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Often dry eye symptoms can result from inflammation of the eye lid margins, which may be caused by a bacterial infection (Staphylococci). This condition is called blepharitis and can compromise the quality of the tear film causing tears to evaporate more quickly. The bacteria produce waste material which can cause a mild toxic reaction leading to chronic red, irritated eyes. The first step in treating this condition is to initiate better lid hygiene. There are many ways in which to do this, but warm compresses and lid scrubs, are the key components. A simple technique is to gently massage the eyelids (eyes closed!) with a hand towel soaked with warm water and baby shampoo.

By doing this 2-3 times per day, the bacterial growth can be controlled. When the inflammation is more severe or uncontrolled with lid hygiene only, antibiotic drops and/or ointments can be prescribed to control the infection. Often another condition called meibomitis is also present. Meibomitis is an inflammation of the meibomian glands, which produce lipids that make up the outer layer of the tear film. This lipid layer is an oily layer which helps retard evaporation of the tears. When the meibomian glands become inflamed or clogged, the tear film quality is poor. Lid cleansing is the first line of treatment for meibonitis. Topical or systemic antibiotics such as azithromycin, tetracycline or doxycycline may be helpful in many cases. Special dry eye nutritional supplements including Omega 3 fish oils often improve the quality of the tear oil film and reduce inflammation of the glands, and are recommended. It may take 4-6 weeks of consistent dosage to achieve relief, however.

Water:The middle layer is mostly water with a little bit of salt. This layer, produced by the tear glands (lacrimal glands), cleanses your eyes and washes away foreign particles or irritants. If your eye produces inadequate amounts of water, the oil and mucus layers can touch and cause a stringy discharge.

Deficient tear production:Keratoconjunctivitis sicca is usually due to inadequate tear production. The aqueous tear layer is affected, resulting in aqueous tear deficiency (ATD) or lacrimal hyposecretion. The lacrimal gland does not produce sufficient tears to keep the entire conjunctiva and cornea covered by a complete layer. This usually occurs in people who are otherwise healthy. Increased age is associated with decreased tearing. This is the most common type found in postmenopausal women.

Causes include idiopathic, congenital alacrima, xerophthalmia, lacrimal gland ablation, and sensory denervation. In rare cases, it may be a symptom of collagen vascular diseases, including rheumatoid arthritis, Wegener’s granulomatosis, and systemic lupus erythematosus. Sjögren’s syndrome and autoimmune diseases associated with Sjögren’s syndrome are also conditions associated with aqueous tear deficiency. Drugs such as isotretinoin, sedatives, diuretics, tricyclic antidepressants, antihypertensives, oral contraceptives, antihistamines, nasal decongestants, beta-blockers, phenothiazines, atropine and pain relieving opiates such as morphine can cause or worsen this condition. Infiltration of the lacrimal glands by sarcoidosis or tumors, or postradiation fibrosis of the lacrimal glands can also cause this condition.

Mucus:The inner layer of mucus helps spread tears evenly over the surface of your eyes. If you don’t have enough mucus to cover your eyes, dry spots can form on the front surface of the eye (cornea).

Abnormal tear composition:Keratoconjunctivitis sicca can also be caused by abnormal tear composition resulting in rapid evaporation or premature destruction of the tears. When caused by rapid evaporation, it is termed evaporative dry eyes. In this, although the tear gland produces a sufficient amount of tears, the rate of evaporation of the tears is too rapid.There is a loss of water from the tears that results in tears that are too “salty” or hypertonic. As a result, the entire conjunctiva and cornea cannot be kept covered with a complete layer of tears during certain activities or in certain environments.

Oil:The outer layer of the tear film, produced by small glands on the edge of your eyelids (meibomian glands), contains fatty oils called lipids. These smooth the tear surface and slow evaporation of the middle watery layer. If your oil glands don’t produce enough oil, the watery layer evaporates too quickly, causing dry eyes. Dry eyes are common in people whose meibomian glands are clogged. Meibomian dysfunction is more common in people with inflammation along the edge of their eyelids (blepharitis), rosacea and other skin disorders.

Additional causes:Aging is one of the most common causes of dry eyes.This is because tear production decreases with age. It may be caused by thermal or chemical burns, or (in epidemic cases) by adenoviruses. A number of studies have found that diabetics are at increased risk for the disease.

About half of all people who wear contact lenses complain of dry eyes. There are two potential connections between contact usage and dry eye. Traditionally, it was believed that soft contact lenses, which float on the tear film that covers the cornea, absorb the tears in the eyes. However, it is also now known that contact usage damages corneal nerve sensitivity, which subsequently may lead to decreased lacrimal gland tear production and dry eye. The effect of contact on corneal nerve sensitivity is well established for hard contacts as well as soft and rigid gas permeable. The connection between this loss in nerve sensitivity and tear production is the subject of current research.

Dry eyes also occurs or gets worse after LASIK and other refractive surgeries, in which the corneal nerves are cut during the creation of a corneal flap. The corneal nerves stimulate tear secretion. Dry eyes caused by these procedures usually resolves after several months. Persons who are thinking about refractive surgery should consider this.

An eye injury or other problem with the eyes or eyelids, such as bulging eyes or a drooping eyelid can cause keratoconjunctivitis sicca. Disorders of the eyelid can impair the complex blinking motion required to spread tears.

Abnormalities of the lipid tear layer caused by blepharitis and rosacea, and abnormalities of the mucin tear layer caused by vitamin A deficiency, trachoma, diphtheric keratoconjunctivitis, mucocutaneous disorders and certain topical medications are causes of keratoconjunctivitis sicca.

Persons with keratoconjunctivitis sicca have elevated levels of tear nerve growth factor (NGF). It is possible that this ocular surface NGF plays an important role in ocular surface inflammation associated with dry eyes.

Dry eyes are caused by a lack of adequate tears. Your tears are a complex mixture of water, fatty oils, proteins and electrolytes. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eyes from infection.

For some people, the cause of dry eyes is an imbalance in the composition of their tears. Other people don’t produce enough tears to keep their eyes comfortably lubricated. Eyelid problems, medications and other causes, such as environmental factors, also can lead to dry eyes.

This can result from chemical (alkali) burns to the eye or as a result of different autoimmune diseases, such as Stevens-Johnson syndrome and cicatricial pemphigoid. This abnormal production of mucin leads to poor spreading of the tears over the surface of the eye. The surface of the eye can dry out and even become damaged, even though more than enough watery tears may be present.