Here’s How You Know You Have Dry Eye: Expert Doctors on the Confusing Symptoms, Causes, and the #1 Mistake Patients Make

Dry eye, medically known as keratoconjunctivitis sicca, affects around 20 million Americans—”and that number is growing in both old and young adults,” says the American Academy of Ophthalmology. Possible factors for the trend may include our increased ocular interaction with tech devices (which research has shown lowers blinking frequency), or changes in air quality due to changes in the climate.

Dry eye refers to a condition where your eyes don’t produce enough tears to stay properly lubricated. To once again cite the American Academy of Ophthalmology, it can also occur when your tears evaporate too quickly or aren’t made with the right mix of oil, water, and mucus. The Cleveland Clinic’s Nicole Bajic, MD is a board-certified ophthalmologist who says, “Dry eye can be tricky because it can present in many ways that are confusing for the average patient.” She adds that dry eye is a chronic condition that often requires long-term care and specific treatment.

Here, Dr. Bajic and Kanwal Singh, MD, a board-certified ophthalmologist at University of Iowa Health Care, share what they wish more people understood about dry eye disease—including causes, symptoms, treatments, and everyday habits that make a real difference.

What are the root causes of dry eye disease?

According to Dr. Bajic, “dry eye prevalence and severity both increase significantly with age,” due to changes in inflammation and eye anatomy. Hormones also play a role. The meibomian glands in our eyelids, which produce the oil layer of our tears, respond to androgens (like testosterone), but these glands can shrink or stop functioning due to aging and chronic inflammation, she adds.

Tears aren’t just water, either. “We commonly think of tears as simply being a watery solution; however, they actually have three layers,” explains Dr. Bajic. These include an outer oil layer (which prevents evaporation), a watery aqueous layer (from the lacrimal glands), and a mucin layer (from goblet cells) that helps the tears spread evenly. When any of these layers are out of balance, dry eye symptoms can flare up.

Dr. Singh suggests thinking of it like a good Italian dressing: “If [the] ingredients are not in the right ratio and not properly mixed, the magic does not happen.”

Sneaky dry eye symptoms that most people miss

While most people expect dry eye symptoms like irritation or blurred vision, other signs can easily be overlooked. “Dry eye is often associated with ocular and systemic allergies, so itching eyes can contribute,” says Dr. Singh. Symptoms like crusting in the morning or discomfort after screen time or reading may also signal problems with oil production in the tear film.

And one of the most confusing symptoms? Watery eyes. People with “evaporative” dry eye often experience what Dr. Singh calls “reflex tearing.” When your tears evaporate too quickly due to poor oil production, your eyes flood themselves with more tears to compensate. “Then their doctor tells them they have ‘dry eye’!” he says. It’s a diagnosis that can leave many patients puzzled, especially when their eyes feel anything but dry.

Why chronic dry eye deserves serious attention

There are two major reasons to take chronic dry eye seriously, notes Dr. Singh.

First, it can interfere with cataract surgery. “If you’re having cataract surgery, you need your tear film optimized before surgery so that your doctor can get accurate measurements of your eyes.”

Second, untreated dry eye can damage the surface of the eye over time. “Severe, chronic dry eye can cause the nerves of the cornea to die,” says Dr. Singh. This nerve loss can increase your risk of corneal ulcers and infections, since the tear film plays a vital role in protecting and nourishing the cornea and surrounding tissue.

The most common mistake people make with eye drops

Notes Dr. Bajic, “The most common mistake I see when patients try to treat dry eye on their own is using ‘redness relief’ drops.”

These drops temporarily reduce redness by constricting blood vessels in the eye, but that also limits blood flow and hydration. “Then, when the drop wears off, the vessels respond by dilating even more,” explains Dr. Bajic. This rebound effect can leave eyes looking and feeling worse—and lead to a cycle of overuse that actually worsens dry eye symptoms. It’s best to work with a doctor to identify a treatment specifically for the dry eye diagnosis.

Another common issue? Misdiagnosis. Many people—including healthcare providers—conflate general eye irritation with dry eye disease. “There are many different diseases that cause eye redness, irritation, and blurred vision,” Dr. Singh says. Without a thorough examination of the entire ocular surface, it’s easy to overlook the true cause. “If your problem is with the eyelid position or oil component of the tear film, adding more drops will not help.”

How dry eye diagnosis and treatment have improved

“Historically we paid a great deal of attention to the amount of tearing patients made with a Schirmer’s strip,” says Dr. Singh. “Today we recognize that evaporative dry eye is likely the majority of disease, especially in the era of increased screen time.”

Doctors consider a range of contributing factors—including medication use, which can disrupt the tear film. “I always carefully examine my patient’s medications list, as many prescribed medications adversely affect the tear film,” he explains.

There’s also “no single, silver bullet treatment for dry eye.” From over-the-counter eye drops and prescription ointments to in-office procedures and even complementary therapies, options are now more customizable than ever. “In my practice, we’re investigating the efficacy of acupuncture,” Dr. Singh adds.

Lifestyle habits that help relieve dry eye

Managing dry eye disease often starts with small but consistent changes to your daily routine. Dr. Bajic and Dr. Singh share their expert-recommended habits that can help reduce dry eye symptoms:

• Use artificial tear ointment at night if you wake up with dry, painful eyes. This is especially helpful if you use a CPAP machine.
• Adjust your sleep environment by turning off ceiling fans, refitting your CPAP mask, or applying a thin layer of petroleum jelly to improve the mask seal and reduce airflow over your eyes.
• Practice good lid hygiene by removing all makeup before bed, avoiding eyeliner on the waterline, cleaning your lashes regularly, and using warm compresses daily as needed.
• Apply artificial tears up to four times a day for temporary relief, but remember, they’re not a cure and work more like lotion for your eyes.
• Follow the 20-20-20 rule when using screens: Every 20 minutes, look 20 feet away, and blink 20 times to keep your eyes from drying out.
• Limit time under fans and direct airflow, which can worsen evaporative dry eye.

Still uncomfortable after eye drops? Here’s what to do next

Dry eye disease can be complex and frustrating to manage—for both patients and providers.

“Many eye care providers are intimidated by dry eye disease,” says Dr. Singh. “It’s hard to diagnose accurately, harder to treat fully, does not reimburse well, and disproportionately affects women.”

Part of the challenge is that symptoms don’t always match what doctors see during an eye exam. That’s why communication is key. “Be patient with your eye care provider,” he advises. “Keep detailed notes on what you eat, your sleep habits, and environmental triggers to help your doctor out.”

If over-the-counter solutions aren’t working, an eye doctor can guide you through other treatment options, ranging from prescription medications to in-office procedures, to help you find lasting relief from dry eye disease.

For daily wellness updates, subscribe to The Healthy by Reader’s Digest newsletter and follow The Healthy on Facebook and Instagram. Keep reading:

• Here’s How I Knew I Had Glaucoma: A Patient’s Story After Putting Off Eye Check-ups
• What Is Commonly Misdiagnosed as Pink Eye? An Expert Eye Doctor Shares the List
• Why Your Eyes Could Be Key to Early Alzheimer’s Diagnosis
• For Sunburn in the Eyes, or Near Them, Optometry Doctors Share Cautions & Solutions