What is evaporative dry eye?

The most common symptom of EDE is uncomfortable or irritated eyes. This discomfort can take several forms:

• stinging or burning sensation in the eyes
• eye fatigue, especially after working on a computer, looking at a phone, or reading for long periods
• grittiness, or a feeling of having something in the eyes
• blurred vision that comes and goes
• difficulty wearing contact lenses comfortably
• crusting around the eyes
• discolored, swollen eyelids

Ironically, some people may experience excessive wateriness in the eyes because the irritation may cause the eyes to produce extra tears.

Adequate eye hydration requires regular tear production. Each time a person blinks, tiny drops of tears coat the eye and keep the surface smooth and free of debris.

Tears are a mixture of water, oil, and mucus. The oil in tears keeps water from evaporating quickly. Without this natural oil, however, the eyes cannot maintain the hydration they need.

Tiny glands in the upper and lower eyelids produce the oil for tears. These glands are called the meibomian glands. If these glands become blocked or irritated, they cannot produce oil for tears properly.

The meibomian glands can become blocked for several reasons. These include:

• Accumulation of debris: Frequent blinking helps wash away germs, dirt, and other debris in the eyes and on the eyelids. People who do not blink regularly may produce less fluid in the eyes, and they may be more likely to experience clogged glands.
• Skin conditions: Some skin issues, such as ocular rosacea, face dermatitis, and psoriasis, can cause blockages in the glands.
• Allergies: Allergies that cause eye irritation or inflammation may cause blockages in the tiny glands.
• Medications: Certain drugs, including antihistamines and decongestants, can increase the chances of blockages in the meibomian glands.
• Eye injury: An injury to the eyelids may interfere with oil production. This can cause a blockage that prevents the glands from making tears.
• Contact lenses: Wearing contacts for too long without cleaning them may irritate the glands and reduce tear production.
• Other diseases and conditions: People with conditions such as Sjögren’s disease, rheumatoid arthritis, and diabetes are more likely to experience blockages in the eyelid glands.

Can prolonged screen time cause evaporative dry eye?

Staring at screens, small or large, can keep a person from blinking for prolonged periods. As blinking is necessary for proper eye hydration, less frequent blinking can lead to a person experiencing dry, irritated eyes.

The more a person stares at screens, the less they blink, and the more likely it is that the water layer will evaporate. This creates an imbalance in the tear film, with a relative excess of mucous and oil. Regular, frequent blinking restores the tear film composition while improving eye comfort and vision.

A person experiencing regular eye discomfort should see a doctor. Uncomfortable, painful eyes that last more than a few days are a reason to consult a professional.

The doctor will review a person’s general health, including any medications they are taking. They will likely also conduct a comprehensive eye exam.

Some doctors may prefer to send people with these symptoms to see an optometrist or ophthalmologist. Both of these doctors specialize in eye health and the treatment of eye issues.

During an eye exam, a doctor may use several tests to diagnose evaporative dry eye. These tests include:

• Schirmer’s test: This test measures the tear production volume of an eye. During the test, a doctor will place strips of thin paper under the lower eyelids. After 5 minutes, they will measure the amount of moisture that the strips have absorbed.
• Eye staining: Specialized eye drops help doctors measure how quickly tears evaporate from the person’s eyes.
• Slit lamp: This magnifying instrument uses a high intensity light source to show the surface of the eye in great detail. A doctor can look for irregularities that could be causing blockages or discomfort.

Anyone can develop EDE. It is a common type of dry eye syndrome, which is a condition that affects millions of people. However, some people are more likely than others to develop it.

For example, females are almost twice as likely as males to develop EDE, and the eye condition is more common among older people.

People with certain conditions may also be at higher risk. These conditions include diabetes, Sjögren’s disease, and skin conditions that cause increased oil production in the skin and glands.

Most cases of EDE are mild and only require minimal treatment. However, EDE can sometimes be chronic, when it can lead to ongoing, debilitating symptoms.

