Although counterintuitive, tearing or watering eyes can be a sign of dry eyes. To understand this better, we should look at the composition of a teardrop.
What’s in a tear?
Tears are broadly composed of water, oil, and mucin. An abnormality in any of the three layers can cause the tears to evaporate too quickly or fail to spread evenly on the surface of the eye. Since your natural tears are unable to provide sufficient lubrication, a distress signal is sent to the nervous system that results in excessive tear production to alleviate the symptoms. This protective mechanism is known as reflexive tearing, however, it doesn’t always work. Reflex tears are different than natural tears. While natural tears have lipids, mucus, and other nutrients that adds to viscosity and helps maintain them on the eye surface, reflex tears lack that composition and is primarily water which doesn’t stay stable on the eye surface, which causes your eyes to water.
Maintaining the layer of tears on the eye surface is key to addressing reflex tearing. Tear supplementation with lipid-based lubricant eye drops and/or ointments can enhance the viscosity of your tear film to reduce watery eyes. Warm compresses, manual expression or thermal pulsation treatments — which are advanced treatments performed by an eye care professional — can also help unclog the delicate eyelid oil glands (meibomian glands) and optimize their contribution to the tear film. In severe cases, immunomodulating therapies can be implemented to address the long-standing inflammation from dry eyes and stabilize the tear film. If your symptoms are persistent, contact your eye care professional for a dry eye evaluation and to develop a personalized treatment plan.
Am I too young to have dry eyes?
Aging is undoubtedly a significant risk factor for dry eyes, however, clinical data suggests that its prevalence is increasing among men and women of all ages.
Lifestyle changes such as more screen time, extended duration of exposure to low-humidity indoor environments, and increased use of refractive treatments — such as contact lens wear, and laser and cataract surgery — are postulated to be playing a role in the emerging dry eye “epidemic.” In fact, studies have estimated that the use of digital screens can decrease the blink rate by 66 per cent, with a higher rate of incomplete blinks which are less effective in circulating tears on your eye surface. Also, about 60 to 90 per cent of people who regularly use computer screens are projected to suffer from some form of computer vision syndrome, or digital eye strain. Symptoms of this include a burning sensation in the eyes, redness, a feeling of grittiness, or tired eyes.
Hormonal fluctuations, autoimmune disease and certain skin conditions around the eyes such as rosacea, acne, and allergic dermatitis can also contribute to dry eyes. Medical history, current medications and diet can also play a role. Medications, such as retinol-based acne therapies, can affect the health of oil producing eyelid glands, while diets low in omega-3 fatty acids and water intake are other key reasons for dry eye disease. Ultimately, there are often a number of reasons for dry eyes which, in turn, requires a combination of treatment to manage this condition.
Why do I wake up with sore, burning eyes?
Patients commonly complain of eye discomfort upon waking in the morning. Waking up with burning eyes or irritated eyes can be a result of poor or incomplete eyelid closure during sleep. This condition is referred to as nocturnal lagophthalmos, and is seen in patients with thyroid eye disease, stroke, Bell’s palsy, cosmetic eyelid surgery, botox treatment, or age-related eyelid laxity (looseness). It can also be an issue for people who use overnight CPAP machines for sleep apnea — an insufficient mask seal can result in air leakage overnight, contributing to eye dryness in the morning.
A thorough eye examination and eyelid assessment can detect nocturnal lagophthalmos. Typical recommendations for alleviating morning dry eye distress include the use of lubricating ointment, eyelid taping or moisture-chamber goggles (which slow the evaporation of tears). In more severe cases, further treatment with advanced therapeutics, thermal pulsation, and/or surgical correction of eyelids that are not positioned properly.
Why do my eyes look red at the end of the day?
With the current pandemic restrictions, working from home and increased screen time has become unavoidable. Consequently, computer vision syndrome has become increasingly prevalent amongst the population. Digital strain results from reduced blinking, infrequent breaks from the screen, and incomplete blinking.
One tip for interacting safely with digital technology is to follow the 20/20/20 rule. This means for every 20 minutes looking at a screen, take a 20 second break, and look 20 feet away and blink. This simple, yet effective, measure can help stabilize the tear film on the surface of your eye. Adjusting your computer’s display settings to reduce brightness, and using a polarized screen filter to reduce glare can also be helpful.
Another tip is to ensure you are not sitting in the path of an air vent — constant drafts, especially while driving, can destabilize the tear film and result in dry eyes. Finally, using a humidifier near your workstation or in your bedroom can also help in maintaining a good moisture level and prevent dry eye symptoms.
Why can’t I tolerate my contact lenses for more than an hour?
Approximately 50 per cent of all contact lens wearers experience dry eye syndrome. In fact, a recent survey found that 34 per cent discontinue contact lens wear due to dryness and discomfort. A few reasons for contact lens induced dryness is that your tears are being absorbed by the contact lens material, reduced tear stability, and problems with the meibomian gland (which produces an oil that prevents tears from evaporating.) Any of these factors can result in increased awareness of the lens material, constant irritation, and discomfort.
A comprehensive dry eye treatment plan can help with preserving the tear film and building up contact lens tolerance. Secondly, it is important to realize that not all contact lenses are the same, and each lens’ water content, oxygen transmission, and corneal fit ultimately dictates the overall comfort of the lens. A proper lens fit by a trained contact lens expert can eliminate the potential risks from improper contact lens placement and poor quality lens material.
With advances in contact lens technology and the availability of daily disposable types, your eye care professional can pick an appropriate lens, replacement schedule, and disinfection solution that meets your needs.
Dr. Harleen Bedi is an ophthalmologist who also specializes in cataract surgery, eyelid plastic surgery and orbital reconstruction. She runs a medical and aesthetics practice in Brampton, Mississauga, and Oakville, and can be reached at email@example.com and on Instagram @eyeplasticsTO.
Dr. Manveen Bedi is a Brampton, Ontario-based optometrist with residency training in dry eye management, specialty contact lens fitting for corneal pathologies, aphakia, and prosthetics as well as myopia control. She can be reached at firstname.lastname@example.org and offers eye health tips via her Instagram account, @drmbedi.