Dry eye syndrome is very common in Canada. Learn about dry eye symptoms, causes, diagnosis and treatment.
Have you noticed your eyes feel sore, uncomfortable or itchy? These could be dry eye syndrome symptoms.
When your eye is healthy, the front of the eye (the cornea) is constantly lubricated with tears. Dry eye happens when your eyes don’t produce enough tears or there are problems with tear quality.
How your eyes make tears
Your eyes are covered in a very thin film of tears. Here's how they're made:
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Lacrimal gland
The lacrimal glands produce tears, which are mainly salt and water. Problems with the lacrimal glands mean you don't produce enough tears.
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Meibomian glands
These glands are found in your eyelids. They produce an oily layer that helps prevent tear evaporation. Any issues or blockages with the meibomian glands can mean that not enough of this oil gets into your tears.
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Mucin glands
These glands are found in the conjunctiva, which is a thin layer on the front of the eye. Mucin creates surface tension, helping the film of tears to stay on the eye. If there's not enough mucin, the tear won't stay in place.
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Tear ducts
Old tears drain away from the eye via the tear ducts on either side of your nose.
What is dry eye syndrome?
Many Canadians have dry eye syndrome symptoms. Dry eye happens when your eyes don't produce tears in the normal way or the quality of your tears is poor. It's often caused by a mix of things.
It's a general term people use to describe this issue. But your optometrist may also use other terms, including dry eye disease, ocular surface disease, dysfunctional tear syndrome and keratoconjunctivitis sicca. Unless you're an eye doctor, it's fine to just refer to it as 'dry eye syndrome'.
Many Canadians suffer from dry eye syndrome. According to one survey in Ontario, about one person in five has symptoms.
Types of dry eye syndrome
Dry eye syndrome usually falls into one of the following two categories (though it may be a mix). An optometrist can figure out what's causing your dry eyes.
Evaporative dry eye
This happens when your tears dry out too quickly, often due to blocked meibomian glands. Without enough oil, tears don’t stay on the eye. It can be made worse by air con, screens or contact lenses.
Aqueous deficiency dry eye
This type happens when your eyes don’t make enough watery tears. It’s less common and often linked to age, health issues or medication. Your eyes may feel dry, sore or tired.
We’ll help clear things up
Noticed your eyes hurting, or a change in your sight? Whether it’s something new or something that’s been bothering you for a while, we’re here to help.
There are many reasons why you might develop dry eye syndrome. Often, it's a mix of factors. Here are some of the common causes independent optometrists at Specsavers see every day.
Blocked glands
When the eyelid glands are blocked (meibomian gland dysfunction), the oily layer of tears is missing, so tears evaporate too quickly and dry out the eyes.
Blepharitis
An inflammation of the eyelid that can be caused by bacterial overgrowth. It may affect the glands that produce part of the tear film, which leads to dry eye.
As we age, our eyelids don’t spread tears across the eyes as efficiently when blinking. Also, the glands which supply the layers of our tears might become less effective.
Contact lens dry eyes
Contact lenses can cause dry eye by disrupting the normal action of the tear film on the surface of your eye.
Digital eye strain
Staring at a screen for a prolonged time can cause dry eye. People tend to blink less often when using computers, so their eyes don't stay as lubricated.
Air conditioners remove moisture from the air, which can make eyes become drier. Spending a lot of time in rooms with air conditioning may cause dry eyes.
Dry, cold, hot or windy places
Spending time in extremely cold, hot, windy or dry environments might make your tears evaporate faster, causing dry eyes.
Post surgery
Some people notice they develop dry eye syndrome after certain kinds of eye surgery, such as cataract surgery. Learn about cataracts
Medication side effects
Some medications, such as antihistamines, some birth control pills or blood pressure medications can cause dry eyes as a side effect.
Alcohol
Drinking alcohol can dehydrate the body. This might reduce the volume of tears your eyes produce.
Hormonal changes
Changes in oestrogen levels can cause hormonal dry eye, which is common during menopause.
Other medical condition
There are a few medical conditions that can contribute to dry eye syndrome, including diabetes, rheumatoid arthritis or Sjögren's syndrome.
If you’re having symptoms of dry eye syndrome, your optometrist will start by asking about how your eyes feel, when the symptoms began, and whether anything seems to make them better or worse. This helps build a clearer picture of what might be going on. They’ll then carry out a few simple tests to examine your eyes in more detail. One common method is a slit lamp examination. This involves a special microscope with a bright light that lets the optometrist check the surface of your eye closely. They may also use a dye, such as fluorescein, which shows up under the light and helps reveal any damage or dryness on your cornea.
