Dry eye disease is the worst.
I got diagnosed with dry eye a few years ago, and not to be hyperbolic or anything, but it’s the worst thing that’s ever happened to me.
Okay fine, it’s not—but it has sure felt that way sometimes.
I have ulcerative colitis, which is what I normally write about on this blog. And in many ways, ulcerative colitis is far worse than dry eye. Dry eye will never force me to have a severely restricted diet. It will never lay me up with months of pain and diarrhea. It will never land me in the hospital for a month and endanger my life.
And yet, there is something about dry eye that feels inexplicably worse, somehow. At times, it has reduced my quality of life to the point that for the first time in my life, I’ve sometimes caught myself dreading living very long.
While I’ve never been suicidal, after getting dry eye, I began looking forward to dying for the first time in my life. Dying would put me out of my misery!
Again, it might seem over-the-top to call this condition “miserable” when so many other conditions are more painful, more inconvenient, more disruptive. And yet, I have a feeling this sentiment is common.
I talked to a friend who’d been recently diagnosed with dry eye, and he confided that one of the thoughts he’d been having was, “Oh my god. I’m in my fifties. I have to live another thirty years with this shit.”
This was affirming. I, too, had found myself envying people who got dry eye in their seventies and eighties instead of their forties like me, because they wouldn’t be living with it as long!
Writing this piece, I googled “dry eye I hate my life,” and I found this post on a dry eye patient forum. It reads:
I find it so painful to remember how just 7 months ago my life was completely different. I could bike in the wind with regular sunglasses on, even back in December…. I walked the streets of Toronto on cold and dry days and I did not feel a thing. And then bam, within a month I developed a full on moderate/severe dry eye disease…. This disease caught me completely off guard.
The uncertainty is the worst part…. I can tolerate pain, discomfort, and the inconvenience, if I know there is an end in sight.
Instead it’s a guessing game….
My partner thinks I am depressed but I am only depressed because of my eyes. If I have a few good days, I instantly almost feel normal, sometimes even joyful. I am sure if my eyes got back to normal I would no longer have dark thoughts.
Many others responded in empathy on the forum, saying they’d been there too.
Thankfully, my own looking-forward-to-dying has vanished in the years since my diagnosis. I’ve somewhat adjusted to living with the discomfort, and I’ve also found several strategies that help a lot, so that I often am quite comfortable. Some of these strategies are free or cheap; others are more expensive. I’m offering all my favorites here, in case they help others.
Table of Contents
- What is dry eye, and what causes it?
- How to Not Get Dry Eye in the First Place!
- Tips for Minimizing Screen Strain & Pain
- Creating Comfortable Air Conditions
- Protecting Your Eyes from Glare & Sunlight
- Water & Oil – Supplements that Help Me
- My Favorite Eye Drops, and How I Carry Them
- Getting the Oil Moving: Eye Masks, Lid Massage, & Blinking 101
- Things That Haven’t Worked as Well…for Me
- One last thing: Attitude matters!
1. What is dry eye, and what causes it?
When I first heard of “dry eye,” I thought it just meant a feeling of dryness in the eyes. It sounded innocuous and temporary. It wasn’t until diagnosis that I understood this to be a disease—a chronic, incurable condition that diminishes your quality of life.
Here’s Mayo Clinic’s simple definition of this disease:
Dry eye disease is a common condition that occurs when your tears aren’t able to provide adequate lubrication for your eyes. Tears can be inadequate and unstable for many reasons. For example, dry eyes may occur if you don’t produce enough tears or if you produce poor-quality tears. This tear instability leads to inflammation and damage of the eye’s surface.
I’m no expert—for in-depth information, read that article. But here’s my basic understanding: Our tears are produced in tear glands at the corners of the eyes. They’re kept from evaporating very quickly by oil that’s produced in the meibomian glands along the edges of our eyelids. Dry eye can result from either diminished tear production or diminished oil production, or both.
Dry eye is often very painful. Imagine getting sand in your eye, or the feeling of your eyes burning from onions or crying. Normally, that pain is temporary, but with dry eye disease, it can be nearly ongoing, or can occur on a daily or hourly basis. The pain depends on the severity of the disease.
In my case, my eyes produce enough tears, but my oil glands aren’t working properly. I therefore have meibomian gland dysfunction, or MGD, the most common form of dry eye. It’s generally MGD that I’ll be addressing in this article.
We have perhaps 50-70 meibomian glands, and MGD typically occurs when they become inflamed. The swollen glands become clogged, because the swelling around the tops of the glands makes their openings become smaller. The oil thus has trouble exiting.
If this clogging continues, the meibomian glands can atrophy and stop producing oil altogether. They may then “die,” shutting down permanently. They don’t regenerate. Since we have a finite number of glands to begin with, it’s crucial to bring the inflammation down and release the clogged oil, so that it will keep flowing. That helps to retain as many glands as possible.
