Dry Eye Symptoms
Your symptoms tell us more than any diagnosis. I see patients every week who've been told they have "dry eye" but have no idea what that actually means. Fair enough — it's a garbage term. Two people with the same diagnosis can have completely different problems.
One person's tear glands don't produce enough fluid. Another's tears evaporate in seconds because their oil glands are clogged. Same label. Different mechanisms. Different treatments.
Start With What You Feel
Gritty and sandy? That's usually aqueous deficiency — not enough tears. Burning that gets worse through the day? Probably evaporative — your oil layer isn't doing its job. Crusty lids in the morning? Bacterial buildup overnight. Each pattern points somewhere different.
When OTC Isn't Enough
If you've tried drops for 2–3 weeks and nothing's changed — or if you have pain, light sensitivity, or blurry vision that comes and goes — see an optometrist. Not everything is fixable with over-the-counter products.
Common Symptom Patterns
| What You Feel | What's Probably Happening | Where to Start |
|---|---|---|
| Mild — eyes feel "off" by evening | Tear film thinning through the day. Often screen-related. | Hylo or I-Drop Pur |
| Moderate — daily grittiness, need drops every few hours | Lipid layer compromised. Tears breaking down too fast. | Thealoz Duo + lid hygiene |
| Severe — constant pain, light hurts, vision fluctuates | Corneal surface damage. Inflammation cycle. | See optometrist. May need Rx. Gel at night helps. |
| Tired eyes + headaches after screens | Digital eye strain. You're blinking 66% less than normal. | Rewetting drops. Also: 20-20-20 rule. |
| Itchy, watery, red — worse in spring/fall | Allergies. Histamine response. Not actually dry eye. | Antihistamine drops from pharmacy. Lubricants won't help. |
| Crusty lids, flaky lashes, styes | Blepharitis. Bacteria + clogged oil glands. | Warm compress + lid wipes |
Quick Anatomy: Your Tear Film
Three layers. Each one fails differently.
| Layer | Job | When It Fails | Fix |
|---|---|---|---|
| Lipid (oil) | Stops tears from evaporating | Burning. Tears vanish fast. | Lid hygiene, omega-3s, lipid sprays |
| Aqueous (water) | Hydrates the cornea | Not enough tears. Severe dryness. | Artificial tears. Punctal plugs if serious. |
| Mucin | Helps tears spread evenly | Blur. Tears bead up instead of coating. | Hyaluronic acid drops |
If you want the deep science, the TFOS DEWS II Report is the gold standard. Dense reading, but it's what eye care professionals reference.
Frequently Asked Questions
How do I know if my dry eye is mild, moderate, or severe?
Mild: symptoms come and go. Tied to environment — AC, wind, long screen days. OTC drops handle it. Moderate: daily symptoms. You're reaching for drops every few hours just to function. Severe: constant. Light bothers you. Vision goes in and out. OTC alone won't cut it — you need professional help.
Can dry eye cause permanent damage?
If it's severe and untreated for years, yes — corneal scarring is possible. But most people? No. Mild and moderate cases don't cause lasting damage if you manage them. The Canadian Ophthalmological Society recommends seeing someone if symptoms don't improve after a few weeks of OTC treatment.
Why are my eyes watery if I have "dry eye"?
Counterintuitive, I know. Here's what's happening: your baseline tear film is unstable, so your eyes panic and flood with reflex tears. Those are the watery ones that run down your face. They don't actually lubricate — they just wash over and leave. The fix isn't more water. It's usually the oil layer. Lid hygiene helps more than adding drops.
Is dry eye the same as eye allergies?
No. Key difference: allergies itch. If itching is your main symptom, it's probably histamine-driven, not dry eye. Burning and grittiness without itching? That's dry eye. Some people have both — lucky them. But lubricating drops won't touch allergies. You need antihistamines for that. Any pharmacy carries them.
What's the 20-20-20 rule?
Every 20 minutes, look at something 20 feet away for 20 seconds. Simple. The point is forcing yourself to blink properly. When you stare at a screen, your blink rate drops from 15–20 times per minute to maybe 5. That's not enough to keep your tear film intact. The CAO has more on this.
Content reviewed by Dr. Davinder Sidhu, Optometrist.
