sensitivity of your corneal.
This means that your eyes may not sense the need to lubricate, sending the signal to your body to produce less tears. Luckily, this issue will only affect you for a few days or weeks at best. However, you have to remember to use lubricating eye drops in that period of time to prevent your eyes from drying out.
How are dry eyes diagnosed in Singapore?
Your eye doctor would have you answer questionnaires and undergo some eye examinations before diagnosing you with dry eyes . Typically, the eye examination would include using topical fluorescent dye applied to your eyes to assess the tear films on the SlitLamp biomicroscope. This test is usually conducted at eye clinics.
There are a few adjunctive tests your eye doctor may suggest but these are not compulsory for a diagnosis of dry eyes:
- Schirmer test. Your doctor will most likely recommend the Schirmer test, which tests the volume of tears you are able to produce. This test includes placing strips of blotting paper under your lower eyelids.
The pieces of paper are left there for about 5 minutes to soak your tears before your doctor measures the amount collected. This test can help determine the volume of tears that your eyes are capable of producing.
If your eyes are healthy, each strip of paper should contain more than 10 millimeters of moisture. Less than 10 millimeters indicate that you probably have dry eyes. Further tests may also be required if your eyes produce more than 15 millimeters of moisture.
- Quality of tears. Another test your doctor may recommend would be to test the quality of the tears that you have produced. Special dyes mixed in eyedrops are used to see the eye surface condition.
These special dyes show the staining pattern on your cornea and allows your doctor to time how long it takes for your tears to evaporate. These are some indicators that your doctor would use to determine the quality of your tears.
Tear Osmolarity Test. This test uses nanofilter (nL) volumes of tear fluid collected directly from the eyelid margin to test your tears.
Infra-red imaging test of the meibomian glands. The test can help your doctor determine if the cause of your dry eyes symptoms is due to chronic inflammation.
Blood tests. This is to test for thyroid function, Vitamin D levels or other possible underlying problems, if indicated.
Are Dry Eyes permanent?
Dry eyes can be permanent depending on the cause and severity of dry eyes that you have.
Most of the time, if you undergo treatment for dry eyes, you can help to stabilise the condition. Dry eyes treatment can help you attain greater eye comfort, fewer symptoms and can even experience sharper vision.
Are Dry Eyes contagious?
Unlike pink eye (conjunctivitis), dry eyes syndrome is not contagious. So do not worry about spreading this condition to your loved ones or avoiding eye contact with other people! They won’t contract dry eyes by maintaining eye contact with you.
Are Dry Eyes dangerous or a symptom of something dangerous?
Dry eyes if managed properly, is rarely dangerous. However, if not well-managed, significant dryness can expose the eyes to an increased risk of infection, and can potentially be sight-threatening, especially for those who wear contact lenses.
What are the treatments for Mild Dry Eye Symptoms?
For most people with occasional or mild dry eye symptoms, regular over-the-counter eye drops and eye gels are sufficient to moisturize the eye.
There are 3 main types of eye drops:
- Artificial tears
- Allergy drops
- Anti-redness drops
Some eye drops can have a combination of effects, but if you understand the basic types, you will be able to choose the right one you need.
Artificial tears are the go-to eye drops for dry eyes. They mimic real tears to keep your eyes moisturized. Various brands uses different mixes of ingredients, such as
- Lubricants to keep your eyes moist
- Electrolytes which helps heal the surface of your eye
- Guar gum, usually found in more oily drops and are extra beneficial for those whose tears dry up too quickly
- Preservatives to prevent bacteria from growing in the bottle of eye drop
However, there are some patients who do not react well to eye drops with preservatives in them. Do avoid artificial tears that contain preservatives if:
- They bother your eyes
- Your dry eyes syndrome is too severe
- You use eye drops more than 4 to 6 times a day.
These eye drops are your go-to when your dry eyes are caused by an allergic reaction and need relief from itchy and red eyes.
They key ingredient to allergy drops are antihistamines, which prevent symptoms that arise when you have an allergy. Newer allergy drops, called mast-cell stabilizers, even help prevent your body from producing histamines and hence, prevent you from getting itchy and red eyes.
Also known as decongestant drops, these eye drops help clear the redness out of the eyes.
The key ingredient for these eye drops are vasoconstrictors, which shrink the blood vessels on the surface of the eye, causing the redness to subside. However, because of this, anti-redness drops should be used sparingly and as indicated by your doctor as using them for more than 72 hours could irritate your eyes further and worsen the redness in the long run.