Like many other inflammatory conditions, dry eye is irreversible. Once your eyelids “learn” to swell, they won’t stop swelling on their own. They need ongoing maintenance and treatment, which can come in many forms—and to a certain extent, different techniques work for different people.
There are several major risk factors for dry eye. One is age. It’s more common among older people, although its prevalence has been increasing across all demographics. It’s nearly three times as common in women than in men. Contact lens use is a risk factor, as is screen time, which is the most likely reason dry eye has been increasing during the pandemic.
The Mayo Clinic also lists other less common risk factors, including certain medical conditions and medications, as well as getting Lasik surgery.
2. How to Not Get Dry Eye in the First Place!
Needless to say, if you don’t have dry eye, do everything you can to avoid it! This section is short, because it’s pretty straightforward. Here are the three most important tips:
- Minimize your time wearing contact lenses.
- Minimize your screen time.
- When you do need to work on a screen, minimize your eye strain by following the additional tips in the next section.
Trust me, you don’t want dry eye. Take these tips seriously.
3. Tips for Minimizing Screen Strain & Pain
Screens are probably the biggest reason more and more people are getting dry eye. When we use computers, tablets, and phones, we don’t tend to blink as often as we normally do, partly out of habit and partly because our eyes are often straining to read the screens. Over time, this strain and lack of blinking can lead to dry eye.
But there are many things all of us can do to reduce this effect, whether we have dry eye or are trying to prevent it. All of them are free or cheap.
- Reduce screen time. This is ideal, although not always possible!
- Increase the font size. Try it! Notice how your eyes subtly relax with a larger font? Change the settings on your computers, tablets, and smartphones to a larger setting; your eyes will thank you.
- Reduce the blue light. Redder hues are more relaxing for the eyes; bluer hues create more strain. Change the settings on your computers, tablets, and smartphones to create a redshift, reducing strain.
- Wear blue light blocking computer glasses. This further red-shifts your screens, reducing strain. Many such glasses are available, for instance here.
- Take 20-20-20 breaks to relax your eyes. My optometrist recommends the 20-20-20 rule: every 20 minutes, turn away from your screen and focus on something 20 feet away for 20 seconds. This helps your eyes to relax. You can set a timer on your phone or an alert on your computer to remind yourself to do this.
4. Creating Comfortable Air Conditions
Dry eye makes you notice every little molecule of moving air, especially in dry-air conditions. Before getting it, I never noticed the air blowing out of heating and AC units, and wind only bothered my eyes a tiny bit.
Now, I inwardly cringe when the heat or AC turns on. In cars, the blowing air can be torture, since the vents are just feet from my face. And several times, I’ve had to hold my husband’s arm and close my eyes while he walked me up a beach against a strong wind, because I couldn’t bear the agony of opening my eyes.
Tragically, blowing air is hard to avoid. But very fortunately, there are tips and tools you can use to reduce the discomfort, both indoors and outdoors.
- Get out of the air’s path. At home or in the office, arrange furniture so you don’t have to sit or stand with your eyes in the air’s path for long. For me, this meant, for example, changing which side of the dinner table I sat on.
- Move the air’s path. Many heating and AC units have movable vents that can be aimed in different directions. Cheap plastic covers are available for heating vents (on the floor and the wall) to redirect the air. In the car, vents can be aimed at the floor and away from your face.
- Buy windproof sunglasses! After those episodes on the beach, it finally occurred to me that these might exist. Sure enough, they do—geared for motorcyclists and dry eye sufferers. They’re expensive, around $80 and up. But to me they’ve been worth it—now I can walk on the beach again with my eyes open! 7eye by Panoptx is a great source. Call them and discuss your options with a live person, because different glasses work for different face shapes.
- Avoid smoke. In the pandemic, I’ve discovered that outdoor campfires are no longer nearly as fun as they used to be. Smoke is the worst! But there are solutions, although they may be costly. You can buy a pair of windproof glasses that fit your face snugly and block out most of the smoke. (I’ve got one pair of sunglasses for daytime and another, clear pair for nighttime.) You can also consider alternative outdoor heating options, such as smokeless fire pits, outdoor heaters, or heated clothing. And of course, with regular old campfires, make sure to sit out of the path of the smoke.
- Humidify the air. This is another indoor tip, obviously. Humidifiers in the bedroom or office can cut down on discomfort, helping your eyes stay moist. They also make a pleasant little burbling sound! 🙂
5. Protecting Your Eyes from Glare & Sunlight
Dry eye makes you much more light-sensitive, making it less relaxing to be outdoors and more dangerous to drive at night. Fortunately, there are some easy solutions.
