Dry eye living in older adults

Overview

Dry eye is a common condition where your eyes don't make enough tears, or the tears dry up too quickly. Tears help keep the surface of your eyes healthy, clear, and comfortable. When they don't work properly, your eyes may feel dry, gritty, or irritated. This is especially common as we get older.

Yes, dry eye is very common, especially among older adults. Studies suggest that about 1 in 5 people over 65 experience dry eye symptoms.

Dry eye affects people of all ages, but it is more common in older adults. Women are more likely to have dry eye than men, especially after menopause. Other factors like certain health conditions and medications can increase your risk.

Symptoms

Common symptoms

• Stinging, burning, or scratchy feeling in your eyes
• A feeling like something is in your eye (grittiness)
• Redness or irritation
• Blurry vision that comes and goes
• Heavy eyelids or eye fatigue
• Watery eyes (your eyes make too many tears to make up for dryness)

Symptoms in children

• Dry eye is less common in children but can still happen. Symptoms are similar: red, irritated eyes, frequent blinking, rubbing eyes, or complaints of blurry vision.

Symptoms in older adults

• Older adults may notice dry eye more often during activities like reading, watching TV, or using a computer.
• Symptoms can worsen with changes in weather, wind, or dry indoor air.
• Some older adults may also have eyelid problems that make dry eye worse.

Causes

Main causes

• Your tear glands produce fewer tears as you age.
• Your tears evaporate (dry up) too quickly because the oil layer of your tears is not working well.
• Eyelid problems, like not blinking fully, can cause dryness.
• Certain medical conditions, such as rheumatoid arthritis, Sjögren's syndrome, or diabetes.
• Medications including antihistamines, decongestants, antidepressants, and some blood pressure drugs.

Risk factors

• Being over 50 years old
• Being female, especially after menopause
• Spending a lot of time looking at screens (computer, phone, TV)
• Living in dry, windy, or smoky environments
• Wearing contact lenses for long periods
• Having a condition like rosacea, blepharitis (eyelid inflammation), or thyroid disease

When to see a doctor

See a doctor urgently if:

• Sudden increase in eye pain or discomfort
• Redness that spreads or gets worse
• Changes in vision that do not go away
• Eye injury or exposure to chemicals

Book a routine appointment if:

• Mild dry eye symptoms that last more than a few weeks despite trying self-care
• Eye irritation that affects your daily activities (reading, driving, working)
• You have other health conditions that may be linked to dry eye (like arthritis or diabetes)

Diagnosis

Your doctor or eye specialist will ask about your symptoms, health, and medications. They will examine your eyes with a special microscope called a slit lamp. They may also do simple tests to check your tear production and tear quality.

Tests that may be done

• Schirmer test: A small strip of paper is placed under your lower eyelid to measure how much tears you produce.
• Tear film breakup time: A dye is placed in your eye to see how quickly your tears evaporate.
• Staining: Drops with a dye help your doctor see damaged areas on the surface of your eye.

What to expect at your appointment

The tests are usually painless and take only a few minutes. You may be asked to blink or keep your eyes open. Your doctor will discuss the results and suggest treatment options based on the cause and severity of your dry eye.

Treatment

Treatment for dry eye depends on the cause and how much it bothers you. It often starts with simple self-care and over-the-counter products. If those are not enough, your doctor may recommend prescription treatments or procedures. Never use eye drops that are not meant for dry eye, and always follow your doctor's advice.

Self-care at home

• Use artificial tears (over-the-counter lubricating eye drops) regularly, especially during activities that cause symptoms.
• Take breaks when reading or using screens – try the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds.
• Blink fully and often, especially when concentrating.
• Use a humidifier at home to add moisture to the air.
• Avoid direct airflow from fans, heaters, or air conditioning onto your face.
• Clean your eyelids gently with a warm, damp cloth to keep them healthy.
• Wear sunglasses or wraparound glasses outdoors to protect your eyes from wind and dust.

Medical treatments

If self-care is not enough, your doctor may suggest prescription eye drops that help your eyes make more tears or reduce inflammation. Other options include tear duct plugs (tiny plugs placed in your tear ducts to keep tears on your eye longer), or treatments like a special light therapy for eyelid problems. Your doctor will explain the best approach for you. Do not use any prescription eye drops without a prescription.

When is surgery considered?

In rare cases, surgery may be considered if other treatments have not helped and the dry eye is severe. This might involve blocking the tear ducts permanently or correcting eyelid problems that cause dryness. Surgery is not usually the first option.

Living with this condition

Living with dry eye means finding a routine that keeps your eyes comfortable. Use artificial tears as needed, protect your eyes from wind and dry air, and take breaks during close work. Most people can manage dry eye well with simple changes.

Lifestyle tips

• Set up your workspace to reduce glare and keep your screen at eye level.
• Drink plenty of water throughout the day to stay hydrated.
• Get enough sleep – tired eyes are more prone to dryness.
• If you smoke, consider quitting – smoke worsens dry eye.

Diet and exercise

A balanced diet rich in omega-3 fatty acids (from fish like salmon, flaxseeds, walnuts) may help some people with dry eye. Staying active and exercising regularly helps overall health, but be mindful of dry or windy conditions. If you exercise outdoors, wear protective eyewear.

Mental health and emotional wellbeing

Chronic dry eye can be frustrating and affect your mood. It may make reading, driving, or enjoying hobbies difficult. It is normal to feel annoyed or discouraged. Talk to your doctor if these feelings affect your daily life – they can help you find better management strategies.

Prevention

You cannot always prevent dry eye, especially as you age. But you can reduce your risk by avoiding dry environments, staying hydrated, and taking care of your eyes. If you use digital devices, take regular breaks. Good eyelid hygiene may also help prevent some causes of dry eye.

Screening programmes

There is no national screening for dry eye. However, regular eye exams (every 1-2 years, or as recommended by your doctor) can help catch dry eye early and manage it before it gets worse.

Complications

If left untreated

• Mild dry eye usually does not cause long-term problems. However, if left untreated, it can lead to:
• Inflammation or infection of the cornea (the clear front part of the eye)
• Scratches or sores on the cornea
• Difficulty with daily activities like reading, driving, or using a computer
• Increased risk of eye infections

Long-term outlook

For most people, dry eye can be managed effectively with simple treatments and lifestyle changes. Even if you have had dry eye for a long time, there are many options to help you feel better. With the right care, most people can keep their eyes comfortable and healthy. Talk to your doctor to find what works best for you.

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