Why Dry Eyes Increase with Age
Several age-related changes contribute to the increased frequency of dry eyes in older adults. These factors affect the quantity and quality of tears, leading to discomfort and vision issues.
Reduced Tear Production
As people get older, the lacrimal glands, which produce the watery component of tears, can become less efficient. This natural decline means fewer tears are available to lubricate the eye's surface, a condition known as aqueous tear deficiency. Studies show that tear production tends to diminish, particularly for those over 50.
Hormonal Changes
Postmenopausal women are disproportionately affected by dry eye syndrome. The decrease in estrogen and androgen levels can alter the tear film's composition, leading to reduced tear quality and faster evaporation. This is one reason why women are more susceptible to dry eye than men, especially after age 50.
Meibomian Gland Dysfunction
The meibomian glands along the eyelids produce the essential oil layer of the tear film, which prevents tears from evaporating too quickly. With age, these glands can become blocked or degenerate, leading to insufficient oil production and an unstable tear film. This evaporative dry eye is a common issue for older adults.
Medications and Health Conditions
Many older adults take multiple medications for chronic conditions, a practice known as polypharmacy. Common medications such as antihistamines, decongestants, antidepressants, and diuretics can cause or worsen dry eye symptoms. Moreover, systemic diseases like diabetes, rheumatoid arthritis, and thyroid disorders are also risk factors that increase in prevalence with age.
Environmental and Lifestyle Factors
Beyond internal physiological changes, older individuals can be more sensitive to environmental factors like dry or windy conditions, air conditioning, and smoke. Additionally, activities that require prolonged visual focus, such as reading or using a computer, cause a reduced blink rate, which accelerates tear evaporation.
Symptoms of Age-Related Dry Eyes
While the severity varies, symptoms of dry eye disease are often experienced in both eyes. Common signs include:
- A persistent stinging, burning, or scratchy sensation
- The feeling that there is sand or grit in the eyes
- Excessive eye watering as a reflex response to irritation
- Blurred or fluctuating vision
- Sensitivity to light (photophobia)
- Eye redness or fatigue
- Difficulty wearing contact lenses
Managing and Treating Age-Related Dry Eyes
Treatment for age-related dry eye focuses on improving tear quantity and quality while managing symptoms.
- Over-the-counter (OTC) remedies: Artificial tears are the first-line treatment for mild to moderate symptoms. Lubricating gels and ointments, used at bedtime, provide longer-lasting relief due to their thicker consistency.
- Prescription medications: For chronic or severe cases, eye doctors may prescribe anti-inflammatory drops like cyclosporine (Restasis) or lifitegrast (Xiidra) to increase tear production and reduce inflammation. A nasal spray called varenicline (Tyrvaya) can also stimulate tear production.
- In-office procedures: Options like punctal plugs, which close the tear ducts to retain moisture, or thermal pulsation treatments (e.g., LipiFlow) to unclog meibomian glands may be recommended.
- Lifestyle and home changes: Using a humidifier, wearing wraparound sunglasses, and staying hydrated by drinking plenty of water can help. Taking frequent breaks from screens and practicing conscious blinking are also beneficial.
Comparison of Artificial Tears vs. Prescription Eyedrops
| Feature | Artificial Tears (OTC) | Prescription Eyedrops |
|---|---|---|
| Purpose | Primarily provides temporary lubrication and hydration for mild symptoms. | Treats the underlying cause of chronic dry eye, such as inflammation. |
| Composition | Contains lubricants, water, and electrolytes; may include preservatives. | Contains active medicinal ingredients (e.g., cyclosporine, lifitegrast). |
| Relief | Offers temporary symptomatic relief that may need frequent reapplication. | Provides longer-term relief by addressing the root cause. |
| Best for | Occasional dryness from environmental factors or screen use. | Persistent, moderate to severe dry eye that doesn't respond to OTC drops. |
| Potential Side Effects | Preservatives in some formulas can cause irritation with frequent use. | Can cause temporary side effects like burning or irritation upon application. |
When to See a Doctor
While mild dry eye is manageable with over-the-counter products, you should see an eye doctor if you experience persistent symptoms that do not improve. Seek professional help if you have significant eye pain, vision changes, or if dry eyes interfere with daily activities. A doctor can perform a comprehensive eye exam to determine the underlying cause and create a personalized treatment plan. For further guidance on dry eye management, refer to resources from the Mayo Clinic.
Conclusion
Aging is a significant risk factor for developing dry eye disease, with reduced tear production, hormonal changes, and meibomian gland dysfunction being primary causes. As the tear film's stability decreases over time, older adults are more likely to experience uncomfortable symptoms that can affect their vision and quality of life. Fortunately, a range of effective treatments, from artificial tears and lifestyle adjustments to prescription medications and advanced therapies, are available to manage the condition. Seeking professional care is essential for creating a targeted strategy that addresses the specific causes of age-related dry eye and ensures long-term comfort.
Additional Reading
For more in-depth information on age-related changes affecting the eyes and management options, scientific reviews are available via reputable sources like the National Institutes of Health (NIH). Understanding the factors contributing to dry eyes as we age is the first step toward effective management and preserving eye comfort and health.