Sometimes, they also contain antihistamines, which function the same way as allergy drops to relieve itchiness.
Which eye drops are preservative-free?
One commonly prescribed brand of non-preservatives eye drops is Optive Fusion. You can also get them over-the-counter at about $20 to $30 and one box can usually last you for a month or so.
Most of the other eye drops that are commonly available in stores contain preservatives. They cost about the same as non-preservative eye drops at about $30.
One easy way to identify preservative-free eye drops would be through their packaging. Preservative-free eye drops do not come in typical eye drop bottles. You would usually find them in single-use vials or sticks and are usually disposed of within 12 hours.
This is different from eye drops that contain preservatives which come in bottles. They can be kept for a longer period of time without the fear of bacteria growing in the bottle. These types of eye drops are usually still good for use a month after opening.
However, there’s still a risk of contamination for both types of eye drops, depending on whether you have accidentally touched the tip with your hands or eyes.
What are available treatments for Serious Dry Eyes Symptoms?
If you are suffering from more persistent and serious dry eye symptoms, you should instead seek treatments that are targeted at the causative factors.
Some common treatments include:
- Home-based warm eye compresses and lid scrubs. This treatment is suitable for those who suffer from chronic inflammation of their eyelid margins or oil glands that supply the oily top layer of our tear films. Eyelid hygiene is especially important.
If you are unsure of how to keep up with proper eyelid hygiene, there is also the option of clinic-based treatments. These treatments include lid margin exfoliation and meibomian gland expression procedures.
Prescribed eye drops. Dry eyes often coexist with eye allergies. Thus, it is important to have a proper diagnosis so an appropriate eye drop can be prescribed to treat both your eye allergy and dry eyes concurrently. Eye gels and creams like Genteal and Vidisic can help with tougher conditions like Nocturnal Lagophthalmos, explained above.
Insertion of punctal plugs. Punctal plugs are tiny medical devices that sit in the tear ducts of the eyes. They help prevent tears from draining away, keeping the eyes moisturized. This treatment is painless and there is an option between temporary collagen or permanent silicone punctal plugs.
Surgical treatments. Very rarely, there are elderly patients who may have redundant and overhanging conjunctiva that contributes to their dry eye syndrome.
These may be surgically treated through a “face-lift” for the conjunctiva. In such rare cases that I have had the chance to operate on, the end results have been positive!
- Heat and light-based treatments. Such treatments generally target the meibomian glands, with the aim of improving oil gland structure and function. Treatments vary in cost, comfort and side effects, examples of these are Thermo-mechanical ablation (TMA) and the LipiFlow Thermal Pulsation System (TearScience).
Thermo-Mechanical Ablation (TMA)
The new Thermo-Mechanical Ablation (TMA) treatment is a non-laser treatment technology that transfers thermal energy to the skin around the eyes quickly and safely to correct dry eyes by increasing lubrication and reducing tear evaporation.
It involves the use of a small probe to the eyelid skin. These small probes deliver heat and mechanical energy to the skin and meibomian glands. TMA treatment does this through quick 10 low-pain pulses per eyelid.
The treatment harnessing thermo-mechanical ablation (TMA) principles have already been used in aesthetic medicine for quite a long time, but now to improve meibomian gland function and dry eyes, it has recently been introduced to Ophthalmology.
This in-clinic treatment serves to complement existing home-based dry eye management. It was found to be safe and produce good results for dry eye care in overseas studies. It is a very quick and low pain procedure and has no reported side effects unlike IPL-based treatment which can affect skin pigmentation.
Lipiflow, on the other hand, is an automated dry eye treatment that combines the best features of warm compress therapy and meibomian gland expression.
New studies have shown that doing Lipiflow treatment before cataract surgery significantly reduces dry eye symptoms following cataract surgery. Lipiflow removes meibomian gland blockages and restores gland function through its thermal pulsation, non-invasive, 12 minute “eyelid spa” treatment.
How can I prevent Dry eyes with Eye Exercises?
Yep, you read that right, eye exercises. Don’t worry, you won’t be sweating or panting after this exercise. The best part? You can do this blinking exercise anywhere and anytime you want!
This eye exercise is a sequence developed by Dr Donald Korb. The sequence is listed below:
- Close your eyes normally. Place your fingers on the bone at the outer corners of your eyes. There should be little to no movement if you are blinking normally.
- Keep them closed for 2 seconds then open them.