- Sunglasses. They are your friend. Wear them all the time when outdoors, even on cloudy days. Be that person. Make sure to get good-quality sunglasses: their label should state that they block 100 percent of UV rays, and they should protect the periphery of your eyes too—sunglasses with wrap-around lenses are safer than those with an opening on the sides.
- Over-the-glasses sunglasses. Many new dry eye patients are wearing their eyeglasses more than before, because dry eye makes contacts unwearable. If your glasses are essential but your sunglasses don’t fit over them, never fear—you have options. If you can afford to, you can replace your lenses with transition lenses, although if you do this, be aware that your peripheral vision will not be protected from the sun. But the cheaper and safer option is Solar Shields, which fit over your glasses and do protect your periphery.
- Anti-glare night-driving glasses. There are several options here as well. Whether or not you wear regular glasses when driving, you can purchase affordable anti-glare glasses to fit either normally or over your glasses. The more expensive option is to get anti-glare tint on your normal glasses. Any of these methods will make night driving much safer with dry eye.
6. Water & Oil—Supplements That Help Me
Perhaps there are other supplements that help others as well, but these are the ones I’ve tried that have definitely helped.
- Staying hydrated. This makes intuitive sense – if we have more water in our bodies, our eyes will be less dry!
- Omega-3 supplements. My favorite is NOW Foods’ Omega-3 180 EPA/120 DHA. I take two a day, and I notice a significant change in comfort within 48 hours of starting or stopping them. Many omega-3 supplements have far higher EPA/DHA levels than the ones I take, but the science shows that beyond around 360 mg of EPA and 240 mg of DHA per day, there’s little additional benefit to treating dry eye. NOW brand is a company known for affordable and high-quality supplements.
7. My Favorite Eye Drops, and How I Carry Them
I’ve tried several kinds of eye drops, and all have helped to an extent. Here are my current favorites, and tips for carrying them around:
- Ocusoft Retaine MGD. These are the main eye drops I carry around with me during the day. They’re $20.64 for a 30-pack with a subscription on Amazon; I use around one 30-pack a month.
- Refresh gel. My optometrist suggested I use gel at night, and I agree that it seems to help. These come in a reusable bottle, which I appreciate for its reduction of plastic trash. One tiny 0.33 oz bottle is $13.06 with a subscription on Amazon; I use maybe one bottle every two to three months.
- Help the drops last, and keep them cool. Most “single-use” droppers allow the twist-off top to be snapped back on with a little dexterity, and most have enough solution for a few uses. Make sure not to touch the tip of the dropper when re-lidding it, to prevent infection. Also be aware that once opened, the dropper’s contents will go bad over time—I’ve found that they last up to a few days, and less time if I allow them to get too warm, so I avoid putting them in my pockets. If they sting, they’ve gone bad. Throw them out.
- Use a carrying pouch! I avoid putting eye droppers in my pockets, to help them stay cool, so for a while I was just placing them on my desk or counters or in the pockets of my bags. There were little piles of droppers following me everywhere I went! Then I bought a small pouch to carry them in, and that feels much better. I recommend finding a pouch, for instance on Etsy, that’s around 3-3.5 inches long and has a zipper or a snap to keep it closed. Many tiny bags are also on keychains.
- Recycling all that plastic. This will depend on your locality, but in mine, I have found a way the eye droppers can be recycled. They are #4 plastic, but they’re not shaped right for my city’s recycling machines, so our city service won’t take them. But a local (Portland, Oregon) supplementary recycling company called James Recycling does, and Ridwell, another beyond-the-curb company that has been growing across the Pacific Northwest, probably accepts them as well.
8. Getting the Oil Moving: Eye Masks, Lid Massage, and Blinking 101
When I first saw an ophthalmologist for my dry eye, she impressed upon me that there’s only one proven treatment for MGD: heat and massage. When your oil glands are clogged, it’s essential to get the oil unclogged and flowing, to prevent your glands from permanently dying. In the process, releasing the oil provides great relief to your eyes.
She advised me to apply a microwavable heat mask to my eyes for fifteen minutes every day, then to perform a gentle lid massage. This helped me immensely…but after a couple weeks, my pain worsened. An optometrist who specialized in dry eye explained that the daily heat was possibly irritating my glands, causing them to swell up again. There needs to be a balance between heating and massaging the glands enough to unclog, and keeping them from getting irritated.
That balance will vary from person to person. Below are some tips and supplies that may help.
- Find the right eye mask. One of the most popular and highly recommended is the Bruder eye mask. Personally, when I’ve used it, it doesn’t seem to get hot enough to unclog my glands, so I use this gel one instead. Because I need so much heat, I find that applying heat no more often than every 3 days is ideal for me.
