Dry, gritty eyes in parents and grandparents: what helps and what to check
A parent or grandparent has sandy, burning or tired eyes by evening. Here is why eyes dry out with age, what makes it worse at home and in the office, what helps, what the evidence says about omega-3, and which signs need a doctor sooner.
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- Dry eye gets more common with age and is more common in women, and the AAO links fewer tears to hormonal change, especially after menopause.
- Air-con, fans, smoke and long screen time make it worse, because reading and screens reduce blinking (AAO, NEI).
- Some classes of medicine can dry the eyes, such as water pills, beta-blockers, antihistamines, sleeping pills and antidepressants. Do not stop any medicine without asking the prescriber.
- Lubricating drops, preservative-free if used more than about six times a day, a gel or ointment at night, and warm compresses with gentle lid care are the usual first steps (AAO).
- In the DREAM trial (NEJM 2018), omega-3 capsules did not do significantly better than placebo for dry eye.
A parent or grandparent says their eyes feel sandy, burning or tired by evening, or that they water for no reason. Dry eye is common and usually manageable, and a few signs mean it is something else. This page covers why it happens, what makes it worse in Malaysian homes and offices, what helps, and what an eye check looks at.
It draws on the American Academy of Ophthalmology (AAO), the National Eye Institute (NEI) and the TFOS DEWS II reports, and it says what each one found. For the children in the house, dry, gritty eyes in a hot spell has its own page.
Why do eyes get dry and gritty as people get older?
Dry eye happens when the eyes do not make enough tears, make the wrong kind of tears, or the tears dry out too quickly. The AAO says people tend to make fewer tears as they get older because of hormonal changes, especially women who have gone through menopause.
The NEI lists being 50 or older and being female as risks. The TFOS DEWS II epidemiology report found dry eye more common with age and more common in women than men, and its sex, gender and hormones report ties this largely to the effects of sex hormones.
A tear is more than water. The AAO describes layers: an oily layer, a watery layer and a mucus layer. The oily layer comes from the meibomian glands, a row of small oil glands along the edge of each eyelid, and it slows the water from evaporating. When those glands clog or make poor oil, the tears evaporate too fast. The TFOS DEWS II definition report says the water-short type and the too-much-evaporation type sit on a continuum, so many people have a mix of both.
One odd feature is watering. The AAO notes that irritated eyes make more tears, so a person with dry eye can have watery eyes. A watery eye in an older parent is not proof that the eye is wet enough.
What makes it worse in Malaysian homes and offices?
Air-conditioning, fans, long screen hours and smoky air are the usual culprits. The NEI advice for protecting the eyes is to avoid smoke, wind and air conditioning where possible and to take regular breaks from screens. The AAO lists being in smoke, wind or a very dry climate, and looking at a computer screen for a long time, among the causes, because reading and screens reduce blinking.
Blinking is what spreads each fresh layer of tears across the eye, so fewer blinks means a drier surface. That is why eyes feel worst at the end of a day of phone, tablet, television or desk work. Reading a phone in bed under a fan combines low blinking with moving air.
Smoke is on the AAO list of triggers. Haze is smoky air, so the same irritation is plausible on those days, though the AAO and NEI pages do not mention haze itself.
The action: shift the fan and the air-con vent so the air does not blow across the face, and move the screen a little below eye level so the eyelids sit lower.
Can medicines make the eyes dry?
Yes. The AAO lists several classes of medicine that can dry the eyes, including water pills (diuretics) and beta-blockers used for blood pressure or heart problems, antihistamines, sleeping pills, antidepressants and some medicines for heartburn. The TFOS DEWS II iatrogenic report says a variety of systemic drugs can induce dry eye through several mechanisms.
This does not mean the medicine is wrong for the person. These are often important medicines. Do not stop or change any of them on your own. Bring the list to the prescriber or the eye doctor and ask whether the dryness could be related, and whether anything can be adjusted. Eye drops used for other conditions matter too: the same report notes that preservatives in some drops can aggravate dry eye.
What helps at home?
Lubricating eye drops (artificial tears) are the first step. The AAO says you can use them as often as you need and buy them without a prescription. If you use them more than about six times a day, the AAO recommends the preservative-free kind, because the preservative may start to irritate the eyes.
For eyes that feel dry on waking, the AAO suggests an artificial tear ointment or a thicker gel just before bed. Ointment blurs the vision for a while, so it suits night, not the morning commute.
Warm compresses and gentle lid massage are listed by the AAO as part of treatment, and the TFOS DEWS II management report reviews lid care for the oil glands. Hold a clean, warm (not hot) cloth on closed eyelids for a few minutes, then clean the lid margin gently. Wash hands first.
Beyond that: blink fully and often when reading or on a screen, and take regular screen breaks. The NEI suggests humidifiers for dry air, avoiding smoke, wind and air-conditioning, and enough sleep. Aim fans and air-con away from the face. If drops are needed constantly or do not seem to help, that is the point to book a check.