Your tear quality and quantity will also be assessed. A Tear Break‑Up Time test checks how long your tears stay in place before they start to break up. For this, a small amount of dye is added to your eye, and you’ll be asked to blink while the optometrist observes what happens under the slit lamp.
Another method is the Schirmer’s Test, which uses a small strip of paper placed on your lower eyelid to measure how much moisture your eye produces over a few minutes. These tests help confirm what kind of dry eye you have and how severe it is.
Most people now spend more time looking at screens than ever before. And experts believe this is contributing to a big rise in people getting dry eye symptoms in Canada.
So, what is it about screens that has this effect on the eyes? To start, when concentrating on screens for extended periods of time, your blink rate reduces by over 60%, or you don’t blink fully. This means that the eye’s surface isn’t regularly being replenished and moisturized with tears. It also means your eyes are exposed longer to the air, evaporating the tears quicker. If you work with an office with air conditioning, this can further dry out the eyes.
Headaches associated with screen usage are more related to the muscles in the eyes working too hard when concentrating on the screen. They might also be battling with glare or reflections from screens, which puts extra pressure on the eyes to get a clear image. Learn more about digital eye strain.
There are several kinds of dry eye treatment available in Canada:
Dry eye drops
Dry eye drops or artificial tears can help relieve the discomfort of dry eyes and reduce irritation and dry eyes by lubricating the eye surface and stabilizing the tear film.
Eyelid cleansing
Eyelid wipes and foam cleansers can help prevent and ease symptoms of eye conditions like blepharitis. They’re also useful for people with allergies, as they can remove pollen or other allergens from around the eyes.
Heat Based Treatments
Applying heat with a warm compress or heated eye mask gently opens the meibomian (oil) glands in your eyelids. This helps the natural oils flow more easily into your tears, keeping the tear film stable and reducing evaporation — so your eyes feel more comfortable.
Many reusable heated masks are available. Always follow the manufacturer’s instructions.
Steps for use of heat mask:
1.
Heat the mask. Microwave for 20–25 seconds (time may vary depending on microwave power).
2.
Check the temperature. Always test the mask with your fingers before applying to your eyelids.
3.
Apply the mask. Place the mask over closed eyes for about 10 minutes, or as advised by your eyecare professional.
4.
Remove the mask.
5.
Massage your eyelids. With clean hands and closed eyes, gently massage your eyelids for about 30 seconds per eye, applying light pressure toward your eyelashes. This helps express the oil from the glands.
Note: The mask may stay warm for up to 30 minutes. If reheating within this time, reduce the heating duration.
Supplements for Dry Eyes
Nutritional approaches for managing dry eye are an emerging area of research, with numerous new studies currently underway. A balanced diet is always recommended, and supplements should only be used to complement your diet. Evidence suggests that certain nutritional supplements may help reduce dry eye symptoms by supporting overall eye health and tear function.
Omega‑3 Supplementation
Omega fatty acids have been widely studied for their potential benefits in dry eye. Although research is ongoing, Omega‑3 fatty acids are believed to help reduce inflammation on the eye surface and are suggested to improve meibomian gland function. A study by Jo & Lee found that omega‑3 dietary supplements improved tear breakup time (TBUT) and meibomian gland dysfunction (MGD) scores.
A range of supplements is available. Some common ones include Systane® OMEGA‑3 and TheraTears® Eye Nutrition.
Important: Always read the nutrition label carefully and take supplements only as advised by your healthcare professional. Do not make significant dietary changes without consulting your doctor.
Additional treatment for dry eyes
Most cases of dry eye aren’t emergencies, but there are situations where you should seek care right away. If you develop extreme sensitivity to light (photophobia), very red and painful eyes, a change in your vision, or feel generally unwell, seek medical advice immediately as it could be a sign of a more serious complication.
Clean your eyelids
Daily cleaning with lid wipes, foams or scrubs helps remove bacteria, oil and debris that can block glands and cause dry eye.
Managing underlying medical conditions
If your dry eye syndrome is caused by a medication you’re taking or an underlying medical condition, you should discuss this with your GP.
Contact lens related issues
If you wear contact lenses, taking a break or switching lens type may help. You can also use dry eye drops that are safe for contact lenses before and during wear.
Staying hydrated and cut down on smoking and alcohol, as both can make dry eyes worse. A diet rich in Omega‑3, or taking Omega‑3 supplements, may also help.
Surgery for dry eye syndrome
In more severe cases, surgery may be an option if other treatments haven’t helped. This might involve blocking the tear ducts to stop tears draining too quickly or treating the meibomian glands to improve oil flow.
If dry eye syndrome surgery is necessary, we’ll explain your options and refer you to an ophthalmologist for further care.
When might you need emergency dry eye treatment?