- Learn the right massage technique. There is a right and a wrong way to massage your eyelids! If you do it wrong, you can send the oil backwards up the glands, which might cause damage. Here is a video on a good technique. I actually do something even less invasive, just lightly touching the eyelid near its edge and very slowly rolling my finger towards the edge, then moving to different places on the lid and repeating. While I only use my eye mask sometimes, I do a gentle eyelid massage every night after steaming my face, either in the shower or with a washcloth (which is already part of my daily skincare routine).
- Blinking exercises. Blinking is how we naturally release oil from the meibomian glands when they’re working properly. Even with clogged glands, blinking properly can still help “massage” and unclog them. But many of us don’t fully close our eyes when we blink, reducing this effect. Blinking exercises can help. Here’s one resource; many more can be found by googling “blinking exercises for dry eye.” The general idea is to spend around 20 seconds blinking slowly and fully. The eye muscles should squeeze gently, but not too much.
9. Things That Haven’t Worked as Well…for Me.
Like I said, different techniques may work for different people—especially when it comes to supplementary and experimental techniques sold at dry eye clinics. Those generally aren’t FDA approved, and are therefore not covered by insurance, but they may be worth a try if you can afford them.
Below are the main ones I’ve tried. Along with these, there are also Lipiflow, BlephEx, and many others!
- Castor oil drops. These were prescribed to me by a doctor certified in Ayurveda, a healing system that originated in ancient India. Since Ayurveda had helped my ulcerative colitis, I thought it was worth a try for dry eye too. Ayurveda typically prescribes sesame oil for dry eye, but sesame oil burned my eye, so the Ayurvedic doctor recommended castor oil instead. The castor oil drops did seem to help my dry eye a bit…but over time, I found their effectiveness to be less strong and consistent than treatments like eyelid massage.
- Restasis, Xiidra, and Cequa. These are three brands of prescription eyedrops that seem to help at least some people. They aren’t always covered by insurance, and Cequa is by far the most affordable. I tried them all. Xiidra unfortunately gave me a metallic taste, and neither Restasis or Cequa had a very noticeable, lasting effect for me.
- MiBoFlo. This treatment involves several sessions (ideally) in which you lie back on a table and a technician slowly runs a heated paddle over your closed eyelid, stimulating the flow of oil from the meibomian glands. I did a few sessions, spaced apart like I had been instructed. I felt immediate relief after each one…but then my pain and discomfort gradually increased again till my next session. As often happens with LipiFlow, MiBoFlow seemed effective in the short term but not the long term.
10. One last thing: Attitude matters!
Especially in the first year or two with dry eye disease, I sometimes spiraled into despair. What finally helped lift me out of that despair, especially when my eye pain initially continued unabated, was a shift in my attitude.
Fortunately, my ulcerative colitis had given me experience lifting myself out of despair. At some point, amidst a bout of dry eye depression, it occurred to me that I needed that same wisdom now. I began looking for ways to lift my own spirits, determined not to let this new disease steal my joy.
The best idea I had was to change how I thought about all the time I was spending on dry eye management. I’d been looking at it as frequent reminders of my misfortune. Now I decided to see it as frequent opportunities for gratitude.
I had been grumbling inwardly to myself every time I put in eye drops. My eyes hurt again. I’m so tired of being in pain! This sucks! Now I intentionally began listing off things to be grateful for instead. I am grateful to have eyes to see with. I’m grateful for the dexterity of my fingers, which are able to put in these eye drops. I’m grateful for this chance to appreciate the gift of sight.
In those moments, the drops began feeling like holy water blessing my eyes. I was nurturing my eyes so they could keep functioning. Most people don’t have to do this, but even so, I had a lot to be grateful for.
I had always taken my eyes, or at least their pain-free nature, for granted before getting dry eye. Now I had a reminder to be thankful for them multiple times every day.
It may seem small, but this was a profound inner shift. Cultivating a better attitude helped me lift myself out of depression and emerge again into a joyful life.
Everyone with dry eyes has their own complicated regime to manage it. I’m like you in that humidity levels are key. I surround myself with humidifiers, even in my car. I have air purifiers in every room. When the marine layer settles in, my eyes do a happy dance. Summer is a hard season. I finally found some good care providers in Seattle, and they got me on IPL, which seems to be helping me get some gland function back. It’s painful AF. When I pulled up the rugs in the living room my eyes really improved, but that could have been coincidental with a new drop I’m doing, Diqufosal. I’m assuming you know about the Facebook Dry Eyes group, which has invaluable resources: https://www.facebook.com/groups/dryeyetalk
Thanks so much, Doug! I didn’t know about the dry eye Facebook group; I’ll check it out. I hadn’t thought about removing rugs either—that could help me too. I also hadn’t heard of IPL (intense pulsed light), but looking it up, it sounds…intense. 🙂 I’m sorry that it’s so painful but glad it’s helping you! Wishing you better eye comfort going forward.