The treatment for EDE depends on the severity of the symptoms, the underlying issues that are causing it, and what treatments a person can tolerate.

The types of treatment for EDE include:

• Warm compresses and eye washing: Stimulating oil production with warm compresses and gentle massages to the eyelids may help the glands produce oil and help break up any blockages.
• Eye drops or artificial tears: These drops help restore moisture to the eyes but only temporarily. They are typically available over the counter, but in more severe cases, a doctor may prescribe medicated drops to help unblock the glands and end the symptoms of EDE.
• Thermal pulses (Lipiflow): A doctor may use a thermal pulsation system to unblock any clogged glands and restore oil production.
• Intense pulse light (IPL): IPL may also help break up any blocked glands. People can use this tool alongside gentle eyelid massages.
• Prescription medications: Anti-inflammatories, antibiotics, and medicated ointments can help prevent blockages in the meibomian glands.
• Surgery: In rare cases, surgery is necessary to unblock the glands so that they can produce oil again. This minor procedure should clear the glands of any accumulation of oils or debris.

Mild cases of EDE may only need minor treatments to ease the symptoms and help improve the outer oil layer of the tear film. These treatments include:

• Warm compresses: If a person has regular EDE, a daily warm compress may help prevent blockages. They can soak a facecloth or cotton pad in warm water, squeeze out the excess water, and then hold the moist cloth or pad over closed eyelids, keeping it there for 5 minutes. It is best to repeat this treatment twice a day until any swelling or irritation subsides.
• Humidifier: Dry air can dry out a person’s skin, including the eyelids. Adding moisture back to the environment may help keep oil production free-flowing in the eyelids. A person can run a humidifier for several hours each day, especially at night when the eyes are more likely to become irritated.
• Gentle massages: Even without a thermal pulse device, it is possible to massage the eyelids to restore oil production. However, a person should be gentle, as too much pressure can harm the eyes. Using just the fingertips, they can gently press and rotate the eyelids.

Ongoing pain and discomfort in the eyes is not a pleasant experience. In fact, it can be debilitating and make it difficult to carry out daily activities.

Without treatment, EDE can cause serious complications. For example, eye infections are more likely. Without proper hydration and cleansing of the surface of the eyes, bacteria and germs can linger longer and cause issues.

The eyes may become inflamed and irritated, which can lead to blurred vision and difficulty seeing.

If the irritation and dryness continue, it is possible to develop chronic exposure of the cornea. This can permanently affect eyesight.

Ulcers on the cornea and scars on the thin conjunctival membrane that lines the eyelids are also possible, and these complications can be very painful.

A person with a history of EDE or conditions that make them more likely to develop dry eye syndrome can take steps to prevent irritating symptoms. These measures include:

• Giving the eyes regular breaks: A person should take blinking breaks when working on a computer, watching television, or reading for prolonged periods. Blinking is important for oil and tear production, and it keeps the surface of the eyes protected.
• Practicing good eyelid hygiene: Gently scrubbing the eyelid margins with mild soap and warm water can remove lid debris and enhance meibomian gland function.
• Avoiding being around smoke: Cigarette smoke and other fumes can irritate the eyes and eyelids and reduce tear production. This can cause the oils to back up and clog in the glands.
• Staying hydrated: Drinking enough water each day is vitally important for many reasons, including eye health and proper eye hydration.
• Removing and properly cleaning contact lenses: Dirt and debris on contacts can irritate the surface of the eye and eyelids, interfering with oil and tear production. It is essential to clean contact lenses regularly to prevent a buildup.

Treatment is successful in most cases of evaporative dry eye. Mild cases typically do not require advanced treatments, and they may clear quickly after even minor remedies.

If EDE is the result of an underlying health issue, such as Sjögren’s disease or eczema, the outlook depends on whether treatment of that condition is effective. The proper treatment of other health issues can help keep the symptoms of EDE under control.

EDE can be chronic. If this is the case, it will require regular, ongoing treatment to ease the symptoms and make them manageable. Medications, artificial tears, and home remedies such as warm compresses can all help.