Dry eye: A common yet underdiagnosed condition

This story first appeared in Healthy You - November 2025, The Gazette’s quarterly health publication.

A sandy, gritty feeling in your eyes. Intermittent blurry vision. The sense that there’s something in your eye, but there’s nothing there. These are all common symptoms of dry eye, a condition that affects millions of people every day.

“I consult with patients about dry eye probably 20 times a week,” said Dr. Liz Gauger of Iowa Eye Center in Cedar Rapids. “But it’s still an underdiagnosed condition.”

Because the symptoms are annoying rather than debilitating, many people just put up with dry, scratchy eyes. However, treating dry eye can be straightforward and effective once the source of the problem is diagnosed.

There are two main types of dry eye. Aqueous deficient dry eye occurs when tear ducts in eyes don’t produce enough tears. Evaporative dry eye happens when the tears evaporate from eyes too quickly. An ophthalmologist can help determine which type a patient has and prescribe the right treatment.

Tears are made in the lacrimal glands above the eye and gently flow down over the eye to lubricate it. Tears keep the eye’s corneas hydrated and healthy, while also washing out debris. When lacrimal glands don’t produce enough tears, several measures can help.

Over-the-counter eye drops are one part of the treatment, but not all eye drops are helpful.

“Anything that says ‘relieves red eyes’ is not meant for long-term use,” she cautioned. “That type of eyedrop will cause rebound redness.”

Sometimes adding moisture to the eyes isn’t enough.

“I tell my patients to think of your eyes like a bathtub,” Gauger said. “You can either turn the water on high — add eyedrops — or you can put a plug in so the water doesn’t drain out as fast.”

To keep tears from draining too quickly, an ophthalmologist can insert tiny plugs, called punctual plugs, into the tear ducts at the inside corners of a patient’s eyes. These plugs can be removed if they don’t work for the patient or left in for years if they do.

More frequently, though, eyes are producing enough tears, but the tears are evaporating too quickly, leading to evaporative dry eye. The evaporation is caused by a lack of lipids — an oily substance — on the surface of the eye.

“The meibomian glands in your eyelids produce oils that work with your tears to coat your eye with oil,” Gauger said. “Sometimes those glands get clogged.”

The first line of treatment for evaporative dry eye is applying a warm compress to the eyes twice a day to unclog the glands. Over-the-counter eye scrubs are also part of the treatment. Sometimes a nightly dose of antibiotic ointment is added to the regimen.

For children with this condition, or for people who frequently get styes, Gauger recommends fish oil.

“Oral fish oils with high amounts of Omega 3 fatty acid are magic,” she said. These fish oils come in a wide variety of flavors that kids like, and within a few weeks, the styes are gone.

Sometimes, patients with dry eyes have conditions that are more serious. For example, Sjogren’s Syndrome, an autoimmune disorder, can cause dry eyes, dry mouth with thickened saliva, and general dryness. Or, a patient with dry eyes might also have a complicated skin condition like seborrhea or rosacea. In these cases, the ophthalmologist will consult with other physicians to treat the underlying cause.

Most often, though, inexpensive and easy treatments will work, as long as the patient is diligent.

“Many patients will ask me ‘how long do I have to do this treatment for dry eye?’” Gauger said. “I tell them that it’s like brushing your teeth: you keep doing it. You wouldn’t ask the dentist how long you should brush your teeth. It’s something you do to take care of them. Same goes for your eyes.”