- Close your eyes again and keep them closed for 2 seconds.
- Squeeze your eyelids tightly this time for 2 seconds before opening them.
- Repeat this sequence 5 to 7 times a day.
This blinking exercise can help keep your eye surface moist and prevent them from drying out. While these exercises may not be very effective for people who already suffer from chronic dry eyes, patients who have mild cases of dry eyes or are trying to improve their eye health can see a more significant impact of this exercise.
Ensure that you take regular breaks from intensive computer use using the 20-20-20 rule to rest your eyes. Basically, it reminds you that after 20 minutes of visual task, rest your eyes for 20 seconds to preserve 20-20 vision!
Do home remedies for Dry Eyes work?
Yes, they do! Home remedies are simple ways in which you can address your dry eyes symptoms and they can be very effective. As mentioned before, cleansing your eyelids and keeping a good eyelid hygiene regime is very important. Here are some home remedies you can try out!
Make sure that you minimise direct exposure to fans, hair dryers and other windy conditions. If you must, wear a pair of wraparound sunglasses to prevent your eyes from drying out when you go out on a windy day.
If you work in an office or spend long hours in air-conditioned environments where the air can be rather dry, I recommend you use a humidifier to keep the air moist. Ensuring that your environment is not dry can prevent your eyes from drying out as your tears do not evaporate as quickly.
To maintain good eye health, you can’t miss out on maintaining a good diet. While making sure you take in adequate amounts of water, you should also look into increasing your intake of beneficial minerals and vitamins.
Increasing the amount of salmon, tuna, and sardine in your diet means an increase in omega-3 fatty acids intake. This nutrient is able to reduce inflammation in your eyes and hence reduce the symptoms of dry eyes.
Chia seeds is another food that can help with eye health. It is high in omega-3 fatty acids and can dramatically improve dry eyes conditions .
Chia seed can be included in drinks or eaten as part of your dessert. If you are unsure how you can prepare chia seed, you can check out this article here. It’s a simple chia seed dessert recipe that can double as breakfast!
There are many more ways to eliminate dry eyes. Read on to find out more.
If a dietary change does not interest you, you can always purchase the supplements instead. Omega-3 fatty acid capsules is one of the many supplements that can aid in improving your eye’s oil film, reducing dry eye symptoms.
For those of you who wear eye makeup, ensure that you properly cleanse your eyes to keep your tear films healthy. Adhesives for cosmetic lashes used on the eyelids can be particularly harmful for the eye surface, so do be careful with them.
For those wearing contact lenses, daily disposables are generally more hygienic and less likely to complicate and cause dry eyes compared to longer-wear contacts. Please also always get your contact lenses from reliable sources. If you are able to, reducing contact lens wear will also help with your dry eyes condition.
What are the cost of Treating Dry Eyes in Singapore?
The estimated costs of treatments for dry eyes can be summarised in the table below.
Eye Drops (per month)
$20 - $30
Punctal Plugs (per pair)
LipiFlow (Both Eyes)
TMA (both eyes)
Most treatments for dry eyes related to eye surgery such as cataract operation are generally covered by Medisave. You can read more about it here.
What’s your treatment philosophy, Dr Han?
As they say, the devil is in the details (the equivalent saying in Mandarin is more apt: 细节决定成败 which directly translates to “details dictate outcomes”). In my experience, working hand-in-hand with my patients and being very patient in managing dry eyes pays dividends for a successful outcome.
I hope to never say “there is nothing else I can do for you” because I believe that with extra thought, things can always be improved. Often, this involves monitoring other aspects of my patients’ health to further improve their quality of life and eye care in particular.
As dry eyes are very common and can affect results following eye surgeries, I highly recommend making its management part of surgical preparation and post-operative care. A beautifully performed eye surgery, from a simple LASIK to complex cataract operation can be elevated to true laser-precision when patients are aware of the need to take care of dry eyes even before the surgery.
It is important to understand that the tear film is made up of a few layers: mucous, aqueous (water) and finally a top lipid (oil) layer. Looking after each of these layers in the treatment will result in a far more successful outcome than just treating a single component.
Dry eyes syndrome often complicates and delays recovery from eye surgery, hence it is important to manage dry eyes properly to fully benefit from elective eye surgery like LASIK and cataract surgery.
Lastly, there is more to dry eyes than what meets the eye. So don’t just brush it off if it troubles you. Book an appointment to get it checked out as soon as possible, even before any planned procedures, like LASIK.