The TFOS DEWS II management report notes that many dry eye treatments lack top-level evidence, and that care is stepped up according to severity.
Do omega-3 supplements help dry eye?
In the largest trial, they did not beat placebo. The DREAM study (New England Journal of Medicine, 2018; 378:1681 to 1690) gave adults with moderate to severe dry eye either 3000 mg of fish-derived omega-3 fatty acids daily or an olive oil placebo for 12 months. The change in symptom score was not significantly different between the groups, and neither were the tear and eye surface measurements. The authors concluded that the group on omega-3 did not have significantly better outcomes than the placebo group.
That is one trial of one dose in people with moderate to severe disease. It does not say that fish in the diet is useless, but it does not support buying omega-3 capsules for dry eye. Ask the doctor before adding supplements.
What else might an eye doctor suggest?
If lubricants and lid care are not enough, an eye doctor may suggest prescription eye drops. The AAO says doctors may prescribe drops that help the eyes make more of their own tears, and the TFOS DEWS II management report reviews anti-inflammatory medicines among the options. An eye doctor may also suggest tiny plugs that block the tear drainage channels; the AAO says these can be removed later if needed. Which step suits which person depends on the examination, so none of these should be started without one.
What does an eye check for dry eye look at?
It starts with the story: symptoms, medicines, screen and air-con habits, contact lens use and other conditions. The TFOS DEWS II diagnostic methodology report describes symptom questionnaires, then tests of how quickly the tear film breaks up after a blink, tear concentration, and staining of the eye surface with dyes. The doctor also looks at the oil glands and the lid margins, and the report says this helps sort dry eye into the evaporative or water-short type, which guides management.
The NEI says the doctor can check how many tears the eyes make and how long they take to dry up. The TFOS report also says conditions that mimic dry eye should be ruled out first. The NEI says severe dry eye that is not treated can sometimes damage the cornea.
The action: bring the glasses, any eye drops in use, the medicine list, and a note of when the symptoms are worst. While there, use the chance to cover the rest of the family; eye checks for the whole family sets out who needs which check, and glaucoma in families explains why a long-standing "dry eye" in someone over 40 is a good moment to ask about it.
When should dry eyes be seen sooner?
Most dry eye is a nuisance, not an emergency, but some signs need a doctor. The AAO says to see an eye doctor if symptoms are persistent, worsening, affect daily activities, or are not relieved by over-the-counter lubricating drops, or come with significant redness, pain or vision changes.
Same-day signs: real pain rather than grittiness, light that hurts the eyes, blurred vision that does not clear with a blink, or one red eye. A contact lens wearer with a red, painful eye should take the lenses out and be seen the same day: the AAO lists pain, redness, blurred vision and sensitivity to light as corneal ulcer symptoms, names contact lens wearers and people with dry eye as at risk, and says to see an ophthalmologist immediately.
If dry eyes come with a dry mouth or aching joints, tell the doctor. The AAO lists Sjögren's syndrome, rheumatoid arthritis, thyroid disease and lupus among the diseases that can cause dry eye, and says long-lasting dry eye can point to eyelid disease or an autoimmune condition that needs medical evaluation.
- There is pain rather than grittiness, or light hurts the eyes.
- Vision is blurred and does not clear with blinking.
- One eye is red.
- A contact lens wearer has a red, painful eye: take the lenses out and be seen today.
Common questions
Why are my mother's eyes so dry and watery at the same time?
Does menopause cause dry eyes?
Which medicines can dry the eyes?
Are eye drops from the pharmacy safe to use every day?
Do omega-3 supplements help dry eye?
What does an eye check for dry eye involve?
When is dry eye an emergency?
- American Academy of Ophthalmology · What is dry eye? · www.aao.org
- American Academy of Ophthalmology · Dry eye treatment · www.aao.org
- American Academy of Ophthalmology · Corneal ulcers and infectious keratitis · www.aao.org
- National Eye Institute · Dry eye · www.nei.nih.gov
- TFOS DEWS II Definition and Classification Report (Ocul Surf 2017) · pubmed.ncbi.nlm.nih.gov
- TFOS DEWS II Sex, Gender, and Hormones Report (Ocul Surf 2017) · pubmed.ncbi.nlm.nih.gov
- TFOS DEWS II Epidemiology Report (Ocul Surf 2017) · pubmed.ncbi.nlm.nih.gov
- TFOS DEWS II Iatrogenic Report (Ocul Surf 2017) · pubmed.ncbi.nlm.nih.gov
- TFOS DEWS II Diagnostic Methodology Report (Ocul Surf 2017) · pubmed.ncbi.nlm.nih.gov
- TFOS DEWS II Management and Therapy Report (Ocul Surf 2017) · pubmed.ncbi.nlm.nih.gov
- DREAM Study Research Group · n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease (N Engl J Med 2018;378:1681-1690) · pubmed.ncbi.nlm.nih.gov