Dry eye syndrome rarely needs emergency treatment, but there are situations where you will need to get urgent help. If you develop extreme sensitivity to light (photophobia), very red and painful eyes, a change in your vision, or feel generally unwell, contact your doctor or call 911 as it could be a sign of a more serious complication.
There are different types of dry eye drops to suit different levels of dry eye. Speak to the team at your local Specsavers store, they can give you advice about the right eye drops for you depending on your symptoms.
Which dry eye drops are right for you?
There are different types of dry eye drops to suit different levels of dry eye. The team at your local Specsavers can give you personalized advice.
How often should you use eye drops?
Most people start using dry eye drops once or twice per day, but you might find this isn't enough. Generally speaking, with preservative free eye drops you can use them as much as you feel you need.
Noticed your eyes hurting, or a change in your sight? Whether it’s something new or something that’s been bothering you for a while, we’re here to help.
It can be worrying to be diagnosed with dry eye syndrome. For some people, dry eye can be temporary, and you'll be back to normal soon if it's treated early. But for others it can become a chronic (long‑lasting) condition. Often it can come and go in certain situations throughout your life.
Yes, it can. When you’re dehydrated, your body tries to retain fluid in the body. So it’s important to try and stay hydrated so that your body can properly produce the tears needed to keep your eyes healthy.
Yes, drinking alcohol can cause dry eye. Consuming alcohol can dehydrate your body and may therefore reduce the volume of tears your eyes produce. When there is not enough fluid to lubricate the eye, you might experience symptoms of dry eye as a result.
Our winters in Canada can get very cold, and this may contribute to dry eye for some people. In extremely cold conditions, there is next to no moisture in the air, and this means tears evaporate very easily from your eyes when you're outdoors. You might want to consider wearing ski goggles to prevent this.
To use eye drops for dry eyes, check the packaging for instructions. Start by washing your hands with soap and water. You tilt your head back, then gently pull down the skin just below your eyelid with one hand. With the other hand, gently squeeze the eye drop bottle until a drop lands on the front of your eye. You should then blink a few times to get the artificial tear to spread across your eye.
The cost of dry eye treatment depends on how serious the issue is. For more significant problems that require minor surgery, this is usually covered by your health insurance. More minor dry eye treatment, such as eye drops or eye masks for dry eyes can cost as little as $10. Some dry eye treatments cost nothing, for example, cold compresses made at home with a clean tea towel and a bag of ice.
If you find you often get dry eyes in the morning, try making some changes to your bedroom. If you use air conditioning, try turning it off at night. Some people find it helpful to use a humidifier in their bedroom too. You may also find it useful to wear a heated eye mask for dry eyes for a few minutes before you go to sleep.
If you need to treat your dry eyes fast, you might want to try using some dry eye drops. These use 'artificial' tears that can lubricate the eye and relieve the symptoms in just a couple of seconds.
Tears play a key role in keeping your eyes healthy. They moisturise the surface, help protect against infection, clear away debris and keep your vision clear. A normal tear film has three layers: the mucin layer, which helps tears stick to the eye; the aqueous (water) layer, which nourishes and protects; and the lipid (oily) layer, which stops the tears from evaporating. If any of these layers aren’t working properly, it can upset the balance of your tear film. For example, if the oily layer is reduced, your tears may dry out too fast. If there’s less of the watery layer, you won’t produce enough tears to keep your eyes comfortable.
Dry eyes and headaches often show up at the same time, but it’s still not clear whether one causes the other, or if they’re both symptoms of something else. Studies suggest that people who get headaches or migraines are more likely to have dry eye too. But there’s still more research needed to fully understand the link. One likely connection is screen time. Both dry eyes and headaches are common signs of digital eye strain. With so many of us using screens every day, it’s no surprise these symptoms often come as a pair.
Written with care and check for accuracy
Dr. Darshan S. Matharu
Dr. Darshan S. Matharu is a licensed optometrist with the College of Optometrists of British Columbia. He is the optometrist partner at Specsavers Terra Nova in Richmond BC and also serves on the Optometry Steering Group for British Columbia, which helps strategize and develop new clinical programs for Specsavers Canada.
Noticed a change in your eyesight?
If you have any concerns about your eye health, contact or visit your local optometrist immediately – even if you do not have an appointment.
Caffery B, Srinivasan S, Reaume CJ, et al. (2019) Prevalence of dry eye disease in Ontario, Canada: a population‑based survey. Available at: https://pubmed.ncbi.nlm.nih.gov/30825521/
NCBI (2015) Chronic migraine is associated with reduced corneal nerve fiber density and symptoms of dry eye. Available at: https://pubmed.ncbi.nlm.nih.gov/25828778/
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